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SUNY Downstate Medical Center

University Hospital of Brooklyn

Managed Care Menu

Managed Care Frequently Asked Questions

What is Managed Care and how does managed care work?

Managed Care is how medical services are provided to you and paid to your provider. With most managed care plans, you usually have to go to one of the doctors on the health plan's list. Many managed care health plans require you to chose a "primary care provider." Your Primary Care Provider (PCP) is the person who will "manage" your health care needs. This person could be a pediatrician, general practitioner, internist, and in some cases, an obstetrician/gynecologist. In an emergency, you should call 911 or go to the nearest emergency room.

Are there different kinds of managed care plans?

The most common types of managed care plans are Health Maintenance Organizations (HMO), Prefferred Provider Organizations (PPOs), and Point of Service (POS). HMOs are the strickest form of managed care plans. If you do not use in-network providers, your benefits will not be covered. For POS and PPO plans, you can go out of network but with higher out-of-pocket costs.

I am uninsured. How can I get coverage for me and my family?

New York State offers several programs that may meet the needs of your family: Child Health Plus (CHP), Family Health Plus (FHP) and Healthy NY. o Child Health Plus is available to all children under the age of 19 who are uninsured or underinsured, regardless of their immigration status. o Family Health Plus is available to all legal residents of New York State between the ages of 19-64 who do not have health insurance, but who have incomes which are too high to qualify for Medicaid. FHP provides comprehensive services with minimum co-payments to its members. o Healthy N.Y. is available for employers who have 50 or fewer employees, working uninsured individuals, and sole proprietors. Healthy N.Y. members have co-payments and deductibles.

Are there Medicare Managed Care Plans?

Yes, Medicare does provide a managed care option for members enrolled in both Medicare Part A and B called Medicare Advantage Plans or Medicare C. For Medicare Advantage Plans in your area call 1-800-MEDICARE or call the Department of Managed Care office at SUNY Downstate.

How do I select my primary care provider (PCP)?

You must pick a provider who is part of your plan's network to serve as your PCP. Call your insurance plan's member services department (the phone number is at the back of your card) or call the Department of Managed Care office at SUNY Downstate (718-826-5026, 718-270-8834 or 718-826-5028) for help in choosing a PCP, click here for a list of the managed care plans that SUNY Downstate participates in.

The name of the PCP on my insurace card is not the doctor I see now. What should I do?

Call your health plan's member services number to see if your doctor is a participating provider in the health plan of your choice or the plan you were assigned to. If so, you can switch.

How do I see a specialist?

For most plans, you need a referral from your PCP to see a specialist who is also in the network. If you go to a specialist without a referral, the health plan may not pay for the services provided by the specialist and you could receive a bill. Tip: Be a smart consumer. If you have the need to see a specialist regularly, some heatlh plans will let you make the specialist your primary care provider.

Can I change my Medicaid managed care paln?

Enrollees are given 90 days to try out the health plan. During this time you can transfer to another Medicaid managed care plan. After the 90 days, you are "locked in" for an additional nine months. During this locked in period, enrollees may only cancel or transfer if is determined they have "good cause." Some enrollees are exempt from the 90 day trial period, and some excluded enrollees can "disenroll". Call N.Y. Medicaid Choice at 1-800-905-5445 for more information.

Important Facts

  • NYS Department of Health (DOH) has started mandatory enrollment of SSI consumers into Medicaid managed care plan. For more information call NY Medicaid Choice at 1-800-774-4241.
  • NYS Department of Health (DOH) implemented Family Health Plus co-payments that range from $0.50-$25.00. Co-pays will affect visits to providers including ancillary services.

What is Medicare?

Medicare is Federally administered helath insurance program that covers individuals who are age 65 and over, disabled, and on dialysis. Medicare has three parts: Part A, Part B, and Part D. Part A covers all in-patients services, and Part B covers outpatient services as well as some other related charges. Medicare now offers prescription drug coverage called Medicare Part D for all Medicare members. This service may have monthly premiums and co-payments. Questions? Call 1-800-MEDICARE (1-800-633-4227) or the SUNY Downstate Department of Managed Care office.

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