Frequently Asked Questions
How do I get help if I need health care after my primary care provider’s (PCP) office closes?
Call your PCP for advice on how to get urgent care. The number is listed on your member ID card. You can call our Member Services department at 1-800-300-8181 (TTY 711) or our 24/7 NurseLine at the same number.
My provider says I need to see a specialist. How do I set up an appointment with the specialist?
Your PCP will refer you to a specialist. If you need specialist services that you can’t get from a doctor in the Empire network, we will work with your PCP to refer you to an out-of-network specialist.
My plan has dental benefits. How do I choose a dentist?
If you need to find a dentist or change your dentist, please call Healthplex toll free at 1-800-468-9868 (TTY 1-800-662-1220) Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 9 a.m. to 5 p.m. You can also call the Member Services department at 1-800-300-8181 (TTY 711). When you visit your dentist, you should show your plan ID card.
How do I get a copy of the Empire provider directory?
You can call the Member Services department at 1-800-300-8181 (TTY 711) and request one. You can also download a free mobile app and search for Empire on your Android or iPhone. Then simply enter the name of your PCP.
How do I see a doctor who is not in the Empire network?
Please call the Member Services department at 1-800-300-8181 (TTY 711) Monday through Friday from 8 a.m. to 8 p.m. and Saturday from 9 a.m. to 5 p.m. with questions.
How can I find out what pharmacies are in the Empire network?
You can look in your new member enrollment package for a list of pharmacies in our network, or you can search our list of network pharmacies. You can also call Member Services at 1-800-300-8181 (TTY 711) or ask your local pharmacy for help.
Are over-the-counter (OTC) products covered, and do I need a prescription?
We cover many OTC products, including pain relievers, antacids, contraceptives and some vitamins. All OTC products require a written prescription from your doctor and can be filled at any network pharmacy.
How does my doctor request prior authorization?
Your doctor can request prior authorization on medicines by calling our Pharmacy department at 1-800-450-8753.
How do I get my medicine if I am traveling?
We have network pharmacies in all 50 states. Most chain pharmacies as well as many independent and grocery store pharmacies participate. If you need a refill while on vacation, contact your doctor for a new prescription to take with you or fax it to the closest network pharmacy where you are.
What happens if my medicines are lost or stolen?
If your medicines are lost or stolen, you should contact your doctor to authorize the pharmacy to refill your prescription early. The pharmacy may have to contact us for prior approval. Replacement of lost or stolen medicines will be reviewed on a case-by-case basis.
What if I paid out of pocket for a medicine and want to be reimbursed?
If you had to pay for a medicine, you may submit a request for reimbursement. You’ll need to mail a completed reimbursement request form along with any receipts to:
P.O. Box 14711
Lexington, KY 40512
Will I be able to receive my enteral nutrition, diapers and medical supplies through a pharmacy?
Enteral nutrition, diapers and durable medical equipment can be obtained through your Durable Medical Equipment (DME) benefit. Some medical supplies can be obtained from your local pharmacy, like bandages, insulin syringes and diabetic glucose test strips.