Insurance Plans & Coverage

Billing and insurance hero

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.


Your Rights and Protections Against Surprise Medical Bills

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

What is “balance billing” (sometimes called “surprise billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, like a copayment, coinsurance, or deductible. You may have additional costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” means providers and facilities that haven’t signed a contract with your health plan to provide services. Out-of-network providers may be allowed to bill you for the difference between what your plan pays and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your plan’s deductible or annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care-like when you have an emergency or when you schedule a visit at an in- network facility but are unexpectedly treated by an out-of-network provider. Surprise medical bills could cost thousands of dollars depending on the procedure or service.

You’re protected from balance billing for:

Emergency Services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most they can bill you is your plan’s in-network cost-sharing amount (such as copayments, coinsurance, and deductibles). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain Services at an In-network Hospital or Ambulatory Surgical Center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers can bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other types of services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

Your Rights and Protections Against Surprise Medical Bills

When balance billing isn’t allowed, you also have these protections:

  • You’re only responsible for paying your share of the cost (like the copayments, coinsurance, and deductible that you would pay if the provider or facility was in-network). Your health plan will pay any additional costs to out-of-network providers and facilities directly.
  • Generally, your health plan must:
    • Cover emergency services without requiring you to get approval for services in advance (also known as ”prior authorization”).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your in- network deductible and out-of-pocket limit.

If you think you’ve been wrongly billed, contact the Department of Health and Human Services’ No Surprises Help Desk: 1-800-985-3059.

Visit www.cms.gov/nosurprises/consumers for more information about your rights under federal law.


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)

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
  • 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
Share This