Empire Health Insurance Company
Empire Health Insurance Company is a Blue Cross Blue Shield company. Their HMO, Direct HMO, and Medicare Advantage HMO products have earned them Excellent Accreditation status from the National Committee for Quality Assurance. Founded in 1934 in New York City, where it is still headquartered today, Empire Health Insurance Company has 5 million members and over 38,000 company accounts. Statistically, they retain 93% of their company client base with a 91% customer satisfaction score.
Read through this review of Empire Blue Cross Blue Shield Health Insurance Company, check out the Empire Health Insurance reviews left by real customers at the bottom of this page, and then leave your own review of Empire BCBS if you are a policyholder.
Once you have completed perusing the Empire Health Insurance reviews then be sure and enter your zip code into the box on the sidebar of this page to compare health insurance quotes from top health insurance providers online.
History of Empire BCBS Health Insurance
After Associate Hospital Service (AHS) was founded in 1934, United Medical Service (UMS) was established in 1944. In 1974, these two companies merged to form Blue Cross Blue Shield of Greater New York. In 1966, Empire HealthChoice and Empire HealthChoice Assurance were created. Later in 2005, WellChoice, the parent company of Empire Blue Cross Blue Shield, was acquired by WellPoint, which created the largest health insurance provider in the United States.
This acquisition formed over thirty-five million members nationwide. 2007 introduced Empire Prism, which are health plans for small to medium sized businesses. Life insurance was added by Empire Blue Cross Blue Shield in 2009, making it a full service benefits provider.
Local network providers service 28 eastern and southeastern counties in the state of New York and 10 counties in New Jersey and Connecticut. Through local Blue Cross and Blue Shield plans, all members have access to participating providers nationwide and worldwide.
It is important to note that Blue Cross Blue Shield is similar to a nationwide franchise and is not a true nationwide company. There are many different health insurance companies that pay a licensing fee to use the BCBS trademark and operate in a specific locale. Click here to read the full Blue Cross Blue Shield Health Insurance Review.
Empire Blue Cross Blue Shield Individual Health Insurance
Child Health Plus is available in select counties of New York State, New Jersey, and Connecticut. Children under 19 years of age who qualify for the plan receive in-network benefits with over 65,000 providers and 147 hospitals. Financial support for coverage may also be available.
Healthy New York is a plan for individuals and sole proprietors in select counties of New York, New Jersey, and Connecticut. Necessary health services are available with Empire’s network of 65,000 providers and 147 hospitals, and emergency care is always accessible at the nearest doctor or hospital. Optionally, a prescription drug benefit is obtainable.
Direct Pay HMO/POS offers dual benefits. The plan is a traditional HMO (Health Maintenance Organization) that offers the choice of a POS (Point of Service) if a member goes out of the network. As is standard with an HMO, a Primary Care Physician (PCP) will provide for your care or refer to you a specialist when needed. As with the Healthy New York plan, emergency care is always accessible.
Direct Pay HMO is a standard Health Maintenance Organization plan. Members choose a PCP for their basic and preventive care and then receive referrals for specialists when needed. By having a PCP you have the added benefit of maintaining your medical history. Hospital admissions must be arranged and special services do require pre-certification. All services must be within the HMO network. Pharmacy benefits are included along with in-patient coverage and emergency care.
Tradition PLUS Hospital is hospital coverage for members and their dependents. It covers hospital related costs, including inpatient hospital protection with 365 days paid in full. Also included are maternity care, newborn hospital care, outpatient chemotherapy, radiation therapy, physical therapy, and Skilled Nursing Facility Care.
Empire Blue Cross Blue Shield Group Health Insurance
HMO is a traditional HMO plan with low out-of-pocket costs and access to over 65,000 providers and 147 hospitals in participating counties in New York, New Jersey, and Connecticut. Typical HMO plans require that you stay within the network, see your primary physician, and get referrals for specialized care.
Empire’s Direct HMO plan is the same as the traditional HMO plan above with the exception that members are allowed to choose a network specialist without a referral.
Direct POS gives members full range of in-network benefits with no claim forms, although full out-of-network coverage is available. Low out-of-pockets costs are made possible by requiring members to have a PCP, but members are not required to get referrals for specialists within the network. The same network of 65,000 providers and 147 hospitals applies.
