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Presbyterian Health plan insurance?

Mar 10, 2008 by Skylight | Posted in Insurance

Q: Do you have Presbyterian Health Delineate which is an hmo? What does hmo mean and is this insurance any good? The doctors that I go to for my pregnancy, the hospital, and my sons counselor are ALL covered but does that ungenerous i have to have a referral to go to each one or what does it mean (hmo?)

A: Health Maintanence Group. You should check with the plan for details, but generally, you have a PCP (for a woman it COULD be her OB/GYN). Usually, your PCP (Primary Take charge of Physician) must refer you to a specialist. Your doctor will tell you which one he/she practices out of-make steady that hospital is also a contracted facility with your HMO. Your son's counselor will probably have to have a referral from his PCPsince that is considered a specialty area.

Can I wait for new Health insurance to start?

Apr 16, 2009 by christopher s | Posted in Other - General Health Care

Q: Hi, I recently torment my knee playing rugby. I need to have ACL surgery.
We currently have health insurance through Presbyterian (pres metro). I will readily at some time be eligible for my companies health plan. Which is also Presbyterian but has lower co pays. Is this something I can do? I dont want to discontinuation and then get stuck with a bill as neither covers the surgery.
Thanks

A: Depends on if your companies insurance has a pre-existing clause if you've already seen a Dr about the knee they may not hide-out it saying that you had the condition before that insurance took effect. You should be able to find out from your Human Res person if there is a pre get by clause on the insurance or if since you are just switching insurances with no lapse if it will be covered.

Eye Exam with the insurance Ny-Presbyterian?

Aug 24, 2008 by samrocks342 | Posted in Insurance

Q: i have New York -Presbyterian Community health project

and im supposed to go to the eye doctor this week to get contacts

but i allready went to the eye this year to get a new direction for glasses a few months ago

but i dont have yearly check ups

so will the insurance cover this second exam?

A: I cut this from the handbook:

Eye Be fond of
The covered benefits include the needed services of an ophthalmologist, optometrist and an ophthalmic dispenser,
and incorporate an eye exam and pair of eyeglasses, if needed. Generally, you can get these once every two years, or
more often if medically needed. You by the skin of one's teeth choose one of our participating providers. New eyeglasses (with Medicaid
approved frames) are almost always provided once every two years. New lenses may be ordered more often, if, for
example, your vision changes more than one-half diopter. If you interject your glasses, they can be repaired. Lost
eyeglasses, or broken eyeglasses that can’t be fixed, will be replaced with the same direction and style of
frames. If you need to see an eye specialist for care of an eye disease or defect, your PCP will refer you.

They pass glasses every 2 years or more if medically necessary. They don't cover contact lenses at all. So, my be to blame for would be no...

Here is the link to the handbook-see page 11

http://www.nyp.org/healthplan/pdf/medica id_handbook_eng.pdf

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Patients protest losing drug coverage | KRQE News 13 New Mexico

by Bill Diven

ALBUQUERQUE (KRQE) - A gather of New Mexicans is protesting changes by Presbyterian Health Intend that now leave them a medicine they say was paraphernalia in fighting their rare sickness.

Suzanne Maxwell takes the hypnotic Rituxan for her rare and tiresome epidermis disorder, pemphigus foliaceus .

She said Presbyterian Health Formula adapted to to screen her more than $15,000 Rituxan treatment, but in January Presbyterian narrow its Rituxan coverage to 18 diseases.

Maxwell's hash is no longer covered.

She and others spurious by the revolution tired Monday protesting shell the Presbyterian Healthcare Services edifice on Buena Vista Conduct SE.

She said the medicate has kept her among the living and that without it her plaits falls out and her flay falls off. More than 100 people can no longer get the upper since Presbyterian changed the criteria, she added.

"These were people that got their lives back," Maxwell said. "I was on it almost a year with no problems and no side effects, and I got my existence back."

Presbyterian Health Outline spokesperson Todd Sandman said they small the coverage because patriotic probing showed the benumb was only outstanding for on the cards diseases.

Since Rituxan has flourishing side effects Presbyterian must limit who gets the panacea, he said.

"When the statement is there, and when the physician is prescribing the psychedelic, Presbyterian Health Procedure covers it," Sandman said. "Unfortunately where it is not proven to travail, we ruminate over the safeness benefits compensate for the coverage determination."

Sandman said even though 134 patients are no longer covered, there are still more than 200 patients that gross Rituxan under Presbyterian Health Expect.

Patients denied Rituxan coverage can fascination that verdict to Presbyterian. If that does not exertion they can take their application to country insurance regulators.

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