New - Individual Network

Effective January 1, 2020, Empire BlueCross BlueShield HealthPlus (“Empire HealthPlus”) will be introducing a new network called the “Individual Network”. This network will replace the Pathway Enhanced Network and will be used for our Commercial Individual products issued both on and off exchange.

 

For questions about your participation status contact your network relations consultant.

 

Empire HealthPlus members enrolled under a benefit plan that utilizes the Individual Network will have member ID cards that read cards that read “Individual Network” at the bottom of their member ID card. The prefixes that this plan will be using are VFG or VJD.

 

If you are included as a provider in the Individual Network, it is important for you to remember that this is an HMO network. The Individual Network will not offer coverage for services received by out of network providers; therefore, please confirm a provider’s participation status with Empire’s Find a Doctor tool found on www.empireblue.com prior to referring to or scheduling services with another provider.

 

Should a non-participating provider be required, Empire’s Use of a Non-Participating Provider Advance Patient Notice Policy will apply. As a reminder, Empire’s Advance Patient Notice form can be found at www.empireblue.com/provider. Failure to refer patients to a participating provider could result in claim denials and increased out of pocket costs for our members.

 

Below is a sample copy of the Member’s Card: