POMCO

POMCO is not an insurance company. It is the company your employer hired to run your health plan. If your ID card says POMCO, here is what that means for you.

Your employer designed a health plan and picked POMCO to process the claims, manage the network, and handle the paperwork. This is called a self-funded plan. The benefits are set by your employer, not by POMCO. That means your coworker at a different company could also have a POMCO card but have completely different coverage.

POMCO works with several provider networks, so network status for Moses Medical at 871B Westchester Ave in the Bronx depends on which network your employer selected. Call (646) 741-2111 with your card and group number and the billing team can check your specific employer plan before your visit.

Services POMCO Plans Typically Cover

Because every employer designs their own plan, the word “typically” matters here. POMCO-administered plans commonly cover the following, though yours may differ:

• Primary care for physicals, sick visits, vaccinations, and chronic disease management
• Primary care for conditions like diabetes, hypertension, and cholesterol issues
• Internal medicine for ongoing blood pressure, cholesterol, diabetes, and chronic condition management
• Dermatology for skin exams, rashes, eczema, and psoriasis
• Mental health visits for evaluation, medication questions or management when appropriate, and referral planning for therapy or counseling when needed
• Podiatry for foot conditions, plantar fasciitis, bunions, and diabetic foot care
• Lab services for blood draws and diagnostic testing, done on-site

The office can check which of these your specific plan covers before your appointment. An eligibility response is not a guarantee that a service will be paid, so ask your plan as well.

Verifying Your Employer Plan

POMCO plans vary more than most insurance. Two people with POMCO cards can have very different benefits depending on their employer. Here is how to confirm yours:

1. Find your POMCO ID card. It has your member ID, group number, and network information. If you lost your card, your employer’s HR department or POMCO at 1-800-272-7906 can get you a replacement.
2. Call us to confirm network status. POMCO works with several provider networks. Call (646) 741-2111 and give us your group number, and we can check whether Moses Medical is in network under your specific employer plan.
3. Check your plan rules. Some POMCO plans require a PCP designation and specialist referrals. Others let you go directly to a specialist. Your plan documents spell this out. If you do not have them, ask your HR department.
4. Bring your card and a photo ID. At check-in, we run your eligibility in real time and tell you your copay or coinsurance before you see a provider.

Making the Most of a Self-Funded Plan

Self-funded plans can be generous. They can also have unusual rules because each employer makes their own choices. A few things to keep in mind:

Your HR department is your best resource. They chose this plan and they have the summary of benefits document. That document lists exactly what is covered, what requires prior authorization, and what your cost-sharing looks like. If you have never read it, ask HR for a copy.

Preventive care is usually covered in full. Federal law requires most employer plans to cover in-network annual physicals, routine lab work, and age-appropriate screenings with no cost to you. This applies to most self-funded plans, and it depends on the office being in network for yours.

Confirm network status before you book. The biggest billing surprises happen when patients go out of network without realizing it. Give us your group number and we can check what your plan reports. Keeping your primary care, specialist visits, and labs in one clinic also keeps records and follow-up together.

Ask about prior authorization. Some employer plans require approval before certain services. Staff can file authorization requests, and the plan decides the outcome, so it helps to know in advance and start the process early.

Questions about your POMCO plan? Ask your HR department for your benefits summary, then call us at (646) 741-2111 to schedule.