CityMD accepts Medicaid in most locations, but coverage varies by state and specific clinic

CityMD is an urgent care chain with clinics across the Northeast and Mid-Atlantic. Most CityMD locations do accept Medicaid, but not all of them do, and the plans they accept depend on which state you are in and which Medicaid managed care plan covers you. Before you go to a CityMD clinic, you need to call ahead or check online to confirm that your specific Medicaid plan is accepted at that location.

The reason coverage varies is that Medicaid is run by each state, and within each state, multiple managed care organizations (MCOs) administer the benefit. CityMD may contract with some MCOs in a state but not others. A clinic ten miles away in a different county might accept your plan while the one nearest you does not.

Key Takeaways

  • CityMD locations in New York, New Jersey, Pennsylvania, and Connecticut generally accept Medicaid, but individual clinics may not accept all plans.
  • You must verify that your specific Medicaid managed care plan is accepted at the CityMD location you plan to visit before you go.
  • The easiest way to check is to call the clinic directly or use the CityMD website's plan search tool if available in your state.
  • If your plan is not accepted at CityMD, your state's Medicaid website or 211 can direct you to urgent care clinics that do accept it.

How to check if your Medicaid plan is accepted at a specific CityMD

Start by finding the CityMD location nearest you. Go to the CityMD website and enter your zip code or city. The site will show you all clinics in your area with their addresses and phone numbers.

Call the clinic directly and tell them the name of your Medicaid managed care plan. Ask whether they accept that plan. Write down the answer and the date you called. If the person on the phone is unsure, ask to speak with someone in billing or the front desk manager, who will have the most current information.

Some CityMD locations have a plan search tool on their website where you can enter your plan name and see which clinics accept it. This is faster than calling, but not all states have this feature yet. If your state's CityMD website has it, use it first.

What to bring when you visit CityMD with Medicaid

Bring your Medicaid card or the member ID number from your plan. CityMD will need this to bill your plan. If you do not have your card, bring a photo ID and the name of your Medicaid managed care plan, and the clinic can look up your information.

Bring any paperwork related to why you are visiting — a referral from your primary care doctor if you have one, or notes about your symptoms or injury. CityMD is an urgent care clinic, so they handle acute problems like infections, sprains, and minor injuries, not ongoing treatment.

What CityMD covers under Medicaid

CityMD visits are covered under Medicaid as urgent care. This means the visit itself is covered, and basic lab work or X-rays done on-site are usually covered. However, your Medicaid plan may require you to pay a copay at the time of the visit. Copays for urgent care visits typically range from $0 to $10, depending on your plan.

If CityMD refers you to a hospital or specialist, that referral is separate from your urgent care visit. Your plan will cover the referral under the same terms it covers other specialist visits, which may include a copay or coinsurance.

Prescription medications that CityMD writes for you are covered under your Medicaid plan's pharmacy benefit, not by CityMD itself. Your copay for the medication depends on your plan's formulary and whether the drug is generic or brand-name.

If your Medicaid plan is not accepted at CityMD

If the CityMD location you want to use does not accept your plan, you have two options: find a different urgent care clinic that does accept your plan, or ask CityMD whether they can refer you to an in-network provider.

To find an urgent care clinic that accepts your plan, go to your Medicaid managed care plan's website and use their provider search tool. Enter "urgent care" as the service type and your zip code. The search will show you all urgent care clinics in your area that are in your plan's network.

You can also call your plan's member services line — the number is on the back of your Medicaid card — and ask them to tell you which urgent care clinics near you accept your plan. They can often give you addresses and phone numbers right away.

CityMD and Medicaid in different states

CityMD operates in New York, New Jersey, Pennsylvania, and Connecticut. In each state, Medicaid is administered differently and managed by different organizations. New York has the most CityMD locations and generally the broadest Medicaid acceptance, but this is not may provide at every clinic.

If you are moving to a different state or traveling, check whether there is a CityMD in that state and whether it accepts Medicaid there. A plan that is accepted in New York may not be accepted in New Jersey, even if it is the same managed care organization, because each state has separate contracts.

What to do if CityMD denies your Medicaid claim

If you went to CityMD with your Medicaid card, the clinic billed your plan, and your plan denied the claim, you will receive a notice in the mail explaining why. Common reasons include: the clinic is not in your plan's network, your plan required a referral that you did not have, or the visit was deemed not medically necessary.

If you believe the denial is wrong, call your Medicaid managed care plan's member services line and ask them to review the claim. Have the denial notice in front of you when you call. If the plan denies your appeal, you can file a formal grievance with your state's Medicaid office. The denial notice will tell you how to do this.

If CityMD billed you directly because they said your plan was not accepted, but you believe it should have been, contact CityMD's billing department and ask them to resubmit the claim to your plan. Keep a copy of any paperwork they give you.

Frequently Asked Questions

Can I use CityMD for my child's Medicaid?

Yes, CityMD accepts Medicaid for children in states where they operate. Bring your child's Medicaid card and a photo ID. Call ahead to confirm that the location accepts your child's specific plan, because pediatric coverage can sometimes differ from adult coverage within the same plan.

Does CityMD accept emergency Medicaid?

CityMD is an urgent care clinic, not an emergency room, so they do not handle true emergencies. If you have a life-threatening condition, go to a hospital emergency room. Emergency Medicaid covers emergency room visits. CityMD handles urgent but non-emergency problems like minor injuries and infections.

What if I don't have my Medicaid card with me?

Bring a photo ID and tell CityMD the name of your Medicaid managed care plan. The clinic can look up your member ID number in their system. If they cannot find you, they may ask you to call your plan's member services line from the clinic to confirm your coverage before they see you.

Will CityMD bill my Medicaid plan directly?

Yes, if your plan is accepted at that location, CityMD will bill your plan directly. You will pay any copay required by your plan at the time of the visit. You should not receive a bill from CityMD after the visit unless there is a claim denial or a service not covered by Medicaid.

Can I use CityMD for a follow-up visit after the emergency room?

Yes, CityMD can provide follow-up care for conditions treated in the emergency room, as long as your Medicaid plan accepts CityMD. However, your primary care doctor or the emergency room may have referred you to a specific clinic or specialist for follow-up. Check your discharge paperwork to see whether you are required to go to a particular provider.