Frequently Asked Questions
VNSNY CHOICE Total (HMO D-SNP) members often ask these questions about benefits and services. If you don’t see an answer to a question you have here, please call us. We’re here to help!
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:
- CHOICE Total 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 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 private 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 with VNSNY CHOICE.
- Call us at 1-866-783-1444 (TTY for the hearing impaired: 711) with your authorized representative and give verbal authorization. Your authorization will be valid for 14 days from the date of the call. For your protection, we do not allow others to see your information without your permission. There are three ways you can give others permission to see information about your care and services with VNSNY CHOICE Total.
- If you want someone to see all your information, you can download this Authorization for Release of Health Information Pursuant to HIPAA (English, Spanish, Chinese). Then, 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.
- 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 this letter to us for processing at this address:
VNSNY CHOICE Total
220 East 42nd Street, 3rd Floor
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, go to this webpage: https://www.health.ny.gov/health_care/medicaid/ldss.htm.
If your new address is within the CHOICE Total service area, your coverage will not be affected. Our service area covers the following counties:
- The Bronx
- Kings (Brooklyn)
- New York (Manhattan)
- Richmond (Staten Island)
If you move outside of this service area, you may no longer be eligible for our plan, in which case you would be disenrolled.
Use our online Provider Search tool. Or you can find a list of providers in the CHOICE Total Provider & Pharmacy Directory. If you need help identifying a provider who meets your needs, you can also contact your CHOICE Total Care Team.
Call us. 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 ID card.
If you have not chosen a new doctor, you can find one using our Provider Search tool, or call us and we will help you find one in our network.
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.
Contact us. Please have the bill with you when you call, as 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 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.
You can check your balance online anytime at www.otcnetwork.com/Member. 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 VNSNY CHOICE Total Member ID Number to log in and check your balance.
You can also check the balance of your OTC and Grocery Card by calling us.
No, you don’t, but you do need to activate the card. Follow the instructions on the information you received with the card, or if you need help, call your Care Team.
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.
If you have limited income and resources that don’t automatically qualify you for LIS (also known as Extra Help), you will need to apply for this subsidy and have your eligibility determined by either the Social Security Administration (SSA) or the New York State Department of Health.
For questions about Extra Help with your prescription drug costs or if you need assistance completing the application:
- Call the Social Security Administration (SSA) at 1-800-772-1213 (TTY: 1-800-325-0778) 7 days a week, 8 am – 8 pm.
- You can also fill out the application on www.socialsecurity.gov.