DirectShare POS (SM) is the same plan as the Direct POS plan, with the additional benefit of allowing members to manage their own healthcare costs with in-network doctors.
The PPO plan is the freedom of choice plan. In addition to the Empire network, members have an extended network of doctors and hospitals through BlueCard PPO providers, giving access to 668,000 physicians and 8,500 hospitals. Coverage is nationwide with in and out-of-network benefits. No referrals are needed and members can help manage their costs with in-network doctors.
Empire’s EPO and national EPO plans have nationwide coverage with over 668,000 doctors and 8,500 hospitals through Empire’s network as well as through participating BlueCard network providers. Although only in-network benefits apply, referrals are not needed.
Empire Total Blue (SM) is a Consumer-Driven Health Plan (CDHP). Members are in control of their health costs and healthcare decisions. Referrals are not required and nationwide coverage gives members access to both Empire’s network and the BlueCard network, which consists of 668,000 physicians and 8,500 hospitals. The plan carries a higher deductible which gives members a lower monthly premium. The plan utilizes Health Reimbursement Accounts (HRA) and Health Savings Accounts (HSA) whether they are employee or employer funded.
Empire BCBS Medicare Health Insurance
Empire offers both Medicare Advantage and Medicare Supplement plans, which are intended to provide members with up to 100% basic Medicare benefits and additional hospital and medical coverage that is not typically provided by Medicare.
MediBlue (SM) HMO is a Medicare Advantage HMO plan with no or low monthly premiums depending on the plan. Medicare prescription drug coverage is also available. Members will receive access to doctors and hospitals in the counties of Westchester, Ulster, Sullivan, Suffolk, Schenectady Saratoga, Rockland, Richmond, Rensselaer, Queens, Putnam, Orange, New York, Nassau, Kings, Dutchess, Bronx, and Albany.
MediBlue Total Solutions is a Medicare Advantage HMO for eligible low income individuals in the Westchester, Suffolk, Rockland, Richmond, Queens, Nassau, Kings, and Bronx counties.
MediBlue PPO is a Medicare Advantage PPO with direct access to providers in and out of the network. Medicare prescription drug coverage is also available under this plan, which can be obtained in the Westchester, Suffolk, Rockland, Richmond, Queens, Nassau, Manhattan, Kings, and Bronx counties.
MediBlue SmartValue (SM) is a Medicare Advantage Private Fee for Service plan where members can go to any licensed doctor who provides Medicare services and is willing to accept the terms and conditions of the plan. Members are not required to have a PCP or get referrals for special care. Medicare Part D prescription coverage is included in this plan, which is only available in Sullivan County.
MediBlue (SM) Medicare Supplement plans, sometimes called Medigap, is available to help pay for out-of-pocket costs for Medicare services that are not covered by Medicare, such as deductibles and copayments. There are twelve standardized Medicare supplements that vary by company, but typically Plan A covers the basics while Plans B through L cover a variety of additional expenses as well, such as emergency health care or skilled nursing facilities. Empire offers Plans A, B, C, F, H, K, and L. The monthly premium and out-of-pocket fees will depend on the plan.
To be eligible for Empire’s Medicare supplemental plans you must be a resident of New York State living in one of the 28 counties that are within Empire’s service area. You must also be 65 years of age or older, although some states will consider participants under 65 years of age if they have a disability or are in the end stages of renal (chronic kidney) disease. Applicants must be enrolled in both Medicare Part A and Medicare Part B. Medicare supplement plan benefits cannot be used along with a Medicare Advantage plan.
Compare Empire Health Insurance Quotes
Empire Health Insurance Company offers many different individual and group plans in addition to supplemental Medicare plans. Utilizing the Blue Cross Blue Shield network in addition to its own large network allows Empire Blue Cross Blue Shield to offer a myriad of plans with varying costs and benefits. In order to find a plan that fits your medical needs and financial budget, enter your zip code above and start comparing Empire health insurance quotes with quotes from many top health insurance companies. Why not take a minute, since you’re already here, and use the quote tool now?
16 Comments to “Empire Health Insurance Company”
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Nick Ecky says:
“While tremendously expensive, empire combines the very comprehensive health insurance plans with the absolute WORST customer service imaginable. If you are ever in need of help they are the most hostile and bureaucratic group you’ve ever seen.
