East River Medical Imaging, PC

PET/CT
MRI
CT Scan
Coronary CT Angio
Ultrasonography
X-Ray/Fluoroscopy
Nuclear Medicine
Bone Density
Dental Imaging

• Richard Katz, MD
• Morton Schneider, MD
• Steven Albert, MD
• Alison Haimes, MD
• Stephen Greenberg, MD
• Douglas DeCorato, MD
• Gavin Duke, MD
• Barbara Braffman, MD
• Clyde Hershan, MD
• Paul Choi, MD
• Sean Herman, MD
• Robert Ludwig, MD
• Gwen Harris, MD

Insurance

Medical insurance coverage has become quite complicated. There are many different insurance carriers, with each company having many different plans. The spectrum extends from those with total freedom of choice and no pre-authorization requirements to those that limit your choice of physician and require pre-authorization by the Insurance carrier and / or a primary care physician.

If you have any questions regarding pre-authorization requirements please feel free to ask at the time of scheduling. Sometimes because of the maze of insurance carriers you maybe referred to our Insurance / Billing Department. Although we take great strides to avoid any problems, sometimes with the complexities of certain managed care programs, problems may arise. If you have any questions or concerns about your coverage that we cannot provide adequate answers for, please call your carrier for details. If at the time of your examination you have been unable to obtain all the necessary clearances that your insurance carrier requires, we will be unable to perform the exam. These major inconveniences for you are of great concern to us, however, they are not rules that we are responsible for, but rules that we must follow as well.

Indemnity policies and Medicare do not require pre-authorization. Patients may schedule appointments either on their own or through their physician.

INSURANCE PARTICIPATION AS OF JANUARY 2007
AETNA *Precerts/Ref requirements vary	MULTIPLAN *Precert necessity varies by plan
BLUE CROSS/BLUE SHIELD Precert varies *Not part of indemnity plans/traditional	NO FAULT *Case must be open, auth req
CHOICECARE/HUMANA PPO *Precert requirements vary	NPPN NETWORK *Precert necessity varies by plan
CIGNA *HMO/POS, Open Access & some PPO’s require auth	NYC FIRE DEPARTMENT *Referral/Auth Required
THE EMPIRE PLAN *Precert required for MRI/MRA	OXFORD HEALTH PLANS *Precert required for MRI/CT/MRA/PET/NUC MED
*First Health Network formerly CCNUSApending verification	HEALTHNET (formerly PHS) *Authorization required for MR/CT/PET/OB SONO/Bone Density
GLOBAL MEDICAL MGMT *Appts scheduled by global staff only	POMCO PLUS+ *Precert/Auth required for all services
GHI HEALTH PLANS *Precert required	PRIVATE HEALTHCARE SYSTEMS (PHCS) *Precerts vary by plan – merged with Multipan
HIP *HIP referral or precert required	TRPN NETWORK Three Rivers Provider Network *Precert varies by plan
MEDICARE *Part B only	UNITEDHEALTHCARE *Precert requirements vary
METRACOMP *Worker's Comp auth required for all	WORKER’S COMPENSATION *Authorization required for all charges $500+

If you do not see your plan listed, please call our office for more current information. Indemnity policy holders require no pre-authorization or primary care referral form.