Members Frequently Asked Questions (FAQs)

Members enrolled in the World Trade Center (WTC) Health Program Nationwide Provider Network have access to a network of providers across the United States and its territories. Nationwide Provider Network providers are available to provide routine and specialized care for certified conditions as well as Initial Health Evaluations (IHEs) and Annual Monitoring Examinations (AMEs).

If you are not a WTC Health Program member and are interested, learn more about Program eligibility and how to apply.

If you have any questions that are not answered on this page, the Nationwide Provider Network is here to help. You can reach the Nationwide Provider Network at 1-800-416-2898 or through the Nationwide Provider Network Member Portal chat feature, 8 a.m.-8 p.m. EST Monday through Friday.

Clinical Centers of Excellence are specialized clinics located in and around the New York metropolitan area. Members who live outside this area have access to providers within their local community through the Nationwide Provider Network. Providers in both the Clinical Centers of Excellence and Nationwide Provider Network are equally educated and licensed to provide care. You can find more information on where the Program provides care on the WTC website.

In-network providers enrolled in the Nationwide Provider Network and have agreed to Program policies including not charging members co-pays, deductibles, or other fees. Care provided by in-network providers for approved conditions is covered by the Program. Member’s do not pay any out-of-pocket cost for this covered WTC-related care.

Out-of-network providers not enrolled in the Nationwide Provider Network have not agreed to Program policies. Care provided by out-of-network providers is not covered by the Program and you would need to pay out-of-pocket or use other health insurance.

Please contact Nationwide Provider Network Member Services at 1-800-416-2898 for assistance in finding an in-network provider and check the network status of any other providers you see. For more information on finding providers and scheduling appointments, see section below.

IMPORTANT: Do not use a provider search tool from the health networks that make up the MCA-Sedgwick network (e.g., First Health, Aetna, Prime Health Services). These tools are not customized to find Program providers and will not accurately present providers available to you through the Nationwide Provider Network.

The Nationwide Provider Network has a provider recruiting team who is happy to reach out to any providers Program members currently see. If your provider is not enrolled in the Nationwide Provider Network, you can nominate your provider to join and a Nationwide Provider Network  representative will reach out to that provider. We will work to enroll this provider into the Nationwide Provider Network, if possible.

Please be aware that this process can take several months and is not guaranteed. Additionally, a provider may choose not to participate in the WTC Health Program Nationwide Provider Network.  If a provider is unwilling or unable to enroll in the Nationwide Provider Network, and your care can be covered by the Program, you will need to transition that care to an in-network provider for it to be covered by the Program. If you continue to see out-of-network providers, you will need to use other health insurance or pay out-of-pocket for any care received from them.

No action is needed if your current provider is already in network. You may continue to see them as usual. Just make sure that you let your provider know that you are a member of the WTC Health Program and any care for your certified World Trade Center (WTC)-related health condition(s) should be billed to the Nationwide Provider Network, once all other billing requirements have been met.

If you are currently seeing an out-of-network provider, you will need to transition to an in-network provider for WTC-related care to be covered by the Program.  In some rare cases, exceptions can be made for members with complex medical needs to see out-of-network providers. These exceptions are uncommon and only when medical needs cannot be met by providers enrolled in the network.

To discuss your care needs and find in-network providers in your area, contact the Nationwide Provider Network.

Responders and Survivors in the World Trade Center (WTC) Health Program Nationwide Provider Network have access to care related to their certified conditions, initial health evaluation, annual monitoring examinations (when applicable), and diagnostic testing.

Not sure when the Nationwide Provider Network needs to make an appointment for your World Trade Center (WTC)-related care or when you can make one on your own? The guidance below is for members in the Nationwide Provider Network looking to schedule new or ongoing appointments with a World Trade Center (WTC) Health Program provider.

First appointment with a provider?

