Cayuga Medical Center, Convenient Care Centers – And Coverage under the Empire Plan
Care Received at Convenient Care Centers
We receive many
questions as to how services received at the Convenient Care Center are
covered when you are enrolled in the Empire Plan.
Convenient Care Centers are located in Ithaca at Route 13 and Warren
Road and in Cortland at The Commons, Route 281.
Physician
Charge
The physician
charge is billed to United HealthCare as a non-participating office visit
and payment is sent directly to you. The charge is reimbursed at 80% of reasonable & customary
(R&C) limits after the deductible has been satisfied.
You need to send payment directly to the physician since they do
not participate with United HealthCare.
Convenient Care: Room Charge and Other Services (lab, X-ray, drugs)
The Convenient Care charge is billed to Empire BlueCross and payment is made
directly to Cayuga Medical Center. The patient/employee is billed for
any applicable co-payment ($35 emergency room co-payment) and any non-covered
charges as determined by Empire BlueCross.
Note: Empire BlueCross will pay the room charge if the Convenient Care visit was for:
- an accidental injury treated within 72 hours of onset; or
- a life-threatening situation treated within 24 hours of onset.
If Empire BlueCross denies your visit to the Convenient Care Center because it was not an accidental injury or it was not a life-threatening situation, you can submit the charges to United HealthCare. United HealthCare will reimburse the charge at 80% of R&C after the deductible has been satisfied.
Convenient
Care Center versus Cayuga Medical Center Emergency Room
If you experience an accidental injury or life-threatening situation,
it might be to your advantage to seek emergency treatment directly at
Cayuga Medical Center’s emergency room instead of at a Convenient
Care Center.
- Empire BlueCross will pay the emergency room visit at 100%. You pay a $35 co-payment
- United HealthCare will pay 100% of the attending emergency room physician charge, even if the physician is not participating with the Empire Plan.
If United HealthCare did not pay your attending physician charge at 100%, please contact Benefit Services at (607) 255-3936 or via email at benefits@cornell.edu
If you receive services at a Convenient Care Center:
- The room charge will be reimbursed at 100%. You pay a $35 co-payment
- The physician charge is paid at 80% of R&C after the deductible has been satisfied.
Laboratory and X-ray Charges, including mammograms
Laboratory and X-ray charges for services received at Convenient Care Center
are billed to Empire BlueCross and payments are made to Cayuga Medical Center.
You pay the $25 outpatient hospital co-payment
However, if Empire BlueCross discovers that you were at Convenient Care instead of Cayuga Medical Center, Empire BlueCross will deny charges or retract payment if payment has already been made because our contract specifically states that you must be physically present at the hospital. Clinic-type hospital settings, like Convenient Care, or remote hospital locations currently are covered under the United HealthCare portion of the Empire Plan contract. Cayuga Medical Center does not participate with United HealthCare. Services are subject to deductible and then reimbursed at 80% of R&C.
Laboratory specimens that are drawn in the physician’s office and sent to the hospital laboratory are known as referred specimens. The Empire Plan contract states that these charges should be submitted to United HealthCare (reimbursed at 80% of R&C after the deductible has been satisfied).
However, if Cayuga Medical Center bills these charges to Empire BlueCross, instead of to United HealthCare and does not indicate that they are referred specimens, Empire BlueCross will pay 100% and you pay the $25 co-payment This is the reason that you may see a difference in the way that these charges are processed each time a claim is paid. You could have your referred specimen paid for by Empire BlueCross on one occasion or by United Healthcare on another occasion (reimbursed at 80% of R&C after the deductible has been satisfied).
To get the maximum Empire Plan benefit on laboratory charges:
Have the specimen drawn in the hospital laboratory or at one of the draw stations. These charges will be billed to Empire BlueCross and you will pay only the $25 co-payment (instead of 80% of R&C after deductible by United HealthCare).
Have the specimen drawn in your doctor’s office and request that your doctor send the specimen to a participating lab. You will pay only a $12 co-payment if your doctor sends the specimen to a participating United HealthCare laboratory such as SmithKline Beecham or Laboratory Corporation of America (LabCorp).
Physical
Therapy Charges
Empire BlueCross
covers physical therapy services received at the Convenient Care Center
only if services are related to prior hospitalization.
In all other cases, you should make sure that you receive treatment
from a Managed Physical Network (MPN) physical therapist or chiropractor.
Call (800) 942-4640 for a list of providers.
Women’s Imaging and Surgicare
Cayuga Medical
Center will bill Empire BlueCross for all hospital charges, all Woman’s
Imaging Center charges, and all Surgicare charges.
Empire BlueCross pays Cayuga Medical Center directly.
You are responsible for any co-payments ($25.00 outpatient).
However, if Empire BlueCross discovers that you were at Convenient Care instead of Cayuga Medical Center, Empire BlueCross will deny charges or retract payment if payment has already been made because our contract specifically states that you must be physically present at the hospital. Clinic-type hospital settings, like Convenient Care, or remote hospital locations currently are covered under the United HealthCare portion of the Empire Plan contract. Cayuga Medical Center does not participate with United HealthCare. Services are subject to deductible and then reimbursed at 80% of R&C.
Mental Health and Substance Abuse Benefits are provided by GHI/ValueOptions
Empire Plan benefits for mental health and substance abuse services are administered
and reimbursed by GHI/ValueOptions, not by Empire BlueCross. You must
call Value/Options at (800) 446-3995 before seeking treatment for mental health
or substance abuse concerns. You receive a significantly lower level of
benefits if you do not follow ValueOptions’ requirements.
Contact Benefit Services at (607) 255-3936 or via E-mail at <benefits@cornell.edu> if you have questions concerning coverage under the Empire Plan. Plan vendors may be contacted at the following toll-free numbers:
- Empire BlueCross (877) 769-7447, option 2
- United HealthCare (877) 769-7447, option 1
- GHI/ValueOptions (877) 769-7447, option 3