Our new advance patient notice policy (starting July 1) asks breast surgeons in our network to provide more information if they refer you to a breast reconstruction surgeon who is not in our network. The doctor will need to fill out the new Advance Patient Notice for Use of an Out-of-Network Breast Reconstruction Surgeon Form and share it with you. You will have to sign to acknowledge receipt of the form and your doctor will keep a copy on file.
If you're a member about to get this type of surgery, please go over this form with your doctor — so you can make an informed choice about your care. Your doctor will also give you a copy of our new Out-of-Network Exception Requests for Breast Reconstructive Surgery Following a Mastectomy Policy.
This exception policy may not apply to your employer benefit plan that is administered by Empire. It does not apply to:
If you have questions about whether this applies to your plan, please call the member services number on your ID card.