Getting Medical Care

Getting the Care You Need, When Urgently Needed

Our member’s health is most important to AgeWell New York and we want to ensure you are getting the care you need, when you urgently need it. While your primary care physician or other treating physicians is the preferred first point of contact for care, Urgent Care is an important alternative to going to the Emergency Department for non-life threatening conditions and provides immediate medical treatment for minor and moderate illnesses and injuries.

AgeWell New York has expanded its Urgent Care network in our covered service areas including Westchester, Bronx, New York, Queens, Brooklyn, Nassau and Suffolk counties.

Covered Urgent Care Services

As a member of one AgeWell New York’s Medicare Advantage Prescription Drug Plans, no referrals are needed to visit an in-network Urgent Care Center and AgeWell New York will cover your services. In most situations, If network providers are temporarily unavailable or inaccessible, we will cover urgently needed care that you get from an out-of-network provider.

Urgent Care is covered anywhere in the United States. Our plan does not cover urgently needed care or any other care if you receive the care outside of the United States. If you need care when you are outside the service area, your coverage is limited to medical emergency, urgently needed care, renal dialysis or services that our health plan has approved in advance.

If you get non-emergency care from non-plan (out-of-network) providers without prior authorization you must pay the entire cost yourself, unless the services are urgent and our network is not available, or the services are out-of-area dialysis services. If an out-of-network provider sends you a bill that you think we should pay, you should send the bill to us for processing and determination of liability.

Our provider manual requires primary care providers to have patient telephone access and appropriate back up if absent 24 hours a day, 7 days a week.

Please contact member services for more information at 1-866-586-8044 or TTY/TDD 1-800-662-1220.

Contact Hours: Hours are 7 days a week from 8:00 am to 8:00 pm. Note: From April 1 to September 30, we may use alternate technologies on Weekends and Federal holidays.


Getting Care in a Medical Emergency

A “medical emergency” is when you have medical symptoms that require immediate medical attention to prevent loss of life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse.

If you have a medical emergency:

  • Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or hospital.
  • Call for an ambulance if you need it. You do not need to get approval or a referral first from your primary care provider.
  • As soon as possible, make sure that our plan has been told about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Please call Member Services at 1-866-586-8044.  TTY users should call 1-800-662-1220. The Member Services contact numbers can be found on the back of your member identification card.

Contact Hours: Hours are 7 days a week from 8:00 am to 8:00 pm. Note: From April 1 to September 30, we may use alternate technologies on Weekends and Federal holidays.

What is covered if you have a medical emergency?
You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health.

If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over.

After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

What if it wasn’t a medical emergency?
Sometimes it can be hard to know if you have a medical emergency. For example, you might go in for emergency care – thinking that your health is in serious danger – and the doctor may say that it wasn’t a medical emergency after all. If it turns out that it was not an emergency, as long as you reasonably thought your health was in serious danger, we will cover your care.

However, after the doctor has said that it was not an emergency, we will cover additional care only if you get the additional care in one of these two ways:

  • You go to a network provider to get the additional care, or;
  • The additional care you get is considered “urgently needed care” and you follow the rules for getting this urgent care.

Out-Of-Network Coverage Rules

AgeWell New York does not cover out-of-network services unless previously authorized by our management team, with the exception of emergency and/or urgent care accessed outside of our service area. When you are outside the service area and cannot get care from a network provider, our plan will cover urgently needed care that you get from any provider


Getting Care in a Disaster

If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area, you are still entitled to care from AgeWell New York.This includes access to emergent or urgent care as well as obtaining needed prescriptions. For assistance during this time, please call 1-866-586-8044. Contact Hours: Hours are 7 days a week from 8:00 am to 8:00 pm. Note: From April 1 to September 30, we may use alternate technologies on Weekends and Federal holidays.

Please visit our website for information on how to obtain needed care during a declared disaster at www.agewellnewyork.com.

Please refer to the link below for more information about obtaining needed care during a declared disaster.

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