Accepted plans

In addition to the entitlement Medicare and Medicaid plans, Phelps has agreements with the health insurance carriers listed below. Each carrier offers many different plans, each with its own benefits and limitations. Therefore, even if your insurance company is listed below, it is not a guarantee of payment. The best way for you to ensure that your plan will cover care provided at Phelps is to contact your insurer directly.

  • AETNA – HMO, IND, PPO, POS, OTH, STUDENT
  • MERITAIN HEALTH
  • UMR – AETNA
  • NIPPON LIFE INSURANCE COMPANY
  • PRINCIPAL LIFE INSURANCE
  • CHRISTIAN BROTHERS EMPLOYEE
  • CORESOURCE
  • LOCAL 1199 – (MEM, NON, & OTH)
  • AETNA MEDICARE
  • AFFINITY HEALTH PLAN – MEDICAID
  • MANAGED CARE includes:
    • HARP & BASIC PROGRAM (EP3 & 4)
  • AFFINITY HEALTH PLAN – NY INDIVIDUAL EXCHANGE includes:
    • BASIC HEALTH PROGRAM (EP 1 & 2)
  • AGE WELL DUAL ELIGIBLE
  • AMIDA CARE MEDICAID
  • BEECHSTREET – PPO, POS
  • EMPIRE BLUE CROSS – HMO, IND, OUT POS, PPO, SWCHP
  • EMPIRE BLUE CROSS CHILD HEALTH PLUS
  • EMPIRE HEALTH PLUS ESSENTIAL PLAN 1 & 2
  • EMPRIE BLUE CROSS EXCHANGE
  • EMPIRE BLUE CROSS MEDICARE
  • BEACON AFFINITY EXCHANGE
    • ALL MEDICARE HMO, CHP, FIDA PLANS except: CENTERLIGHT
    • ALL MEDICAID HMO PLANS except: CHP AND FIDA
  • BEACON CENTERLIGHT
  • BEACON EXCHANGE
  • BEACON HARP
  • BEACON STRATEGIES
  • CARECONNECT – LIJ EXCHANGE
  • CENTERLIGHT MEDICARE ADVANTAGE
  • CHAMPVA – CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE DEPT OF VETERAN
  • CONSUMER HEALTH NETWORK
  • CIGNA COM, HOM, IND, POS, PPO
  • GREAT WEST HEALTHCARE (GWH-CIGNA)
  • CIGNA MEDICARE
  • CIGNA BEHAVIORAL HEALTH
  • DEVON
  • EMBLEM HEALTH – PLAN 3-4
  • EMBLEM GHI – BMP, EPO, PPO
  • GHI – HMO, NET, EPOCBP, FLEX, NYC, PPOCBP
  • EMBLEM HEALTH ESSENTIAL PLAN 1, 2 , 3 & 4
  • EMBLEM HEALTH SELECT CARE EXCHANGE
  • HARP
  • ELDER PLAN
  • FIDELIS MEDICAID CHP
  • FIDELIS ESSENTIAL PLAN 1 & 2
  • FIDELIS ESSENTIAL PLAN 3 & 4
  • FIDELIS HEALTH BENEFIT EXCHANGE (INDIVIDUAL ON-EXCHANGE)
  • FIDELIS HARP
  • FIDELIS MEDICARE ADVANTAGE
  • FIDELIS MEDICAID FHP
  • GALAXY HEALTH NETWORK
  • HEALTH PLAN OF NEW YORK MEDICAID
  • GHI MEDICARE
  • HIP MEDICARE
  • HIP MONMR
  • HIP HMO, OTH, MONTE
  • EMBLEM HIP – ALL COMERCIAL LINE OF BUSINESS
  • HEALTH FIRST EXCHANGE
  • HEALTH FIRST MEDICAID
  • HEALTH FIRST MEDICARE
  • GREATWEST
  • MAGNA CARE – HMO, PPO
  • MEDICAID
  • MEDICARE
  • METRO PLUS CHILD HEALTH PLUS
  • METRO PLUS ESSENTIAL PLAN 1, 2, 3 & 4
  • METRO PLUS HARP
  • METRO PLUS – EPO, HMO, IND, PPO
  • PLANMETRO PLUS HARP
  • METRO PLUS
  • MULTIPLAN – PHCS PPO
  • MVP – EPO, HMO, IND, PPO
  • MVP ESSENTIAL PLAN 1,2,3, & 4
  • MVP HARP, HH
  • MVP – MANAGE MEDICAID
  • NATIONAL HEALTH ADMIN
  • OXFORD EXCHANGE/UNITED HEALTH EXCHANGE
  • OXFORD – HMO, OTH, POS
  • UMR – UNHC
  • UNITED HEALTHCARE – STUDENT, HMO, IND, NH, OTH, POS, PPO
  • UNITED HEALTH COMMUNITY
  • UNITED HEALTH CARE ESSENTIAL PLAN 1 & 2
  • UNITED HEALTH CARE/OXFORD MEDICARE
  • POMCO
  • POMCO – OTH
  • QUALITY HEALTH PLANS OF NY
  • SENIOR WHOLE HEALTH OF NY
  • TODAYS OPTIONS MEDICARE ADVANTAGE PLUS
  • TRICARE
  • VA CHOICE PROGRAM
  • VNS NY
  • WELCARE CHILD HEALTH PLUS
  • WELCARE ESSENTIAL 1,2,3 & 4
  • WELCARE MEDICAID
  • WELCARE MEDICARE
  • VALLUE OPTIONS (BEACON HEALTH OPTIONS)
  • CHCS including:
    • EMBLEM & MVP HMO MEDICAID MEDICARE
    • GHI BMP & MEDICARE
    • COMMERCIAL/NON HMO MEDICARE

