EmblemHealth

City workers, teachers, transit employees, and public sector staff often carry EmblemHealth. If you got your insurance through the City of New York, the MTA, or another public employer, you likely have either HIP HMO or GHI PPO. They look similar but work differently.

Whether Moses Medical at 871B Westchester Ave in the Bronx is in network depends on your specific EmblemHealth product. Bring your current card and call (646) 741-2111 before your visit so the office can check your plan and help you identify the questions to ask EmblemHealth.

HIP vs. GHI: What Each Covers

Depending on your plan, your EmblemHealth card may cover these visits:

• Primary care for physicals, sick visits, and chronic condition management
• Primary care for diabetes, high blood pressure, and cholesterol
• Internal medicine for ongoing blood pressure, cholesterol, diabetes, and chronic condition management
• Dermatology for skin conditions, rashes, and mole checks
• Mental health visits for evaluation, medication questions or management when appropriate, and referral planning for therapy or counseling when needed
• Podiatry for diabetic foot exams and heel pain
• Lab services drawn and processed on-site

The difference is how you access care and what you pay per visit.

HIP HMO requires you to pick a primary care provider. All specialist visits go through your PCP, who writes referrals. In exchange, your copays are lower. You must stay in-network.

GHI PPO lets you see specialists without a referral and go out of network if you choose. The tradeoff is higher copays per visit. Staying in network keeps those costs down, so ask EmblemHealth which offices are in network for your product before you book.

If you have a choice during open enrollment, think about how you use care. HIP works well if you want one doctor coordinating everything. GHI works better if you want to see specialists on your own schedule.

Getting Your EmblemHealth Card Set Up

HIP HMO members: You need a PCP on file before you can see specialists. Call EmblemHealth at 1-877-411-3625 to ask whether a Moses Medical provider can be selected under your product, and what the plan requires before a specialist visit.

GHI PPO members: GHI generally lets you book an appointment without a PCP designation or a referral. Ask EmblemHealth how your product treats an office that is not in network.

Everyone: Bring your EmblemHealth card and a photo ID. The office can run an eligibility check and tell you what the plan reports, though an eligibility response is not a guarantee that a service will be paid. If a service needs prior authorization, staff can file the request, and EmblemHealth decides the outcome.

Four Ways to Use More of Your Coverage

1. Book your annual preventive visit. HIP and GHI both cover a yearly wellness exam, and federal rules require most employer plans to cover in-network preventive care at no cost to you. Ask EmblemHealth what applies to your product before the visit.

2. Use mental health benefits. Public sector work can be grinding. Long shifts and difficult situations add up. Mental health visits may be covered, including evaluation and medication management when appropriate. Therapy or counseling coverage and referral options depend on your plan; call with your insurance card to confirm.

3. Ask about network status before you book. For HIP members, out-of-network care is generally not covered. For GHI members, staying in network means lower copays. Ask EmblemHealth which offices are in network for your specific product.

4. Keep follow-up simple. See your PCP, get a referral when needed, and have lab work drawn in the same clinic. That matters when you are on a shift schedule.

Call (646) 741-2111 to schedule your appointment, or walk in during office hours. We are on Westchester Ave, about a 2-minute walk from the 2/5 trains at Prospect Av.