Save yourself time and money. Set up mail-order for medications you take regularly.
Need to see a specialist? No problem. With HAP, specialty office visits don’t require referrals from your primary care physician (except HAP Primary Choice Medicare (HMO)). But in some cases, the specialist you see may require a referral from your PCP. Many specialists are booked out months in advance, and may only accept patients whose PCP believes they need specialty care.
Sometimes specialists may suggest procedures we don’t feel are the best course of action for a patient. That’s why we want members to check with us so we can help manage their care. This is called prior authorization. If your service requires prior authorization, your doctor will take care of it on your behalf.
When Mary visits the ear, nose and throat doctor for the first time, she pays her specialist office copay. After her consultation, the ENT recommends a sinus surgery for Mary. Before she has the surgery, the ENT’s office must get prior authorization from HAP to make sure the service is covered and that it’s medically necessary.
For inpatient hospital stays, your doctor will get prior authorization from HAP. Emergency room visits don’t require prior authorization. Simply, notify HAP within 48 hours of the emergency admission.
You don’t need to worry about referrals, but your PCP would be a good resource to find a specialist who is right for you. With a PPO plan, you have the flexibility to seek care from doctors in and out of the network. But remember, you might pay more if you choose a doctor outside of our network.
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2020 Health Alliance Plan of Michigan
Health Alliance Plan (HAP) has HMO, HMO-POS, PPO plans with Medicare contracts. HAP Empowered Duals (HMO SNP) is a Medicare health plan with a Medicare contract and a contract with the Michigan Medicaid Program. Enrollment depends on contract renewals.
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