The problem maybe your physicians hospital may not have signed a contract with your insurance. My doctor has no privlages at our local hospitals. I have to use the hospital physicians then see my primsary when I get out. Doctors have to pay for privlages. Are u sure its not your doctor dropping his privlages? Oh, to answer your question, I think u have to wait for open enrollment and that is Oct, I think.
Hi Pzelak - Part D is prescription drug coverage did they change pharmacies too? How did you get this information? Did you receive a letter, or did someone in the doctor's office tell you this? The reason I ask this, is because if it came from the doctor's office, you may have been misinformed.
To answer your initial question: I don't believe so. That's one of the drawbacks of HMO's. But it doesn't make sense either.
Part C (HMO Advantage) Plans are administered by several different companies and each can be slightly different. I'd call whoever administers your Part C coverage. There should be a number on the back of your membership ID card.
If you don't like the answer provided, you are entitled to file an Appeal/Grievance with the Plan. They are mandated to reply in 30 days. There should be instruction on where to send the letter, etc., in the "Evidence of Coverage" that was sent to you or on their website. If you've misplaced your copy; call that number on the back of your card and request another.
The grounds for your Grievance COULD be this: As an HMO, patients are required to have a PCP that is contracted with the plan. In order for your PCP to refer or authorize services for you at a hospital, they must also contract with at LEAST ONE facility, of which, that PCP is affiliated. How else are you to receive full and proper services? I believe this is in violation of the Federal Health Maintenance Act of 1973, of which, all HMO's must comply.
Perhaps the Provider Relations Dept. (the department that handles the credentialing of providers (hospitals, doctors, labs, etc) overlooked the fact that they have contracting physicians that cannot authorize services within the Plan? (I've seen this happen during contract renewals & it was temporary; frustrating, but temporary).
To answer your initial question: I don't believe so. That's one of the drawbacks of HMO's. But it doesn't make sense either.
Part C (HMO Advantage) Plans are administered by several different companies and each can be slightly different. I'd call whoever administers your Part C coverage. There should be a number on the back of your membership ID card.
If you don't like the answer provided, you are entitled to file an Appeal/Grievance with the Plan. They are mandated to reply in 30 days. There should be instruction on where to send the letter, etc., in the "Evidence of Coverage" that was sent to you or on their website. If you've misplaced your copy; call that number on the back of your card and request another.
The grounds for your Grievance COULD be this:
As an HMO, patients are required to have a PCP that is contracted with the plan.
In order for your PCP to refer or authorize services for you at a hospital, they must also contract with at LEAST ONE facility, of which, that PCP is affiliated.
How else are you to receive full and proper services? I believe this is in violation of the Federal Health Maintenance Act of 1973, of which, all HMO's must comply.
Perhaps the Provider Relations Dept. (the department that handles the credentialing of providers (hospitals, doctors, labs, etc) overlooked the fact that they have contracting physicians that cannot authorize services within the Plan? (I've seen this happen during contract renewals & it was temporary; frustrating, but temporary).
I'm hoping you were misinformed.