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Empire’s surgical site of care clinical guideline for coverage purposes began on January 1, 2021. Learn more about it and what it means for you.

May 05, 2021

We know you want healthcare to be effective, efficient and affordable. That is why we’ve created broad networks with various quality providers and multiple options to receive care – at the most appropriate (i.e., medically necessary) site of care for routine, non-urgent procedures. This is particularly important now during a pandemic, with notable infection rates and other concerns and lack of efficiencies that lead individuals (past and present) to frequently seek routine care and procedures in accredited non-hospital settings.

Empire’s surgical site of care clinical guideline reviews where you receive care for coverage purposes. That review helps determine if it is medically necessary for you to have a procedure done in a hospital setting or if it could be done in another accredited site of care, such as an ambulatory surgery center or an office-based setting, like your doctor’s office, which are effective, efficient and many times easier/less impactful on your co-pays and deductibles.

Places like accredited ambulatory surgery centers and office-based settings provide safe and more comfortable options to perform certain non-urgent surgeries, diagnostic and preventive screenings, and other routine procedures; importantly, these options provide you with convenience, affordability and greater choice and flexibility in scheduling.

Empire will authorize coverage for requested care at an accredited ambulatory surgery center or certain office-based setting if it is not medically necessary to provide the service in a hospital.