Member Questions

If you require non-emergency services you should contact your Primary Care Physician and your doctor will tell you what to do. In some cases, your doctor may ask you to come to the office for an appointment. In other cases, depending on the time of day and type of problem, your doctor may direct you to an Urgent Care Clinic, Emergency Room or Walk-In Clinic.

In order for you to see a specialist you must first get an approval- called a Referral- from your PCP.

Your PCP’s office contacts Monroe Plan’s Provider Services department when a referral is made. We will load the referral into the computer system. This will allow your bills to be paid.

Hospital admissions and some surgical procedures must be prior approved by Monroe Plan. Please contact member services for details.

If you are a Blue Choice Option, HMO Blue Option or a Family Health Plus member you may self refer for 1 Mental Health visit a year. After that, you must get a referral from your PCP. If you are in Child Health Plus you must get a referral from your PCP before you see a Mental Health Provider.

Transportation is currently a benefit for Blue Choice Option and HMO Blue Option members only. Monroe Plan currently assists Monroe County members only with transportation. Members from all other counties must contact your Local Department of Social Services for transportation assistance.

Currently Family Health Plus is the only program requiring members to pay a co-pay.

Under New York State Department of Health regulations a provider can not deny services to a member who is unable to pay their co-pay. However, you will still owe the doctor the co-payment and the doctor may bill you and send you to collection for failure to pay.

You should call the Monroe Plan Member Services department at 585.244.5550 or 800.724.4658 when ever you want to change your PCP. If you have an appointment arranged with a new doctor you should call us before you see the doctor.