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Insurance Plans - New York
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AETNA HEALTH INC
AMERICAN PROGRESSIVE LIFE AND HEALTH INS CO NY
Where to Get Forms: Call 1-800-244-5800 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-244-5800
Phone # to request Exception: 1-800-244-5800
Fax #: 513-881-6841
E-mail Address: JRoesch@pharmacare.com Updated: May 2006
AMERICHOICE OF NEW JERSEY, INC
CAMBRIDGE LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available Updated: May 2006
CAPITAL DISTRICT PHYSICIANS' HP, INC.
COMPREHENSIVE CARE MANAGEMENT CORP.
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com Updated: May 2006
CONNECTICUT GENERAL LIFE INSURANCE COMPANY
COVENTRY HEALTH AND LIFE INS COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
ELDERPLAN, INC.
EMPIRE HEALTHCHOICE ASSURANCE, INC.
EXCELLUS HEALTH PLAN, INC.
FIRST UNITED AMERICAN LIFE INSURANCE COMPANY
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com Updated: May 2006
GROUP HEALTH INCORPORATED
Where to Get Forms: Call 1-877-665-6609 and ask to have form sent.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com Updated: May 2006
HEALTH NET LIFE INS CO/HEALTH NET INS OF NY
HEALTHNOW NEW YORK, INC.
HEALTHNOW\BLUE CROSS BLUE SHIELD OF WESTERN
HIP HEALTH PLAN OF NEW YORK
Where to Get Forms: Call 1-800-992-6227 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-992-6227
Phone # to request Exception: 1-800-992-6227
Fax #: Call 1-800-992-6227 and ask for fax number.
E-mail Address: fdelacruz@hipusa.com Updated: May 2006
INDEPENDENT HLTH BENEFITS CORPORATION
Where to Get Forms: Call 1-800-247-1466 and ask to have form sent.
Phone # to request Prior Authorization: Request must be faxed; call 1-800-247-1466 for more information
Phone # to request Exception: 1-800-247-1466
Fax #: 1-800-273-7397
E-mail Address: mburrano@independenthealth.com Updated: May 2006
LIBERTY HEALTH ADVANTAGE, INC.
Where to Get Forms: Call 1-800-546-5677 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-546-5677 x32
Phone # to request Exception: 1-800-546-5677 x32
Fax #: 1-800-458-1646
E-mail Address: eschram@pti-nps.com Updated: May 2006
MANAGED HEALTH INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com Updated: May 2006
MEDCO CONTAINMENT INSURANCE COMPANY OF NEW YORK
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: Not Available
Updated: May 2006
MEMBERHEALTH, INC.
NEIGHBORHOOD HEALTH PROVIDERS LLC
Where to Get Forms: Call 1-800-756-3805 and ask to have form sent.
Phone # to request Prior Authorization: 1-800-756-3805
Phone # to request Exception: Not Available
Fax #: 212-808-4772
E-mail Address: skahn@royalhc.com Updated: May 2006
NEW YORK STATE CATHOLIC HLTH PLAN INC
OXFORD HEALTH PLANS (CT), INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: provider.relations@walgreens.com Updated: May 2006
PACIFICARE LIFE AND HEALTH INSURANCE COMPANY
ROCHESTER AREA HEALTH MAINTENANCE ORG.
Where to Get Forms: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Prior Authorization: Your pharmacist will receive information from the plan if your prescription is denied because of a coverage problem.
Phone # to request Exception: Not Available
Fax #: Not Available
E-mail Address: pharmcontracting@medco.com Updated: May 2006
RXAMERICA, LLC
Where to Get Forms:
Call 1-866-772-7737 for fax on demand automated phone service.
Phone # to request Prior Authorization: 1-866-549-0991
Phone # to request Exception: 1-866-549-0991
Fax #: 1-866-855-2676
E-mail Address: lois.mastin@rxamerica.com Updated: May 2006
SILVERSCRIPT INSURANCE COMPANY
STERLING LIFE INSURANCE COMPANY
Where to Get Forms: http://www.foxrxcare.com/exceptions.htm
Phone # to request Prior Authorization: 1-888-369-7979
Phone # to request Exception: 1-888-369-7979
Fax #: 1-866-284-4509
E-mail Address: Not Available Updated: May 2006
TOUCHSTONE HEALTH PARTNERSHIP
Where to Get Forms: Call 1-888-777-0204 and ask to have form sent.
Phone # to request Prior Authorization: 1-888-777-0204
Phone # to request Exception: 1-888-777-0204
Fax #: Not Available
E-mail Address: robert.reynolds@sxc.com Updated: May 2006
UNICARE
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6646 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6646
Phone # to request Exception: 1-800-207-2605
Fax #: 1-866-617-6722
E-mail Address: provider.relations@walgreens.com Updated: May 2006
WELLCARE HEALTH PLANS
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