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If you’re in the Empire Plan, make sure you’re paying the right copay

Make sure you’re paying the right copay

PEF Members,

If you’re in the Empire Plan, make sure you’re paying the right copay.

I speak from experience when I say that nothing is more frustrating than knowing your Empire Plan office visit copay is only $20 and being told by the provider that you’re wrong, it’s $25.  Despite several mailings that UnitedHealthcare (UHC) has sent to Empire Plan participating (par) providers notifying them that PEF-represented enrollees have not had any changes to their copays, we continue to hear from members who have been told their copay is now $25 (for most services) or $30 (for urgent care).  In fact, I recently experienced this myself when receiving services at a LabCorp office.  That’s why I want to encourage all members to make sure you’re paying the right copay, and to contact our PEF Health Benefits staff (Karen Conte) if you’ve been charged the wrong copay.

Under the state’s Taylor Law, management is prohibited from reducing or eliminating contract rights or benefits while PEF and the State negotiate for a successor agreement.  Management must continue to provide PEF-represented state employees the level of Empire Plan benefits indicated in Article 9 of the 2016-2019 PS&T Contract.  If you are enrolled in the Empire Plan as a PEF-represented employee (not a retiree), there have been no changes to the Empire Plan copays.  You should only be paying $20 for office visits, lab/radiology services, physical therapy, and urgent care visits.

After notifying our staff of the problem I experienced with LabCorp, UHC took immediate action to address it.  I also learned something about LabCorp that I’d like to share with you.   Although it’s LabCorp’s policy to request a credit card for payment at the time of service, it’s not required that the patient provide a credit card to receive services.  Since LabCorp is unable to determine an Empire Plan enrollee’s copay at the time of service, the “Summary of Estimated Charges” LabCorp gives to patients may indicate a copay of $25 (or the total charge if less).  However, the patient’s credit card is not charged until after the claim has been submitted and LabCorp receives a response from UHC that identifies the patient’s correct copay.  In other words, although the “Summary of Estimated Charges” may indicate a $25 copay, your credit card will only be charged the correct copay of $20.

I hope you find this information helpful.  Health care costs can add up quickly and add to the overall strain on family budgets.  That’s why it’s so important to me that none of you pay a higher copay than what our current contract requires.  If you need assistance in getting a refund of any overpayments that you have made, please contact our Health Benefits staff.

In Unity,

Wayne Spence
President
PEF