Questions about Coordinated Care
Our Case Management program can help make sure that you get quality, affordable care for a long-term injury or illness. Our Medical Director and Case Managers will review your needs and identify the best care for you. They may even suggest other programs or treatments beyond what you're receiving.
Before being admitted to a hospital, and for certain medical services, you need to contact GHI. We'll review certain proposed treatments or services for medical necessity before they are given. (The services that require precertification are listed in your Certificate of Insurance.) For precertification, please call GHI's Coordinated Care Department at 212-615-4662 (NYC) or 800-223-9870 (outside NYC).
For hospital admissions...
Before you're admitted to a hospital, you, a family member, or your physician need to call GHI's Coordinated Care Program for precertification. For elective (non-emergency) procedures, please call at least ten days before the planned date of admission. For emergency admissions, please call within two business days after admission.
For other medical services...
If you're being treated by a provider in the GHI network, your provider should call GHI before providing services. We'll give precertification, by telephone or in writing, no more than 2 business days after we receive the necessary medical information. Please remind your provider about precertification before services are given.
If you are being treated by a provider who is not part of the GHI network, you must call GHI to get precertification before you receive services.
For mental health benefits...
If you have GHI BMP coverage and you need care, please contact GHI BMP directly at 800-692-7311 for precertification. If you don't have GHI BMP coverage, please call GHI Coordinated Care to precertify your treatment.
Important: If you or your provider do not receive precertification, your GHI benefits may be reduced, and the paid-in-full benefit of using a GHI network provider may not apply.
Discharge planning is a valuable part of GHI's Coordinated Care program. It helps ensure that patients stay in the hospital long enough to get the medical care they need — and to get better.
If you are discharged too early, you may not fully recover, and you may need to return to the hospital. We help prevent this by making sure that you leave the hospital only when you're ready, and not before.
If you or your dependents have other health insurance besides GHI, New York State has Coordination of Benefits (COB) rules that determine which is your primary insurance plan and your secondary plan. The primary plan pays its full benefits first. If those benefits don't cover all charges, the secondary plan pays the difference, up to its maximum benefit amount.
If GHI is your secondary plan, we pay the amount eligible for a covered service after your primary plan has paid. In some cases, depending on your plan's benefits and deductibles , you may still be responsible for some costs even if you have a secondary plan.
For details about New York State's Coordination of Benefits for your specific plan — and which of your plans is primary and secondary — please see your Certificate of Coverage.