• It is very important that the Nationwide Provider Network schedule initial appointments. This makes sure that all bills are properly sent to the Nationwide Provider Network, and you do not receive a bill. Scheduling your own initial care may cause you to be billed for services instead of the Nationwide Provider Network.
• As always, if you need to contact the Nationwide Provider Network with questions on how to schedule an appointment, please call Nationwide Provider Network Member Services at 1-800-416-2898 (Mon – Fri, 8am to 8pm ET).

Who makes the appointment?

The Nationwide Provider Network.

The Nationwide Provider Network will contact you after enrollment to help you schedule your Initial Health Evaluation (IHE) and any additional care you may need. For newly enrolled Responders, the IHE is the same as your first monitoring exam.

Who makes the appointment?

The Nationwide Provider Network.

The Nationwide Provider Network will contact you directly to schedule these appointments. You may also call the Nationwide Provider Network for assistance.

Please do not attempt to schedule your own AME, even if you are seeing a provider you have previously seen. The Nationwide Provider Network must ensure the provider is prepared to provide any testing you need, and that they send the NPN copies of the results afterwards. The results are used to identify any diagnostic testing or certifications you may need.

Who makes the appointment?

The Nationwide Provider Network.

• The Nationwide Provider Network will contact you to transition your care to new in-network providers in your area. Please do not attempt to establish care with a new provider until you have spoken with the Nationwide Provider Network.
• Why do you have to speak with us? We must make sure that the provider(s) is in network. We may also need to send your medical records to that provider(s) along with important NPN information before you can see that provider.

Who makes the appointment?

The Nationwide Provider Network.

• If you need to see a new provider for any reason, including a new certification, referral to a specialist, need for additional diagnostics, moving to a new area, or dissatisfaction with a previous provider, please contact the Nationwide Provider Network for assistance. The Nationwide Provider Network will assist you with locating an in-network provider in your area and scheduling your first appointment.

Who makes the appointment?

You do (or the Nationwide Provider Network can help).

• If you are already seeing an in-network provider for World Trade Center-related care, you may schedule follow up appointments on your own, directly with the provider. If you would like assistance doing this, you may contact the Nationwide Provider Network.

Who makes the appointment?

Contact the Nationwide Provider Network first.

• If you are unsure whether your provider is in network or out of network, please contact the Nationwide Provider Network for confirmation. If your provider is out of network, our team will assist you to transition your care to an in-network provider. We will also let you know at that point if you can schedule the appointment directly or if we need to do it.

REMEMBER! If you need to contact the Nationwide Provider Network for one of the situations above or for other needs, please call Nationwide Provider Network Member Services at 1-800-416-2898 (Mon – Fri, 8am to 8pm ET). If you do self-schedule an appointment, please contact the Nationwide Provider Network as soon as possible so that we can confirm your provider is in network.

All newly enrolled Responders and Survivors are eligible for an initial health evaluation (IHE) once they are assigned to the World Trade Center (WTC) Health Program Nationwide Provider Network. The IHE is a medical exam used to determine if you have any illnesses or conditions that may be related to your exposure at 9/11 and may be eligible for treatment under the Program. IHEs are provided at no cost to you and include a medical and exposure history, a physical examination and additional medical testing as needed.

After enrolling in the Program and being assigned to the Nationwide Provider Network, a Nationwide Provider Network Member Services representative will call you to welcome you to the Program. You will also receive a welcome packet with additional information and, if you are a Responder, an Nationwide Provider Network ID card. During your welcome phone call, the representative will begin the process to prepare you for your IHE.

Before the Nationwide Provider Network can schedule your IHE, you will need to complete required forms:

• Exposure Questionnaire
• Medical Health Questionnaire

You can complete these forms online through the member portal, or the representative can schedule a time to assist you in completing the forms over the phone. Once you complete any forms required, a representative will prepare a summary for your Initial Health Evaluation provider. This will help guide your provider during the examination.

After your forms are completed, a representative will call you to schedule your appointment with an in-network provider near you. Please do not attempt to make this appointment yourself.

