Insurance Plans & Coverage

Englewood Hospital is committed to protecting our patients from surprise medical bills. In accordance with New Jersey’s new “Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act,” we have provided the information below regarding potential healthcare costs. At Englewood Hospital, we are constantly working to ensure we meet the requirements of the new law and will update the below information as is necessary.

If you have health insurance, there are important steps you should take to understand your coverage and protect yourself from unexpected bills. Some of this information may be available on your insurance card. Your insurance card also includes a customer service number where you can get answers to your specific coverage questions.

Questions to ask before your hospital visit

• Before scheduling a procedure at the hospital, ask your insurance company whether you need pre-authorization or a referral.
• Ask your physician to provide you the specific diagnosis descriptions or procedure descriptions. Then ask your insurer if the services ordered by your physician are “covered services.”
• Ask your insurance company if Englewood Hospital is “in network” with your insurance plan.
• Ask your insurance company for an estimate of your total out-of-pocket costs. That may include a copayment if required by your insurance plan or a deductible amount that you must pay yourself before insurance coverage kicks in. The Affordable Care Act requires health insurance companies to provide this pricing information to their customers.

In network vs. out of network

Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. Receiving care from an out-of-network hospital could increase your out-of-pocket costs. To verify your cost for out-of-network services, contact your insurance company directly.

IN ADDITION, THE PHYSICIANS WHO PROVIDE CARE WITHIN OUR HOSPITAL MIGHT NOT PARTICIPATE IN THE SAME INSURANCE PLANS AS THE HOSPITAL. You should directly contact your insurance company or the physician who is arranging your healthcare services to see which insurance plans the physician participates in. You should also know that these healthcare professional(s)’ costs are not included in the facility’s charges. They will bill separately.

Physicians and hospital-based physicians groups we employ or contract

See information regarding physicians who are employed by Englewood Hospital.

Below is a list of the physicians or physician groups that have a contract with the hospital to provide certain healthcare services that prevents us from using any other physicians for these services. Regardless of the physician’s relationship with Englewood Hospital, these healthcare professionals’ costs are never included in the facility’s charges and you will still receive a separate bill for these services. Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital.

• Teamhealth Anesthesia: 350 Engle Street, Englewood, NJ 07631; 888-983-4885
• Englewood Pathologists, PA: 350 Engle Street, Englewood, NJ 07631, 201-894-3420
• Englewood Radiologic Group: 350 Engle Street, Englewood, NJ 07631; 800-889-4447

Important note regarding emergency care

In cases of emergency, go to the nearest emergency room. In New Jersey, patients receiving emergency care will not be responsible for the added costs associated with care in an emergency department that is out-of-network.

Plans we participate in

Englewood Hospital (EH) strives to ensure that all patients have access to EH services. Below is a list of the network and plans we currently participate in. If you do not find your insurance plan on the list below, we may still be in network. Please give us a call at 201-894-3099 to verify if we are a participating facility.

Marketplace/exchange plans (Affordable Care Act)

• Amerihealth (all plans)
• Horizon Blue Cross Blue Shield (all plans)
• Oscar (NJ)
• Wellcare Ambetter

Medicaid plans

• Aetna Better Health
• Amerigroup
• Fidelis Care NY
• Horizon NJ Health
• United Healthcare Community Plan (formerly Americhoice)
• Wellcare

Medicare plans

• Aetna Medicare (except NNJ Prime)
• Aetna Better Health
• Aetna Whole Health
• Amerigroup Medicare
• AmeriHealth Medicare
• Braven (Horizon)
• Clover
• Healthspring (Cigna)
• Horizon Medicare
• Horizon Blue Advantage
• Horizon NJ Health DSNP (Dual)
• Humana Medicare
• Oxford Medicare
• United Healthcare (also AARP)
• United Healthcare Community Plan (formerly Americhoice)
• USA MCO
• Wellcare

Major plans

• Aetna
• Amerihealth
• Blue Cross and Blue Shield – most out of state plans
• Cigna (including Great West)
• Coventry (First Health)
• Emblem Health: Group Health Incorporated (GHI) – Comprehensive Benefit Plan (CBP/Outpatient only)
• Emblem Health: HIP of New York
• First Health (Coventry)
• Great West (Cigna)
• Health Care Payers Coalition
• Horizon Blue Cross and Blue Shield of NJ
• Horizon Casualty
• MagnaCare (Direct Plus, PPO, Worker’s Comp and Create)
• MultiPlan (including PHCS)
• Oxford
• QualCare
• United Healthcare

Other plans

• 1199 National Benefit Fund (Health Care Payers Coalition)
• Bergen Risk Managers
• Consumer Health Network Plus
• CorVel
• Devon Health Plan
• Evolutions Healthcare Systems
• First MCO
• FOCUS Healthcare Management
• Galaxy Health Network
• Great West
• HealthNet Federal Services (Tricare)
• Health Payers Organization
• Intergroup Services Corporation
• Integrated Health Plan
• National Provider Network
• NBS Diving Preferred Provider Network
• PHCS (Multiplan)
• Preferred Health Strategies (Family Health Choice Alliance)
• Religious Order of Jehovah’s Witnesses (Health Care Support/Watchtower)
• Three Rivers Provider Network
• Unison Health Plan