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Department of Managed
Care and Clinical Business Plan Development
Vice President: Grace Wong
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 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 individ uals
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 Mangaged Care office.
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