Always call your health plan when in doubt about insurance requirements.
Understanding health insurance plan requirements for accessing medical care before seeking care will prevent denial of services, unpaid medical bills and administrative headaches. In Pennsylvania, you may have coverage through one of the five regional Blue Cross Blue Shield plans, state-sponsored plans such as Medical Assistance, adultBasic, PA Fair Care or another health plan. Of course, in an emergency, do not hesitate to call 911 or go to the emergency room. Your health is more important than sorting out insurance requirements.
Instructions
1. Arrange for a primary care provider (PCP) to manage your care and coordinate health care services. Call the number on your medical ID card to get help with picking a PCP. Some Pennsylvania Medical Assistance programs, such as Access Plus, will choose a PCP for you if you do not make a selection. You may also visit your health plan's website to complete a network provider search and select a PCP.
2. Visit your PCP for routine checkups and when you are sick or hurt. Call the office for an appointment or if you need immediate care. If you are ill or hurt after normal business hours, avoid the emergency room and call your PCP first for instructions, unless you have a true emergency that cannot wait until morning.
3. Obtain a referral to see a specialist from your primary care provider (PCP), as your health plan requires. Most Health Maintenance Organizations (HMO) and Medical Assistance plans require a referral; however, other types of insurance plans may not. Check with your PCP's office or your health plan, if you aren't sure.
4. Call your health plan to get preapproval for services such as specialist visits, hospitalizations, behavioral health services, substance abuse care, surgeries or any other procedures that may need approval. Your provider may handle this step for you, but make sure you have approval before receiving services.
5. Call 1-800-692-7462 if you have Medical Assistance or a Pennsylvania-sponsored health plan and need help in accessing services. They can help or refer you to a representative who can help you find a doctor and schedule an appointment. For health insurance information for children, call 1-800-986-KIDS.
Tags: health plan, your health plan, Medical Assistance, your health, call your, care provider
