As a participating provider, Independent Health would like to make you aware of some changes that may affect your practice/business or how you interact with us. The changes we outline below are a result of New York State legislation passed as part of the 2014 Budget.
The following mandates will take effect on April 1, 2015, and will apply to our commercial line of business.
- If you or our member have requested an out-of-network referral and the member receives an out-of-network referral denial from Independent Health, the member is allowed to appeal it by submitting a written statement from their attending physician. Independent Health may require additional information such as:
- A statement that the in-network provider recommended by the plan does not have the appropriate training and experience to meet the particular needs of the member for the service; and
- A recommendation for an out-of-network provider with the appropriate training and experience to meet the particular needs of the member and who is able to provide the requested service.
Independent Health encourages participating providers to always refer patients to other participating providers. Patients and providers can use the “Find a Doctor” tool at independenthealth.com to search our participating provider network.
In addition, the legislation requires the following:
- Physicians are required to provide a patient with the contact information for any provider scheduled to perform anesthesiology, laboratory, pathology, radiology, or assistant surgeon services in connection with the physician’s services.
- For hospital admissions or outpatient hospital services, providers are required to give the patient and the hospital contact information of any physician whose services will be arranged by the physician and are scheduled at the time of the pre-admission testing, registration or admission; and information as to how to determine the plans in which that physician participates.
Updated Independent Health policies and forms reflecting these mandated changes will be available on independenthealth.com on April 1, 2015.
For additional information on the mandate, visit the New York State Department of Financial Services at http://www.dfs.ny.gov/insurance/ihealth.htm.
If you have questions, please contact our Provider Services department by calling (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m.