is published to share information and generate ideas on subjects important to retirees. CSEA has been made aware that Anthem, the Published by CSEA 143 Washington Ave., Albany, N.Y. 12210 (518) 257-1000 (800) 342-4146 www.cseany.org Danny Donohue, President CSEA Local 1000 AFSCME AFL-CIO Anthem security breach: what you need to know parent company of Empire Blue Cross/Blue Shield, has experienced a data breach that has potentially impacted ALL Anthem (formerly Wellpoint) customers and members, including the following: • NYSHIP Empire Plan enrollees; • “Blue Card” (Blue Shield insurance products used in a state where Anthem, Inc. operates) Information accessed may have included the following: • names • dates of birth • Social Security numbers • health care ID numbers • home addresses • email addresses • employment information, including income data Visit http://www.anthemfacts.com to get the latest information. Those without Internet access can call 1-877-263-7995. A new state law that went into effect on March 31 helps protect New Yorkers from unexpected medical expenses. The state’s new Emergency Medical Services and Surprise Bills Law provides additional protections for patients who receive services from non-participating (non-network) providers. The following provisions of this law are effective for services provided on or after March 31, 2015. Emergency services The law includes new provisions for services provided in an emergency room in New York state: • Enrollees receiving treatment in the emergency room from the attending physician shall not incur costs greater than the applicable in-network co-payments. • Evaluation and management services provided by non-participating specialty physicians will no longer be subject to a deductible. However, other services provided by non-participating specialty physicians will be subject to a deductible. • In most circumstances, if a provider disagrees with the plan’s payment of benefits, they will have the right to file an appeal with an Independent Dispute Resolution Entity certified by the New York State Department of Financial Services (DFS). Surprise bills Another provision of the law protects patients from being responsible for paying the full charge for surprise bills when they are treated by non-participating providers without their knowledge. • Enrollees can complete an “Assignment of Benefits” form to notify the plan and provider that they have received a surprise bill. The form outlines the situations that qualify as a surprise bill. To request the form, contact DFS or call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Program. • Expenses that qualify to be a surprise bill will be considered by the plan at the in-network benefit level, subject to applicable co-payments. • Non-participating physicians who issue a surprise bill will only be able to collect the applicable in-network co-payment from enrollees. Utilization Review Disclosures Notifications or authorizations obtained through the Benefits Management Program for pre-certification and prospective procedure reviews will include the following information when the provider of service is identified: • Whether the provider is a participating (in-network) or non-participating (non-network) provider; • The enrollee’s out-of-pocket expenses such as co-payment, deductible and/or coinsurance amounts; • If the provider is non-participating, the letter will include an estimate of what the plan will pay; and • An explanation of how to determine the usual and customary allowance. If you have any questions, please call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447) and press or say 1 for the Medical Program. New patient protections under state’s emergency medical services and surprise bill law
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