FAQs

To protect your privacy, we will always ask you to provide three pieces of information to identify yourself. You can use any three of the following:

• Total member ID number
• First and last name
• Date of birth
• Full address
• Phone number
• New York Medicaid ID number

You may appoint a relative, friend, attorney, or anyone else whom you trust to act on your behalf. A representative who is appointed by the court or who is active in accordance with state law may also file an appeal or a grievance for you. To appoint a representative, you must complete an Appointment of Representative form.

To protect your privacy, we need your permission before we allow anyone else access to your health information. There are three ways that you can authorize a family member or friend to serve as your representative with access to information about your care and services.

1. Check your online account anytime at vnshealthplans.org/account or call us toll free at: 1-866-783-1444 (TTY: 711) with your authorized representative, and give verbal authorization. Your authorization will be valid for 14 days from the date of the call.
2. If you want someone to see all your information, you can download this Authorization for Release of Health Information Pursuant to HIPAA form (English, Spanish, Chinese). Fill out the form, and send it back to us for processing. Or call us, and we will mail you a form to fill out and return.
3. If you want to allow someone to see just some of your information, write a letter saying that you give your permission to that person to speak on your behalf. Tell us their name, their relationship to you, and the sort of information you are allowing them to see. Send the letter to us for processing at this address:
   VNS Health
   Health Plans – Care Team
   220 East 42nd Street
   New York, NY 10017

If your home address or other contact information changes, please call us. You will also need to notify your local department of social services of your new contact information. To find the number for your local office, visit the New York State Department of Social Services website.

If your new address is within our service area, your coverage will not be affected.

If you move outside of our service area, you may no longer be eligible for our plan, in which case you would be disenrolled. See the counties we serve.

If you need your services put on hold because you will not be at home — for example, if you go away on vacation or have to go into the hospital — please contact us. To suspend your home health aide services while you’re away, please contact the agency that provides your aide.

If you are dissatisfied with the quality of care you get from your aide, please contact their home care agency. If you are dissatisfied with the agency, please call us.

Some New Yorkers with monthly incomes above the Medicaid limit can be eligible for Medicaid in certain circumstances. The amount above the Medicaid level is called spenddown — also known as surplus or “excess income” — because it must be “spent down” in order to meet the income level requirement for Medicaid. You may receive a bill for this monthly amount, or it may be covered in some other way. Talk to your local social services department for more information. Or call us, and ask to speak with a Medicaid eligibility specialist.

There are a couple of ways to pay your Medicaid spenddown.

• One way is online through our partner, InstaMed. It is fast, easy, and secure. You can pick the way you want to pay (credit card, debit card, or bank account). You can also view your payment history and receipts, and set up automatic payments. Visit vnshealthplans.org/paybill on your phone, computer, or laptop to get started. For more details, check out the flyers below.
  • InstaMed Flyer (English)
  • InstaMed Flyer (Spanish)
  • InstaMed Flyer (Chinese)

• Or you can send us the payment by mail. When you receive a bill for your spenddown, a pre-paid envelope will be included with the statement. Use the envelope to mail us your payment. Include the payment stub from the statement so we can credit your account. If you no longer have the envelope, please use the address below.

If you have any questions about your spenddown, please call:
1-877-357-8544 (TTY: 711) Monday – Friday, 9 am – 4:30 pm.

If you have any questions about using InstaMed, please call:
1-877-357-8544 (TTY: 711) Monday – Friday, 9 am – 4:30 pm.

Use our online Provider Search tool. Or you can find a list of providers in the Provider & Pharmacy Directory. If you need help identifying a provider who meets your needs, you can also contact your Care Team.

Check your online account anytime at vnshealthplans.org/account or call us toll free at: 1-866-783-1444 (TTY: 711). If you have already chosen a new doctor, give our representative the doctor’s name. Once they confirm that the doctor is in our network, we’ll send you a new member ID card.

If you have not chosen a new doctor, you can find one using our online Provider Search tool.

If you have any questions or concerns about getting authorizations for medical services, check your online account anytime at vnshealthplans.org/account or call us toll free at: 1-866-783-1444 (TTY: 711).

Contact us. Please have the bill with you when you call, because we will ask for specific information found on the bill. We will work with you and your doctor to clarify the bill and determine whether you may be responsible for any charges.

From time to time, you may receive in the mail something from us called an Explanation of Benefits (EOB). This is a report for your records about the medical services and prescription medications your plan has paid for you. The EOB will also note whether you paid out of your own pocket or whether you owe anything for any services or medications.

The EOB is not a bill. It is purely for your information to help you understand how your medical costs are being covered during the year. 

If you notice any inaccuracies, or if you have other questions about your EOB, please talk to your Care Team.

Hospice and palliative care focus on improving quality of life for people with serious and terminal illnesses and are provided by health professionals who are expert in these types of care. Learn about how hospice and palliative care can help you and your family get the support and comfort you need.

You can check your balance online anytime at mybenefitscenter.com. Once on the site, you will be asked to enter your 19-digit OTC and Grocery Card number. On the next screen, you will be asked to enter your member ID number to log in and check your balance.

You can also check your balance by calling our partner, Convey at 1-855-858-5937 (TTY: 711) Monday – Friday, 8 am – 11 pm.

Yes. There are two ways you can order OTC items for home delivery.

• Order by phone – If you would like to place your order over the phone, call our partner Convey at 1-855-858-5937 (TTY: 711), Monday – Friday from 8 am to 11 pm EST. You will need to order from the Over-the-Counter (OTC) and Grocery Program Catalog and have your item number(s) ready when you call.
• Order Online – Visit mybenefitscenter.com. Have your Total member ID card ready and follow the simple instructions provided on the site.

Your items will be delivered at no cost to you and you generally can expect to receive your order in 5 to 7 business days. You do not need to use your full OTC and Grocery Card balance at one time, but remember that your OTC and Grocery Card balance does not carry over from month to month.

That’s great! Please tell them to call us at 1-855-216-8307 (TTY: 1-800-662-1220), Monday–Friday, 9 am–5 pm. The health plan advisor can answer questions about eligibility and explain the enrollment process. For general information about the plan, tell your friend to visit vnshealthplans.org.