Important update regarding Saint Michael's Medical Center
Effective August 31, 2016, St. Michael's Medical Center is no longer in AmeriHealth New Jersey's network. Here are a few things you will need to consider:
- Request a continuity of care exception. If you are in active treatment with a SMMC provider and it is medically required to continue to receive care after the agreement ends, either you or the provider will need to request a continuity of care exception. To request a continuity of care exception, call Customer Service at 1-888-YOUR-AH1 (1-888-968-7241).
- Exercise the out-of-network option. If you are an AmeriHealth New Jersey PPO member, you may continue to use SMMC providers with out-of-network coverage, but will be subject to higher out-of-pocket costs.
- Emergency services will be covered. Emergency services by SMMC and its providers will continue to be covered as outlined in your benefit plan.
- Elective Care. If you need elective care at SMMC after August 31, 2016, you will need to go to another facility that is in the AmeriHealth New Jersey network. You will need an appropriate referral from your primary care provider (PCP) if you are a HMO or HMO-POS member and obtain authorization by AmeriHealth New Jersey. If you do not have out of network benefits, you will need to go to a participating provider in our network and obtain a precertification from AmeriHealth New Jersey, where required if you want that care covered at the highest level under your in-network benefits. Other AmeriHealth New Jersey in-network facilities in the affected area include:
- University Hospital - Newark
- Newark Beth Israel Medical Center - Newark
- East Orange General Hospital - East Orange
- Clara Maass Medical Center - Belleville
- Hackensack UMC Mountainside Hospital - Montclair
- Saint Barnabas Medical Center - Livingston
If you have any questions, please contact Customer Service at 1-888-YOUR-AH1 (1-888-968-7241).