A World Trade Center Lawyer Can Help You Earn Compensation

The World Trade Center Health Program (“WTCHP”), now fully funded until 2090, covers a specific list of health conditions which includes almost all cancers, lung diseases, and aerodigestive disorders as well as psychological conditions such as post-traumatic stress disorder (PTSD) and anxiety. If eligibility criteria is satisfied during the application process, the WTCHP will accept individuals (known as WTCHP members) into the program and schedule an evaluation. During the evaluation, a physical examination is conducted along with a review of a member’s existing medical records. If WTCHP physicians determine that a member’s health condition is on the list of covered health conditions and their 9/11 exposures are substantially likely to have been a significant factor in aggravating, contributing to, or causing the health condition, all future[1] medically necessary treatment, diagnostics, procedures, and prescription medications for covered conditions will be provided at no cost to the responder or survivor. This means no co-insurance charges, copayments, deductibles or bills of any kind.

Services are provided at Clinical Centers of Excellence (CCEs)[2] located throughout the New York metropolitan area or through a collection of clinics across the United States known as the Nationwide Provider Network (NPN)[3]. The WTCHP is administered by the National Institute for Occupational Safety and Health (NIOSH) which has the final word on eligibility for potential WTCHP members and certifies that a condition is eligible for treatment.

Choice of Care

These WTCHP services and benefits are completely voluntary and do not require WTCHP members to stop treatment by an existing healthcare professional outside of the WTCHP for non-9/11 related conditions. The WTCHP is specifically designed and limited to medical needs of WTCHP members related only to specific 9/11-related conditions. WTCHP physicians have specialized expertise in the diagnosis and treatment of 9/11-related physical and mental health conditions across nearly 80,000 members nationwide, which makes participation in the WTCHP appealing to affected individuals.

Because participation in the WTCHP is voluntary, WTCHP members have the freedom to choose whether to receive treatment for 9/11-related conditions from the WTCHP, an existing healthcare professional outside of the WTCHP, or some combination thereof. In this respect, a WTCHP member may choose to use the WTCHP as a primary, additional, or alternative source of care. Some WTCHP members may even choose to continue treatment by their existing health professionals and only use the WTCHP pharmacy benefits to eliminate their prescription drug copayments for chronic conditions. WTCHP members may also withdraw from participation in the WTCHP at any time, without any financial or other consequences, other than loss of WTCHP services.

Coordination of Benefits

The WTCHP does not conflict with any existing private or public health plans and generally serves to ensure that benefits are provided at no cost to the WTCHP member. However, coordination of benefits does apply in some instances.

For responders, the WTCHP serves as the first payer for medical and mental health treatment services (meaning that existing health insurance[4] will never be billed for any medical treatment service rendered by the WTCHP to treat a certified 9/11-related health condition).

For survivors with existing public or private health insurance, the existing health insurance serves as the first payer and will be billed first for any medically necessary treatment rendered by the WTCHP to treat a 9/11-related health condition.

It is important to note that, regardless of which coordination of benefits scenario applies, WTCHP services are still offered at no cost because the member will never be responsible for paying any co-insurance charges, copayments, or deductibles for care of certified 9/11-related health conditions (so long as WTCHP-affiliated healthcare providers are utilized).

Don’t worry if you find the above confusing. Contact us today and let a World Trade Center lawyer at our firm provide you with a review of your claim. 

[1] Benefits are provided for future treatment only, meaning there is no retroactive payment of medical bills incurred prior to enrollment and/or from outside providers.

[2] Responder CCEs: Icahn School of Medicine at Mount Sinai, New York University School of Medicine, Northwell Health, State University of New York-Stony Brook, Rutgers University. Survivor CCEs: Bellevue Hospital Center, Gouverneur Healthcare Services, Elmhurst Hospital Center. FDNY CCEs: FDNY Headquarters, Brentwood, Commack, Fort Totten, Manhattan, Middleton, Staten Island. Memorial Sloan-Kettering is an in-network provider for all victim classifications. Program members may change their CCE once per year.

[3] The NPN is administered by Logistics Health Incorporated (LHI) and is available to survivors and responders who live in the United States but outside of the New York metropolitan area. NPN clinics are located within 30 miles of those living in urban areas and within 70 miles of those living in rural areas.

[4] Survivors without existing health insurance are required to meet ACA (Affordable Care Act) requirements.

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