Page 17 - PA_PPO_Member_Kit

Basic HTML Version

Understanding Where to Go for Care
Some visits should be scheduled even when you’re feeling just fine. Others need to be scheduled when
you have a medical problem or concern. These problems can vary in degree of urgency, and we think
it’s useful to offer a guide to help you decide where to go for the kind of care you need.
Continuity of Care
If you’re in an active course of treatment with a non-HAP or non-Alliance doctor, we provide continuity
of care. This means we will work with you and your doctor to move your care to one of our doctors
when it is safe to do so.
Here’s how it works:
1. Continue to see your current doctor for regular visits to track your condition and receive
direct treatment
2. Your current doctor prescribes your medicines and monitors your treatment plan
3. A nurse will call you and your health care provider to talk about the diagnosis, history and
current treatment plan, reviewing the information and coordinating care with your doctor
4. We will move you to an affiliated provider when it is safe to do so
To get things started, call Client Services. When you call, be sure to have this information
handy, so we can send it to our medical team:
• Your name, address and phone number
• Your ID number
• Active coverage date
• The name, address and telephone number of the doctor who is currently treating you
Hospital Services
You must have prior authorization before being admitted to a hospital. Hospital services should be
coordinated with your PCP. This is a review process to ensure that you meet the criteria for elective or
emergency admissions before going into the hospital.