You should prepare for your Initial Health Evaluation appointment in the following ways:

1. Confirm appointment details (date, time, location of your provider, directions, and travel time).
2. Follow any instructions from the provider before your appointment, such as fasting or changing your medication schedule.
3. Complete any paperwork provided by the Nationwide Provider Network prior to your first visit.
4. Write down a list of any medications you are currently taking and take the list with you to your appointment.
5. Write down a list of symptoms you are experiencing, even those that you think might not be related to your 9/11 exposures. Symptoms may include trouble sleeping, persistent cough, runny nose, etc.

*Keep in mind that an Initial Health Evaluation usually takes longer than a routine check-up, so please plan your time accordingly.

Your Initial Health Evaluation may be like physical examinations you have had in the past. The exam may include:

• Physical assessment
• Laboratory test and/or bloodwork (Blood counts (CBC), metabolic panel (electrolytes, kidney function, and sometimes liver function), cholesterol, and a urine test are what the WTC Health Program authorizes at your physical)
• Pulmonary function testing
• Chest X-ray
• EKG

During the exam, be sure to share any concerns you have with the provider including any recent symptoms you have experienced. This is your opportunity to ask questions and talk through your conditions.

The Nationwide Provider Network will send you a letter that summarizes your results and what, if any, conditions may be eligible to be certified, what conditions require further testing or medical documentation as recommended by your provider, and what conditions are not WTC-related, but should be discussed with your personal provider.

The Annual monitoring examination (AME) is available to Responders and Survivors with a certified WTC-related health condition. The Annual Monitoring Examination looks for World Trade Center (WTC)-related physical and mental health conditions. Findings help determine whether a member has a condition that can be certified (approved) for treatment in the WTC Health Program. Like other WTC-related health care from in-network Program providers, the AME is provided at no cost to you.

A Nationwide Provider Network (NPN) Member Services representative will call you to schedule your next annual exam. It is important that the NPN schedule this appointment to be sure it is completed per Program guidelines and at no cost to you. Do not attempt to make this appointment yourself even with your previous AME examiner. The NPN is available to help.

As with your prior monitoring exam, you will need to complete required forms before the NPN can schedule your exam.
For the AME, this typically includes only the Medical Health Questionnaire. An NPN representative will contact you if additional forms need to be completed.

You can complete these forms online through the member portal, or you can schedule a time to complete the forms over the phone with a representative. Once you complete any forms required, a representative will prepare a summary for your AME provider. This will help guide your provider in the examination.

A representative will call you to schedule your appointment with an in-network provider near you. If possible, the NPN will schedule you with your previous monitoring provider.

You should prepare for your Annual Health Examination appointment in the following ways:

1. Confirm appointment details (date, time, location of your provider, directions, and travel time).
2. Follow any instructions from the provider before your appointment, such as fasting or changing your medication schedule.
3. Complete any paperwork provided by the NPN prior to your first visit.
4. Write down a list of any medications you are currently taking and take the list with you to your appointment.
5. Write down a list of symptoms you are experiencing, even those that you think might not be related to your 9/11 exposures. Symptoms may include trouble sleeping, persistent cough, runny nose, etc.

* Keep in mind that an Annual Health Examination usually takes longer than a routine check-up, so please plan your time accordingly.

Your Annual Health Evaluation will be like other Program monitoring exams. The exam may include:

• Physical assessment
• Laboratory test and/or bloodwork (Note: The blood tests performed at your exam are limited to those allowed under WTC Health Program policy)
• Pulmonary function testing
• Chest X-ray
• EKG

During the exam, be sure to share any concerns you have with the provider including any recent symptoms you have experienced or changes in your health.

The NPN will send you a letter that summarizes your results and what, if any, conditions may be eligible to be certified, what conditions require further testing or medical documentation as recommended by your provider, and what conditions are not WTC-related, but should be discussed with your personal provider.