How to choose your own provider in the WTC Health Program

You have a say. Most members do not know it.

Members outside the New York area receive care through the Nationwide Provider Network. When people first hear the word “network,” they picture a fixed list handed down from somewhere, and they take whatever name appears on it.

But members can nominate a provider to that network. If there is a clinician or an agency you want involved in your care, you can ask the Program to add them rather than working around their absence.

Why it matters more than it sounds.

For a clinic visit, the name on the door may not matter much. For care in your home it matters a great deal. Home care is a person in your kitchen several days a week, learning how you move, noticing when something has changed. Continuity is most of the value, and continuity comes from choosing rather than accepting.

A network you can add to is a different thing from a network you are assigned to. The difference is one phone call that almost nobody makes. 9/11 responders and survivors in Nevada →

How a nomination works.

1. Decide who you want. A local agency, a clinician you already trust, someone another member recommended.
2. Tell your Program contact you would like that provider added to the Nationwide Provider Network for your care.
3. The provider supplies what the Program asks for — licensure and the administrative paperwork that lets them be part of the network.
4. Care itself still needs the usual two things: your physician prescribes it, and the Program approves it for your certified condition.

Step three is the part members should never have to do themselves. Any competent agency will deal with its own paperwork. If a provider tells you the nomination is your job to figure out, that is a useful thing to learn early.

What to have ready.

• Your member information for the Program.
• Which of your conditions are certified — not just which ones you have. Certification is what care is approved against.
• The most recent order or note from your treating physician about the help you need at home.
• The name and contact details of the provider you want.

If you are not sure which of your conditions are certified, start there. It is the single most common gap, and it is fixable.

What a nomination does not do.

It does not certify a condition. It does not substitute for a physician’s order. It does not guarantee approval — the Program still decides what is medically necessary for a certified condition. Anyone who tells you otherwise is overselling.

What it does is put the choice of who back with you, once the what has been established through the Program’s own process.

If you want Alara.

Tell your Program contact you would like Alara Home Care in Las Vegas added, or call us first at (702) 814-9630 and we will do the paperwork with you. We are a Nevada-licensed, nurse-owned agency, and we are not affiliated with or endorsed by the Program — nominating us is a member’s choice to make, and being asked for is the only way we would want it.

If you want to talk to somebody who has no stake in that answer, ask us for the benefits mapping instead. It is free, it covers the doors that are not ours, and plenty of those calls end with us pointing somewhere else.

Where to start.

Find out what is certified, get a current order from your physician, then make the nomination call. If you would like a nurse to read the paperwork with you first, that conversation costs nothing.

Not sure what applies to your household at all? Start with a few questions about your history and your care.

Common questions.

Sources: CDC, World Trade Center Health Program.