Empire Blue Cross PPO plans may require prior authorization for partial hospitalization (PHP), depending on the member’s specific plan. Empire BlueCross is now branded as Anthem Blue Cross in New York. Trinity Behavioral Health accepts Empire Blue Cross insurance, but not every plan automatically covers PHP.
Before admission, verify the specific Empire PPO benefits.
Can prior authorization be required for PHP?
Yes. Anthem New York’s current resources state that certain behavioral-health services require prior authorization. The exact rule depends on the plan and service.
What is PHP?
Partial hospitalization is an intensive level of care delivered during the day without an overnight residential stay. Trinity offers a PHP / day treatment program.
How does medical necessity affect approval?
The plan may review clinical information to determine whether PHP meets applicable criteria. Having behavioral-health benefits does not guarantee approval for every level of care.
What should I verify?
- Active eligibility
- PHP benefits
- Network status
- Prior authorization
- Deductible and coinsurance
- Utilization-review requirements
See the Empire Blue Cross PPO rehab overview.
Verify Your Empire PPO PHP Benefits
Authoritative resources
- Anthem New York — Prior Authorization Requirements
- Anthem New York — Behavioral Health
- Anthem New York — Empire Name Change Information
- SAMHSA — Know What Your Insurance Covers
Exact benefits vary by plan and should be verified directly.