Insurance Information
What insurance does HSS take?
HSS accepts most major insurance plans for Hospital services. Insurance taken by individual physicians varies. See insurance plans listed below.
Click on an insurance company name to display more information. Since health insurance providers may offer different coverage plans, it is important for you to confirm that HSS participates in the specific plan by which you are covered.
Please note: The information listed below applies only to Hospital services and is subject to change. (The HSS Insurance Advisory Service can provide you with the most up-to-date information at 212.774.2607.) Insurance coverage accepted by individual HSS physicians varies. Some may not accept a plan listed below. If you plan to consult or receive care from one of our doctors, please review their physician profile page or contact their office to confirm whether they accept your insurance. If you need help finding an appropriate doctor who takes your insurance, contact our HSSConnect at 877.606.1555.
Health insurers that provide access to Hospital for Special Surgery
(click the insurance company name for more details)
Aetna
Hospital for Special Surgery is an in-network provider with the following Aetna programs:
- HMO
- POS
- PPO
- QPOS
- Choice
- Elect Choice
- Managed Choice
- Open Access
- Select
- NY Community Plan
- Signatures Administrators PPO
- City of New York Aetna Medicare Advantage
Exceptions:
- Hospital for Special Surgery is NOT an in-network provider for Aetna's Medicare Managed Care/Advantage, Medicaid, Savings Plus, NY Signature and QHP plans.
Affinity by Molina Healthcare
Hospital for Special Surgery is an in-network provider with the following Affinity programs:
- Affinity Essential
- Affinity Medicaid
To SCHEDULE AN APPOINTMENT, PLEASE CALL THE AMBULATORY CARE CENTER AT 212.606.1267
Blue Cross Blue Shield - Empire
Hospital for Special Surgery is an in-network provider with the following Empire Blue Cross Blue Shield programs:
- EPO
- HMO
- POS
- PPO
- Indemnity
- HealthPlus - Individual Network Only (Not Medicaid)
- NYC Healthline
- The Empire Plan/New York State Health Insurance Program (NYSHIP) – See Below Exception
- Federal Employees (FEP)
- Basic (May be limited to HSS NYC Locations)
- Standard
Exceptions:
- Hospital for Special Surgery is NOT an in-network provider for Empire's Medicare Managed/Advantage and Medicaid Managed Care plans.
- The Empire Plan/New York State Health Insurance Program (NYSHIP)
Hospital for Special Surgery is an in-network provider for New York State employees covered by the “Empire Plan.” Please note: Empire Blue Cross Blue Shield administers your inpatient and outpatient hospital services under this plan. United Healthcare administers the network of physicians. HSS and Participating Physicians are contracted directly with the Empire Plan/NYSHIP. Empire BCBS and United Healthcare are utilized only for administrative purposes.
Blue Cross Blue Shield - Horizon
Hospital for Special Surgery is an in-network provider with the following Horizon Blue Cross Blue Shield programs:
- Commercial EPO
- POS
- Direct Access
- OMNIA with Bluecard (PPO logo and no disclaimer) at Tier 2 Benefit Level
- Federal Employee Program (FEP)
- HMO
- PPO with Bluecard (PPO logo and no disclaimer)
- Metallic Designation Plans with Bluecard (PPO logo and no disclaimer)
Exceptions:
Hospital for Special Surgery is NOT an in-network provider with Horizon’s OMNIA without Bluecard, Metallic Designation plans without Bluecard, NJ Health (Medicaid), and Horizon Medicare Advantage Plans (HMO & PPO)
Blue Cross Blue Shield - Out-of-Area
HSS is an in-network provider with the following Out of Area Blue Cross Blue Shield programs:
- Out of Area (Cards with PPO Suitcase logo)
- UniCare Affiliated PPO
Members of the UniCare Affiliated PPO plans have in-network access to Hospital for Special Surgery through an affiliation with Empire Blue Cross Blue Shield.
Some, but not all, out-of-area Blue Cross Blue Shield plans include Hospital for Special Surgery as an in-network provider through the National PPO BlueCard® Program. The BlueCard® program allows you to access in-network benefits from other local Blue Cross PPO plans and all authorized and covered services provided by the hospital would be subject to your in-network deductibles and coinsurance levels. The existence of the “PPO in a suitcase logo” on your member identification card typically confirms your plan’s participation in the BlueCard® program.
CIGNA
Hospital for Special Surgery is an in-network provider with the following Cigna programs:
- EPO
- HMO
- POS
- PPO
- Indemnity
- Open Access
Exceptions:
- Hospital for Special Surgery is NOT an in-network provider for Cigna's Medicare Managed Care/Advantage and Connect Network Plans
EmblemHealth (Connecticare, GHI and HIP Plans)
Hospital for Special Surgery is an in-network provider with the following EmblemHealth programs:
- Connecticare Commercial
- Connecticare Medicare
- GHI CBP (NYC Healthline)
- GHI National Network
- GHI Network Access Network
- GHI Tristate Network
- GHI Medicare
- EmblemHealth – Select Care Network (Large Group Only)
- HIP Prime Network (Including: CHP Plans)
- HIP Bridge Network
- HIP VIP Bold Network
- HIP VIP Prime Network (Including: Dual Eligible Plans*)
- HIP Vytra
- HIP Essential Plans
- HIP Enhanced Care Prime Network (Medicaid*)
- HIP Enhanced Care Plus Prime Network (HARP*)
Exceptions:
- Hospital for Special Surgery is NOT an in-network provider with Connecticare plans through Access Health CT, EmblemHealth Select Care Network (Exchange, Individual, and Small Group), HIP Millennium Network, and HIP VIP Reserve.