BCBS makes a great case for why we NEED some sort of government mandated health care solution!”
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Dani says:
“Empire Tradition Plus Hospital Program is a rip off insurance.
3 months after enrolling into the plan I broke my foot and went to the ER for an x-ray. The Tradition Plus Hospital Program does NOT PAY FOR ANY DOCTORS OR PROCEDURES IN THE ER. Did you get this? The do not cover the ER. The cover the “”visit”” to the ER but NOT any procedures like X-ray or any doctor that will speak to you about your condition.
They will bill you afterwards and have 6 months time to do so. This is NOT disclosed anywhere in the paperwork clearly. The do not disclose that 99% of doctors that work in the hospital do NOT work for the hospital and will bill privately. Be very careful with this plan it is NOT the coverage you think it is and will not prevent a huge bill should you have an accident.
The customer service is likewise terrible, rude, condescending and avoiding direct answers to direct questions. When I stated that I was never told this fact about doctors not being included in the plan, they blamed it on the broker that sold me the plan who is not employed by Empire (how convenient for them as they can, therefore, not be sued for this misinformation.) The told me “”as long as you’re handled by the doctors who work for the hospital inside the ER you’re fine”” little did I know that 99% of them do not work FOR the hospital. Who knows such things?
Its a rip-off and clearly waiting for a huge class action suit.”
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Kevin Bailey says:
“Empire BCBS isn’t just the worst insurance company I’ve ever had the misfortune to deal with, they are without a doubt the worst company of any kind I’ve ever had to deal with. Forget trying to get assistance on the phone.
After spending an inordinate amount of time working through their obtuse voicemail system whatever representative you speak with will prove to be totally and completely useless. I’ve spent more hours on the phone with these people than I can recount and spoken with numerous agents, not once have I ended up with anything approximating a useful outcome.
At the moment I’m just trying to get them to change my mailing address. That’s taken 7 calls so far and I’m nowhere close to completion. Each time I get a completely different story. Of course, I should be able to change my address online, but their website is just as bad as their phone service.
Briefly, it simply doesn’t work, and of course forget about using the backspace since that causes the entire app to crash, and that’s even before logging in. In short, it is not possible to communicate with this company.”
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Sue Wirick says:
“Couldn’t agree more with the other reviews on how terrible the customer service is, though I would add the words belligerent and obnoxious to describe the customer service representatives (when in fact, you actually get to speak to a “”human being”” (not sure “”human being”” describes the creature at the other end of the phone).
Our son was hospitalized twice for 4 days in March and then 1 week in April. The BCBS paid the 2nd hospital stay but not the first one because they said it was a pre-existing condition. He was hospitalized both times for the same condition? These folks aren’t even rational.”
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Mario says:
Altho I have had no serious medical problems the customer service and the website have always answered my questions in a polite and concise way in explaining payments, coverages etc. They have sent reimbursements soon after I have submitted my claims.
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Robert says:
“Totally agree with the above comments about rude, smug, obnoxious customer service as well as the fraudulent representation of the tradition plus hospital plan. After more than a year of paying good money for hospital coverage, I had to go to the emergency room.
Apparently, empire will pay the hospital but not the doctor that works at the hospital. WTF is that??? Who would even think of creating an insurance plan like that? Although the policy never actually states that the doctor bill is covered, it also never states that the doctor bill is not covered.
Wouldn’t any reasonable person safely assume that if they are buying hospital coverage that it would also cover doctors at the hospital as well?? CLASS ACTION SUIT? Count me in.”
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Walter Young says:
“They don’t get any worse. Customer service is nonexistent. They keep switching providers to the cheapest but most incompetent to save a few bucks. What they don’t realize is too stupid that the providers force Empire to spend extra time to straighten out the wrong submissions.
I guess they never heard of ‘time is money.’ Empire is a classic example of what is wrong with our healthcare system. They put the burden on their customers and providers while they sit back and collect all the profits.”
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Bruce Walker says:
“Worst customer service imaginable.
They process in-network claims as out of network, admit they made a mistake, then demand the physician reimburse them for the out-of-network payment previously made prior to issuing a check for full payment to cover in-network preventive care that’s supposed to be 100% covered.
