Participating Healthcare Plans

East Orange General Hospital accepts major health insurance and managed care plans. For specific information on co-payments or for coverage information regarding a specific procedure, please consult the insurance carrier or your employer’s human resources representatives.

The following is a list of the plans with which East Orange General Hospital is currently a participating hospital provider:

Aetna Better Health Medicaid In Network
Amerigroup Medicaid Medicare (DNSP) In Network
Horizon BCBS Commercial and Medicare In Network
Horizon NJ Health Medicaid and Medicare (DSNP) In Network
MagnaCare Commercial and Workers Compensation In Network
QualCare / CCN Commercial and Workers Compensation In Network
United Commercial and Medicare In Network
Wellcare Medicare and Medicaid (DSNP) In Network
United Commercial and Medicare In Network
United Health Plan Medicaid HMO In Network

Out of Network Information

On June 1, 2018 Governor Murphy signed the “Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act” (“OON”)

It is the law that hospitals provide patients with multiple notices when they contact the hospital to schedule an appointment.

The following information is for individuals with a fully insured, New Jersey-issued plan, a State Health Benefits Plan, a School Employees’ Health Benefits Plan or members of self-funded insurance plans.

Disclosure Prior To Scheduling Covered Services: Click Here Disclosures 

Disclosures are not required for emergent or urgent services.

The following types of plans are not part of the OON “Out-of-Network Consumer Protection:

  • Medicaid
  • Medicare
  • Medicare Advantage
  • Accident Only Plans
  • Disability Plans
  • Long-Term Care Plans
  • Tricare
  • Workers’ Compensation
  • Auto Medical Insurance
  • Personal Injury Protection (PIP)
  • Dental Insurance
  • Hospital Confinement Indemnity

East Orange General Hospital Commercial health insurance plans:

  • Aetna Better Health
  • Horizons BC HMO/PPO/Indemnity
  • Qualcare Commercial HMO/POS/PPO
  • United Healthcare All Payer/Oxford

Prior to receiving services, please contact your insurance company to confirm the potential out-of-pocket costs designated by your insurance plan and to ensure that the individual healthcare services are covered and/ or authorized.

East Orange General Hospital participates with major health care plans, please be aware that physicians are NOT employees of the East Orange General hospital and may or may not participating with the same health insurance plans.  Please check with your referring physicians to ensure the plans the physician participates with.

Please be advised that these healthcare professional(s)’ costs are not included in the hospital’s charges. All physicians’ charges are separate from any bills from East Orange General Hospital.

Employed Physicians and Physicians Groups

The following is a list of the physicians or physician groups that are employed by East Orange General Hospital.  On the physicians that are employed by the hospital you may still receive a separate bill for their services if and when they administer their own billing.

Physicians and Physicians Groups with Whom We Contract

East Orange General Hospital contracts with hospital-based physician groups which provide services to our patients e.g., anesthesiology, pathology and radiology.  Contact your insurance company to verify that the independent providers / group are in network with your insurance carrier.  The costs for the hospital based physician groups are billed separately from the hospital.   The facility charges do not include the healthcare professionals cost therefore, they will bill you separately.

Click here to see a list of the physicians and physician groups that are contracted with East Orange General Hospital

NAPA (North American Partners in Anesthesia)                   UPA (University Physicians Associates)

P.O. Box 65                                                                                  220 Davidson Avenue

Glenhead, NY 11545 Telephone (888) 240-1793                  Somerset, N.J 08873 telephone (973) 972-1150

 

Please speak to your ordering physician to ensure he/ she is in network or out of network with your health insurance plan. In addition, ensure that other physician’s that may be involved in your care are in network or out of network.

The physicians bill separately. So, you may receive more than one bill for your healthcare services.

If a physician is in network, you should never be charged more than your in-network copayment, coinsurance or deductible.

Please notify your health insurance plan and the Department of Banking and Insurance/Department of Health if an in-network provider charges more than your in-network co-pay, coinsurance or deductible.

In-network Disclosures

  • Since East Orange General Hospital in network, you will not pay more than your in-network copayment, coinsurance or deductible for the hospital’s services.
  • If and when East Orange General Hospital network status changes with your health insurance plan prior to your scheduled visit, you will be notified.

Out-of-network Disclosures

  • Since East Orange General Hospital is out of network, you may pay more than your in-network co-payment, coinsurance or deductible for the services received or performed at this facility.
  • You may be responsible for any difference between what your insurance company pays East Orange General Hospital for the service and what East Orange General Hospital charges.
  • If you wish to receive services at East Orange General Hospital, first please contact your insurance company to determine if you have an out-of-network benefit option. If you do, you should ask what your potential out-of-pocket costs may be and double-check that your services will be covered. If you do not have an out-of-network benefit option, you will be responsible for all charges.

Self-funded Plans that did not opt-in Disclosures

  • You have a health insurance plan that is self-funded.
  • Self-funded insurance plans are not required to follow the “Out of Network” law.
  • We must advise you that any services you receive at East Orange General Hospital may be out-of-network with your health insurance plan.
  • Because of this, you may pay more than your co-payment, coinsurance or deductible for services received or performed at this facility.
  • You may also have to pay the balance above any amount that your insurance plan paid for the services.
  • If you wish to receive services at East Orange General Hospital, please contact your insurance plan to find out if you have an out-of-network benefit option. If you do have an out-of-network benefit option, you should inquire about your potential out-of-pocket costs and double-check that the healthcare services will be covered. If you do not have an out-of-network benefit option, you will be responsible for all charges.

If you have any questions about insurance or out-of-network benefits, please contact us between 8 a.m. and 5 p.m. at 973-266-8400 and dial 3 for Admitting.