For Members

Benefits Updates

Durable Medical Equipment, Prosthetic, Orthotics, and Supplies (DMEPOS) Medical Supply Quantity Update

• This DME Medical Supplies Monthly Quantity Update for urinary catheter with insertion supplies (A4353) are effective for dates of service beginning March 1, 2022.
  • The DME Procedure Code Manual has been updated for June 1, 2022. Any changes reflected in the manual are effective for dates of service beginning June 1, 2022. 
• Changes include update to the maximum monthly amounts for reusable incontinence protective underpad (T4537) and reusable incontinence protective chair underpad (T4540).

Network Provider

Use our simple online provider search tool

**We are aware of an issue that some providers who are not in-network or within our service area are showing up in our online provider search tool.  You may view/download an up-to date Provider Directory below, or please call us at 1-800-469-6292 (TTY 711) for assistance.  We are currently working with our partners to resolve this issue, and we thank you for your patience during this time.**

The VillageCareMAX Provider Directory, which can be downloaded in pdf by clicking on the link below, provides a list of our participating providers in Manhattan, Brooklyn, Bronx and Queens. You can view the directory in English, Chinese, Spanish and Russian by scrolling through the document.

VillageCareMAX­ Provider Directory (PDF, 9.8 MB)

This directory is current as of October 29, 2024. Some participating providers may have been added or removed from the list after this directory was printed. To get the most up-to-date information about VillageCareMAX participating providers in your area, please call our Member Services Department at 1-800-469-6292 (TTY: 711), 7 days a week from 8:00 AM through 8:00 PM. TTY users should call 711.

Dental Providers

Click here to search for a dental provider near you

Member Rights and Responsibilities 

Member Rights

• You have the Right to receive medically necessary care.
• You have the Right to timely access to care and services.
• You have the Right to privacy about your medical record and when you get treatment.
• You have the Right to get information on available treatment options and alternatives presented in a manner and language you understand.
• You have the Right to get information in a language you understand; you can get oral translation services free of charge.
• You have the Right to get information necessary to give informed consent before the start of treatment.
• You have the Right to be treated with respect and dignity.
• You have the Right to get a copy of your medical records and ask that the records be amended and corrected.
• You have the Right to take part in decisions about your health care, including the right to refuse treatment.
• You have the Right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation.
• You have the Right to get care without regard to sex, race, health status, color, age, national origin, sexual orientation, marital status or religion.
• You have the Right to be advised of where, when and how to get the services you need from VillageCareMAX, including how you can get benefits from out-of-network providers.
• You have the Right to complain to the New York State Department of Health or your local Department of Social Services, the right to use the New York State Fair Hearing System and the right to use the New York State External Appeals Program.
• You have the Right to appoint someone to speak for you about your care and treatment,
• You have the Right to make advance directives and plans about your care. You will receive written information on advance directives including a description of the applicable State Law.
• You have the Right to receive assistance in completing a health care proxy form and to ensure that your advanced directives are carried out.
• You have the Right to begin disenrollment from VillageCareMAX at any time.
• You have the Right to assist in the development and evaluation of new and existing programs and policies.
• You have the Right to choose your primary care physician.
   

Member Responsibilities

As a Member of VillageCareMAX you have the following responsibilities:

• Accept services without regard to the race, color religion, age, sex, national origin or disability of the caregiver.
• Obtain prior authorization for services and treatments provided by VillageCareMAX from your physician, nurse care manager and Member Services (emergency services do not require prior approval).
• When applicable, make payment to VillageCareMAX of any “spend-down” monies as identified by the New York City Human Resources Administration (HRA).
• Keep appointments or notify the program if an appointment cannot be kept.
• Supply accurate and complete information to caregivers.
• Participate in the development and updating of your care plan.
• Request further information from your nurse care manager regarding anything you do not understand.
• Assist in developing and maintaining a safe environment.
• Comply with all requirements of VillageCareMAX as noted in the Member Handbook.
• Obtain services within the VillageCareMAX Network Provider list when necessary.
• Participate in questionnaires, surveys and focus groups to enhance our quality of service regarding the Plan and its program.
   

What is a Complaint?

A complaint is any communication by you to us of dissatisfaction about the care and treatment you receive from our staff or providers of covered services. For example, if someone was rude to you or you do not like the quality of care or services you have received from us, you can file a complaint with us.

To file a complaint or to appeal a plan action, please call: 1-800-469-6292 (TTY: 711) or fax us at: 1-347-226-5180. When you contact us, you will need to give us your name, address, telephone number and the details of the problem.

Or write to:

VillageCareMAX
Quality Assurance Department
112 Charles St. 
New York, NY 10014