Patient Advocates for Highmark Blue Shield of Northeastern New York - Find one today.
Supporting and empowering Highmark Blue Shield of Northeastern New York patients.
Highmark Blue Shield of Northeastern New York serves a 13-county region including Albany, but navigating their complex authorization requirements and appeal process can be overwhelming, especially with recent transitions following Highmark's acquisition of the plan. Your Solace advocate understands Highmark's evolving policies inside and out—from securing prior authorizations to appealing denied claims and coordinating care between specialists across Northeastern New York's diverse geography. They'll handle the paperwork, follow-ups, and persistent phone calls so you can focus on your health instead of battling insurance bureaucracy.
Best of all, most patients pay nothing out of pocket.
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About
Highmark Western and Northeastern New York Inc., doing business as Highmark Blue Shield of Northeastern New York, is an independent licensee of the Blue Cross Blue Shield Association serving a 13-county region in Northeastern New York that includes Albany, Clinton, Columbia, Essex, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington counties. As a relatively recent addition to the Highmark family, the plan continues to integrate with Highmark's systems while maintaining specific regional requirements for claims submission and provider networks. Members often face challenges navigating the complex transition period, with some claims still being processed through previous administrative systems depending on the member's location within the service area. Their claim processing system requires claims to be submitted within 365 days from the date of service, with different procedures for electronic versus paper claims, creating additional hurdles for members seeking resolution for denied claims or delayed authorizations.
What problems can a Highmark Blue Shield of Northeastern New York patient advocate help you with?
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Get the clarity you need to make sense of your care and take charge of your health.
We’ll make the calls (and the callbacks) so you can spend more time doing what you love.
Keep your care affordable with lower medical bills and access to local financial help.
Advocates review coverage, handle preauthorizations, and even help with appeals.
Stay on top of the cutting-edge treatment options and leave no stone unturned.
Advocates coordinate your care team so your health never falls through the cracks.
Get the tools and answers you need to make informed decisions about your care.
Advocates help you overcome your healthcare hurdles—no matter how big they might be.
Solace has helped over 14,000 patients and families
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05/01/2024
Stephen I.
04/27/2024
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07/27/2024
Highmark Blue Shield of Northeastern New York Appeals with a Patient Advocate
Highmark Blue Shield of Northeastern New York's appeal process involves multiple stages that can be challenging to navigate alone, especially during the ongoing transition period following Highmark's acquisition. Your Solace advocate knows how to prepare comprehensive appeals that include all necessary documentation, proper coding references, and address Highmark's specific coverage criteria. They'll track deadlines, follow up persistently, and guide you through each stage from internal review to external review if necessary.
When facing a denial, your advocate will immediately identify whether the issue stems from missing documentation, coding errors, network limitations, or medical necessity determinations. They'll work with your healthcare providers to gather supporting evidence and may coordinate peer-to-peer reviews between your doctor and Highmark's medical directors. They also understand the unique challenges of coordinating care in certain counties where claims may still be processed through previous systems like Empire/Anthem or Excellus for specific members. For Medicare Advantage members, they know how to navigate the requirements for expedited reviews when your health requires a quick response, ensuring you receive timely resolution during a period of administrative transition.
Northeastern New York's healthcare landscape combined with Highmark's evolving integration creates a particularly complex system that a Solace advocate is uniquely qualified to help you navigate.
The Solace care team model
With Solace, you get both a patient advocate and a supporting physician, which we refer to as your “care team”.
Your advocate will be there to manage the day to day aspects of your care: coordinating with doctors, researching potential solutions and communicating updates to you.
Your supporting physician can unlock resources for you and your advocate that might otherwise be out of reach.
We’ve Got Answers
Still unsure how an advocate can help? Explore these answers to the questions we’re asked the most.
How are Solace advocates qualified to help?
Advocates on Solace are experienced physicians, nurses, pharmacists, and other healthcare professionals from a wide range of backgrounds. 98% of Solace patients report better healthcare outcomes after working with an advocate.
What else can a Solace advocate help me with?
What can a Solace advocate not do?
We know our advocates sound like miracle workers, but they have limits. They can’t prescribe medications or diagnose an illness, for instance. They can’t replace your doctor, but they can break down the barriers standing between you and the quality care you deserve.