Managed Care Organization

POS Requirements

Aetna (Excluded OP service at UH.)

(Contracted w/UH for all product lines.)

Patient assumes responsibility. Patient must pay deductible, co insurance and any balance bill. Pre-certification required in order reducing co-payment. Call 1-800-624-0756, Option 1 for member benefits. Give clerk patient’s insurance #.

AMERIGROUP (AmeriCaid)

No POS plan. Amerigroup is a Medicaid HMO.

AMERICHOICE (formerly Managed HealthCare Systems of NJ)

No POS Plan

AmeriHealth, Inc. (Excluded OP service at UH.)

AmeriHealth POS

(Contracted w/UH for all product lines.)

Patient must request a POS claim form from AmeriHealth. Patient assumes responsibility. Patient must pay deductible and co insurance.

CIGNA HEALTHCARE

Excluded Service

Empire Blue Cross

Empire HMO

Empire POS

Empire Blue Choice Plan-POS

(Contracted w/UH for all product lines.)

All procedures/services require authorization. Patient must pay deductible, co insurance and co-payment. Bill is paid according to out-of-network/ benefits policy. Member’s benefit policy varies. Call phone number on the back of ID card for each individual member’s benefits policy.

Great West Health Care (formerly One Health Plan)

All services require authorization. Patient responsible for co-insurance and deductible. Bill is paid according to out-of-network benefits policy. Member benefit policy varies. Please Call -1-800-663-8081 or -800-325-5079 to verify member’s benefit and eligibility.

HEALTHNET (formerly First Option Health Plan & Physician Health Services)

All services require authorization. If out-of network, deductible and co-insurance depends on patients benefit policy. Call 1-800-438-7886 for member benefits.

Horizon Blue Cross & Blue Shield of NJ

(Contracted w/UH for all product lines.)

Pre-certification required. Patient responsible for co-insurance and deductible. Bill is paid according to out-of-network/ benefits policy. Member’s benefit policy varies. For each individual member’s benefits policy, call 1-800-664 BLUE (2583) Option 3.

Horizon NJ Health (formerly Mercy Health Plans)

No POS plan.

QUALCARE

All services require authorization. Patient responsible for co-insurance and deductible. Bill is paid according to out-of-network benefits policy. Member benefit policy varies. Please Call -1-800-254-0130 toto verify member’s benefit and eligibility.

University Health Plans

Call UHP at 1-800-429-4585 or 973-623-8700 to verify patient’s benefits and eligibility. Each patient may have different benefits, which apply.