Understanding the Health Insurance Exchange HIX

Due to the confusion caused by conflicting and often confusing information concerning the NY State of Health Exchange and AHCA, we have been receiving many calls inquiring which of these insurance plans we accept at our office. The Health Insurance Exchange is a “work in progress” and information may change. We will attempt to keep you informed as best we can.
Currently we do accept Oxford Liberty
This is the only plan on the Exchange that we do accept.
This plan will also be known as: Oxford SHOP (Small Group Products); United Health-Care EPO (bronze, silver, gold, and platinum); and United Individual Compass products.
Caution concerning Empire Blue Cross
Note that although we do accept Empire Blue Cross/Blue Shield at this office we DO NOT accept the Pathway plan which is a “skinny” network with a fraction of Empire’s current providers – hospitals and physicians – from their current network. We are NOT part of their Pathways Network, Pathways, and Pathways X Enhanced. We have been excluded from this plan as Empire has also excluded NYC-UMC and all of its associated physicians.
The plans that utilize the Pathway network include: Core Guided Access, Preferred Guided Access, Premier Guided Access, and Bronze/Silver/Gold/and Platinum Guided Access.
Empire Blue Priority is also an Empire “skinny” network which is NOT accepted at this office.
Note that the Pathway Plans are being offered on and off the Government Exchanges. Please be advised that we are not able to accept any version of these plans.
Additionally most (if not all) Healthy NY members will be transitioned to the Guided Access Plans as per the first of the year. These plans utilize the Pathway network which we are excluded from.
Note on Member Eligibility
Member eligibility in an Exchange Plan does not assure that your insurance is valid. Enrollees are given a 90-day grace period to pay their premiums. During that time their eligibility is confirmed. During the first 30 days, the insurance carrier is liable for payments. During the following 60 days, although they might confirm you as eligible for coverage the insurance carrier is not responsible for payments if your insurance enrollment is denied and subject to retroactive termination. This will leave you, the Member, fully responsible for services rendered. We ask that you please keep aware of your insurance coverage and inform this office thereof.
We at Pediatrics East of New York understand your concerns and will attempt to keep you informed as best we can concerning future variations and policies concerning the Health Exchange Network.
If you feel that you have further questions that have not been addressed on this page we will be very happy to accept your calls.
Thank you.
In response to the COVID-19 outbreak, we are now offering Telemedicine/Video Visits and Rapid COVID PCR Testing in office. Meet with your doctor to get a prescribed treatment plan, refill or get a new prescription and much more all from the safety and comfort of your home.