POMCO

POMCO is not an insurance company. It is the company your employer hired to run your health plan. If your ID card says POMCO, here is what that means for you.

Your employer designed a health plan and picked POMCO to process the claims, manage the network, and handle the paperwork. This is called a self-funded plan. The benefits are set by your employer, not by POMCO. That means your coworker at a different company could also have a POMCO card but have completely different coverage.

Moses Medical at 871B Westchester Ave in the Bronx is in-network for POMCO-administered plans. Our billing team checks your specific employer plan before each visit so you know what you owe up front.

Services POMCO Plans Typically Cover

Because every employer designs their own plan, the word “typically” matters here. Most POMCO plans we see cover the following:

• Primary care for physicals, sick visits, vaccinations, and chronic disease management
• Internal medicine for conditions like diabetes, hypertension, and cholesterol issues
• Cardiology for heart health evaluations and cardiovascular screening
• Dermatology for skin exams, rashes, eczema, and psoriasis
• Behavioral health for therapy, counseling, and psychiatric care
• Pain management for chronic pain, back problems, and joint inflammation
• Podiatry for foot conditions, plantar fasciitis, bunions, and diabetic foot care
• Women’s health for annual gyn exams, cervical screenings, and reproductive care
• Lab services for blood draws and diagnostic testing, done on-site
• Radiology for X-rays and imaging

We verify which of these your specific plan covers before your appointment. No surprises.

Verifying Your Employer Plan

POMCO plans vary more than most insurance. Two people with POMCO cards can have very different benefits depending on their employer. Here is how to confirm yours:

1. Find your POMCO ID card. It has your member ID, group number, and network information. If you lost your card, your employer’s HR department or POMCO at 1-800-272-7906 can get you a replacement.
2. Call us to confirm network status. POMCO works with several provider networks. Call (646) 741-2111 and give us your group number. We will verify that Moses Medical is in-network under your specific employer plan.
3. Check your plan rules. Some POMCO plans require a PCP designation and specialist referrals. Others let you go directly to a specialist. Your plan documents spell this out. If you do not have them, ask your HR department.
4. Bring your card and a photo ID. At check-in, we run your eligibility in real time and tell you your copay or coinsurance before you see the doctor.

Making the Most of a Self-Funded Plan

Self-funded plans can be generous. They can also have unusual rules because each employer makes their own choices. A few things to keep in mind:

Your HR department is your best resource. They chose this plan and they have the summary of benefits document. That document lists exactly what is covered, what requires prior authorization, and what your cost-sharing looks like. If you have never read it, ask HR for a copy.

Preventive care is almost always covered at 100%. Federal law requires most employer plans to cover annual physicals, routine lab work, and age-appropriate screenings with no cost to you. This applies even to self-funded plans.

Stay in-network. The biggest billing surprises happen when patients go out-of-network without realizing it. At Moses Medical, your primary care, specialists, labs, and radiology are all in one in-network location.

Ask about prior authorization. Some employer plans require approval before certain services. Our staff handles authorization requests, but it helps to know in advance so we can start the process early.

Questions about your POMCO plan? Ask your HR department for your benefits summary, then call us at (646) 741-2111 to schedule.