June 28, 2013
By using providers and facilities in the Empire network, members can get our discounts on health care services. However, from January 1, 2006 through December 31, 2012 we made an error and listed some medical, dental and vision providers and facilities in our Empire network directory that were no longer in the network (out-of-network providers). We paid these providers and facilities at our discounted rates as if they were a part of the Empire network. However, they were not in our network. So they were allowed to charge more than we pay (“balance billing”).
Because they may charge more, some members may have been balance billed for the care they received from these out-of-network providers. This was our mistake, and we’ll reimburse impacted members for those added costs that they paid.
For impacted members, the good news is they may be eligible for a refund. Were’ here to assist Empire members and will notify the potentially impacted members. And we want to make sure that we keep you informed about this too.
We’ll send potentially impacted members a letter with details about how to get a refund if they’re eligible. Sample letters are provided below.
Here’s what they need to do:
1. Find out if they were billed more than their co-pay. They should check their
- Canceled checks
- Letters from the provider or facility
- Paid invoices
- Other proof of payment
If a member paid more than their co-pay for the services listed above, they may be eligible for a refund. They may also submit refund claims for services rendered by the listed provider prior to January 1, 2006.
2. Make copies of the bill and proof they paid
3. Send those copies within thirty (30) days of the date of this letter to:
Attention: Grievance and Appeals (Mail Drop 6U)
P. O. Box 11800
Albany, New York 12211-0800
4. If we find a member is not due a refund either due to the documentation they submitted to us or for some other reason, we’ll tell them why. But if they are eligible, they’ll get a check.
And… Impacted members may also ask for a refund for balance billing they received before and during January 1, 2006 – December 31, 2011 if they think other providers or facilities were listed as in-network on the Online Provider Directory and they billed impacted members more than they expected. In this case, members should follow the same steps above, and we’ll check.
Remember, we’re here to assist Empire members and will notify the potentially impacted members via letter. If a member has questions, they should call the number on the back of their member ID card. We want to make this right!
Members also have the right to file a complaint with the Office of the Attorney General. For more information, they should go to this website or call the general helpline at 800-771-7755 (within NYS only) or 518-486-6622 (if calling from outside of NYS).