If after you have spoken with your insurance company, you have additional questions, please call Phelps Patient Accounting Customer Service at 914-366-3113.

Authorization of services

Health Insurance coverage is a contract between you and your insurance company. Many insurance companies require prior authorization. Before your arrival at the hospital for tests and procedures, you should contact your insurance company to obtain benefit and pre-certification information. Please verify that your physician has obtained the necessary authorization/pre-certification for your scheduled surgery or procedures. Without authorization, your insurance company may impose penalties or deny your claim. You may also be asked to reschedule your appointment.

Co-pay & deductible responsibilities

Patients are responsible for all financial liabilities on the date of service. These include deductibles, co-payments, and co-insurances. If the exact dollar amount has not been determined, you will be asked to pay the estimated amount and will be billed for the balance. For non covered services, payment in full will be requested. Payment can be made at the department where services are rendered or at the Cashier’s Office located near the main entrance. Phelps accepts cash, checks and all major credit cards. We also have an ATM located near the cafeteria on the ground floor.

Amounts generally billed

Under Northwell Health Inc. and affiliated subsidiaries’ Financial Assistance Policy, all hospitals use the look back method as prescribed under § 501(r)(5) of the Internal Revenue Code, to ensure that all not-for-profit hospitals limit the amount generally billed (AGB) for emergency or other medically necessary care provided to individuals who are eligible for financial assistance under Northwell Health Inc.’s Financial Assistance Policy (FAP). The AGB composite percentage used for Phelps Memorial Hospital (the Hospital) is 21.13%. The patient’s actual rate will vary depending upon what kind of inpatient/outpatient health services are performed.

The Hospital’s AGB percentages are based on the total allowable payments during a prior twelve month period from Medicare for each different category of care divided by the total gross charges associated with those claims.

The resulting AGB percentage is applied to the Hospital’s total gross charges for the care provided to the FAP eligible individual to ensure that individual is not charged more that the amount allowed. The final amount charged may further be discounted based on the individual’s family income and size in relation to the Federal Poverty Guidelines (FPG). In addition to adherence to the Internal Revenue Code, the Hospital’s FAP is in full compliance with New York State Public Health Law Section 2807-k (9-a).

The AGB is recalculated annually and is adjusted in accordance with updates to the FPG and/or in accordance with changes to the Public Health Law.

Amounts Generally Billed