More on the New Emblem (GHI) Copays

Yesterday I wrote about the new copays. A couple more details today.

Advanced Imaging

We are talking MRIs, CAT scans, PET scans, NMR, and other stuff. Copays in network were $50. But the City and the MLC and Mulgrew and the Insurance companies found a cost savings. (Cost savings mean you get less medical care, or you have a harder time accessing medical care, or you have to pay more out of pocket for medical care. “Cost Savings” is short for “Cost Savings for them, at our expense”)

In any case, the way they are going to charge us more is by declaring everyone to be out of network, with double the copay ($100 instead of $50).

Me? In a dozen years I’ve had six “advanced images” – an emergency CT for what turned out to be kidney stones (twice). One almost needed surgery. Two MRIs for a large tumor, which turned out to be benign (they weren’t sure until they removed it. A CT looking for a foreign object I swallowed. And an MRI looking at a possible issue with my pancreas (false alarm). And every one of those images was done either in the emergency department, because, well fuck. Or in the imaging department of the hospital that my doctor is part of. I have never gone to a third party for a CT, and would never think of doing so.

But this cost savings says that copays double except for preferred providers. And who are those? Sloan Kettering. Hospital for Special Surgery. And RadNet.

Sloan Kettering? That’s Manhattan, with satellites in White Plains, and Long Island?

Hospital for Special Surgery? That’s Manhattan? With one site each in Brooklyn, Queens, and White Plains? And a few on Long Island?

RadNet? What’s RadNet? It appears to be, in the NYC area, Lenox Hill Radiology. 17 sites in Queens. 12 in Manhattan. 17 in Brooklyn. 3 on Staten Island (smallest borough). And 3 in the Bronx.

The Bronx is getting screwed, again, by Emblem and Unity. First, all of our Montefiore copays went up October 1. And then we get disproportionately the fewest “preferred” radiology sites. No Sloan Kettering. No Hospital for Special Surgery. And only three “RadNet” storefront sites.

And what do the Bronx sites look like?

I’m really supposed to get to one of these (at least Little Caesars has parking) rather than use the center associated with my doctor?

Notification?

I got a letter from Emblem on Saturday October 22 informing me of the change. The letter was dated October 20. But I got nothing from the UFT. And the Montefiore changes (which affect me) were effective October 1. Hmm. They billed me the copay on October 17. That’s kind of dicey – before they notified. But they also billed me on September 26, 5 days before the change was supposed to be effective. That’s even dicier. I contacted the Welfare Fund – maybe they can address this positively.