Fidelis
Hospital for Special Surgery is an in-network provider with the following Fidelis programs:
- Fidelis Medicaid
- Fidelis Child Health Plus
- Fidelis Essential Plan
- Fidelis HARP
Exceptions:
- Hospital for Special Surgery is NOT a participating provider with Fidelis Medicare, Dual Advantage, and Exchange Plans.
To schedule an appointment, please call the ambulatory care center at 212.606.1267
Healthfirst
Hospital for Special Surgery is an in-network provider with the following Healthfirst programs:
- Healthfirst Medicaid
- Healthfirst HARP
Exceptions:
- Hospital for Special Surgery is NOT a participating provider with Healthfirst Essential, Healthfirst Leaf, or Healthfirst Medicare plans
*To schedule an appointment, please call the ambulatory care center at 212.606.1267
Medicaid
Hospital for Special Surgery is participating with Traditional New York State Medicaid insurance. You are responsible for any co-payments. If you are enrolled in a Medicaid Managed Care HMO and Child Health Plus plan your benefits and coverage at Hospital for Special Surgery may be limited. Please contact VOICES Medicaid Education Program at 212.774.2011 to determine your options at Hospital for Special Surgery.
Medicare
Hospital for Special Surgery is participating with Traditional Medicare insurance. You are responsible for co-insurance and deductible costs. If you are enrolled in a Medicare Managed Care/Advantage plan, the benefits and coverage at Hospital for Special Surgery may be limited.
It is possible that even if you stay overnight in the hospital, you will not be considered an inpatient. You may instead receive Ambulatory Surgery Extended Stay services as an outpatient. This is in accordance with Medicare Part A insurance plan guidelines. If this applies to you, you will be given more detailed information about your coverage and options.
If you have Medicare Part A or Part B and have questions about your coverage, please call the HSS Insurance Advisory Service at 212.774.2607 or email your question through our online form.
Multiplan/PHCS
Hospital for Special Surgery is a participating provider with Multiplan/PHCS. In-network status depends upon your policy's plan. Please call your plan’s customer service phone number to determine if the services of the Hospital will be considered in-network.
New York State Healthcare Exchange/Marketplace Plans
Hospital for Special Surgery is participating with the following NYS Healthcare Exchange/Marketplace plans:
- Empire BCBS Healthplus Gatekeeper Individual Network
- United Healthcare – Compass
SEE PHYSICIANS PARTICIPATING WITH EMPIRE BCBS HEALTHPLUS GATEKEEPER INDIVIDUAL NETWORK
New York State Essential Plan
Hospital for Special Surgery is participating with the following NYS Essential Plans:
- Affinity by Molina Healthcare
- EmblemHealth HIP
- Fidelis Essential Plan
- United Healthcare
TO SCHEDULE AN APPOINTMENT, PLEASE CALL THE AMBULATORY CARE CENTER AT 212.606.1267
No-Fault
Hospital for Special Surgery accepts No-Fault Insurance. You must have a valid case/claim number and authorization (if applicable) prior to seeking care at HSS.
Oxford Health Plans
Hospital for Special Surgery is an in-network provider with the following Oxford programs:
- Freedom Network
- Liberty Network
- Metro Network
UnitedHealthcare
Hospital for Special Surgery is an in-network provider with the following UnitedHealthcare programs:
- HMO (Choice, Select Plus)
- POS (Choice Plus, Select Plus)
- EPO
- PPO
- Indemnity
- UnitedHealthcare Compass
- UnitedHealthcare Medicare HMO
- NYS Essential
- UHC Community Plan of NY Medicaid*
- HARP
*To schedule an appointment, please call the ambulatory care center at 212.606.1267. Learn more here
Exception:
Participation status of UnitedHealthcare Medicare PPO varies depending on the individual plan. For more information please call the HSS Insurance Advisory Service at 212.774.2607 or complete our online form.
Workers' Compensation
Hospital for Special Surgery accepts Workers' Compensation. You must have a valid case/claim number and authorization (if applicable) prior to seeking care at HSS.
If you have specific questions regarding the plans with which the Hospital participates, please call the HSS Insurance Advisory Service at 212.774.2607 or email your question through our online form. The HSS Insurance Advisory Service can serve as a liaison service among you, your insurance carrier, and the Hospital to provide information regarding your insurance coverage. You may be responsible for payment of deductibles and co-insurance amounts, and you may be subject to other limitations, such as pre-certification requirements.
If the Hospital does not participate with your particular insurance plan, you still may have coverage subject to the availability of "out-of-network" benefits. The HSS Insurance Advisory Service can advise you.
Your surgeon, your anesthesiologist, your medical doctors, and other specialists make their own decisions regarding participation in insurance plans. There are many physicians affiliated with the Hospital who participate in the same insurance plans with which the Hospital itself participates. For more information regarding specific physician practices, please contact the individual physician offices or the HSS Connect at 877.606.1555.