The laim has dragged on for 6 months, each time I contact Empire BCBS they say it will be taken care, and then they do nothing. The provider has now flagged my account. If ever there were a company that represents everything wrong with the present healthcare system, Empire Blue Cross would have to be the winner of such a dubious honor.”
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pulseps says:
“try to get an appointment to neurologist and Psychiatric but over 50% doctors not accept this insurance in north New Jersey! really surprised. I am paying 10.5K a year for my family insurance and it’s not worth paying.
I have this insurance from my work but I would definitely try to change to different insurance than Empire BCBS”
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Mo says:
“This is the worst customer service I have ever dealt with.
I receive only inconsistent answers from rude agents. The technical support personnel is poorly educated and massacre the English language: “”We gots to verify…””. Who speaks that way at a professional service firm? I am wishing and hoping that my company will switch to another provider.
No wonder our healthcare system is in the state that it is.”
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Sheina says:
“If you are having problems with Empire you can complain directly to these people. Tell them Sheina sent you.
President Mark Wagar work phone: 212-476-1237 email: [email protected]
Lyn Houlihan Manager of Group Member Services-work number is: 518-367-6438 email: [email protected]
Kimbra Shelton direct work number: 706-985-2101 email: [email protected]
Jacklyn Williams Manager, Member Services Phone: 706.985.2018 email: [email protected]
Marketing Arden Buchanan [email protected]“
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doris says:
“with EMPIRE bc,bs. FROM MY EXPERIENCE, I made a big mistake when I choose this co. I am not Satisfy with them. I pay them a lot of money for what. Every year they go up on the Premium.
I agree with everything you people said. but believe me, they are going to be dropped like hot potatoes. next time I will do my research. who ever continue to use them. I wish them luck. I will neve recommend this co. I was warned but I didn’t listen.”
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Lyndsay says:
“Just wanted to say that empireblue.com is probably the WORST website EVER created. It’s so far beyond ridiculous, I can’t even find the right words to voice my frustration. I am pretty good with computers, so I know I’m not an idiot. They don’t even provide a link for feedback.
This site is NOT user-friendly (as it should be), and it’s constantly down (not working). What am I supposed to do now? I have to have surgery in the morning, and no one can get ahold of anyone to ask about coverage, and the freaking website is down!?! Thanks for the excellent service, guys!”
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Landy says:
“Worst customer service I have ever experienced! They make it almost impossible to get through to an actual person.
As a provider, the automated system doesn’t give you everything you need. Once finally figuring out how to get to the operator, she told me that she could NOT help me get to a person and the company took that option out in December.
Then I asked her what the purpose of an operator was if she couldn’t get me to the right person. That’s when she transferred me to , guess what, another automated system… That was the wrong department!!!
The person I actually spoke to there apologized for me being transferred to the wrong place and seems to be the only person of the day that seemed to be concerned with my ordeal. It has now been over an hour and I still do not have my insurance verified! WHY BCBS, WHY? DO YOU MAKE THINGS SO HARD??? CAN WE HAVE THE OPTION BACK TO SPEAK TO A PERSON??”
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Gloria E Torres says:
“This is the most incompetent insurance company I have ever dealt with.
Firstly, I agree with everyone on this site. I have been calling them all week to no avail. I am kept on hold for hours and then disconnected. I am so frustrated with the incompetence. I finally spoke to one person who gave me incorrect information regarding my dental coverage. I have the PPO 1 Plan which affords me to go in and out of network — the Enhanced Dental and Vision Plan.
I inquired as to the Dental Plan…..you can’t even imagine the maize on the website they sent me to. Empire tells me one thing and the Dental plan coordinators that I reached tell me something else. One says I can only go In-Network, the other says I can go In and Out-of-Network.
Forget about their website, either it is down or tells me I do not qualify for Vision, where I know I do, as it is on the ID card they sent me (which by the way I tried calling their dental and vision and no one is giving me the correct information. The whole darn system is a puzzle).
Where do they get these associates that answer the phone? I know I am not dealing with professionals. It is a horrible system run by incompetents!!!”
“I am very satisfied with my MediBlue Plan. At this time, however, the gym where I go for the Silver Sneakers Program is cutting the days down to ONE!! I do not drive & can walk to this gym. The instructor is fantastic but we need more days, not less.
Overall, your company is very good–they pay the doctors in a quick time & when I’ve had a question your people have been very helpful.
Thank you, Fostina”