|
QUESTIONS TO ASK
YOUR PLAN: PEOPLE WITH SPECIAL HEALTH NEEDS General Information about Managed Care Care Physician Treatment Centers INDEX |
||||
SELECTING A PRIMARY CARE PHYSICIAN • Which primary care providers and specialists are in the health plan’s network of providers? Where do they practice? Tip: Ask for a current listing of the primary care providers, specialists and health care facilities that are part of the health plan’s network of providers. • How do I know if the primary care provider or specialists will accept new patients? Tip: Even though a physician or group practice may be listed in a provider directory it does not necessarily mean that the practice accepts new patients. When a physician’s practice is full, he or she may stop taking new patients. It is important to ask the health plan or call the physician’s office to see if new patients are being accepted. • What if my current provider is not a member of the managed care plan? Tip: Find out if you can continue to obtain care from your current provider. If so, for how long? Some health plans will allow certain individuals to continue to obtain care from their health care provider even if the provider is not part of the health plan’s network. Generally, continuation provisions are limited to individuals with special health conditions, and only last for a limited amount of time. • Can I select a specialist to serve as my primary care provider? (HMO, POS) Tip: If you have a special health care condition, you may want to check whether the HMO will let you use your specialist to coordinate your care. For example, you may want to have your specialist serve as your care coordinator, if you have received a transplant, have sickle cell anemia, HIV or kidney failure (End Stage Renal Disease). It is important to receive regular check-ups and to obtain preventive clinical screenings (such as mammograms or pap smears) even if a specialist is coordinating your care. • How often can I change my primary care provider? (HMO, POS) •Where can I obtain more information about the educational background and specific interests of the different primary care providers? I am interested in choosing a doctor with an expertise in ________ (name special health condition). • Is my primary care provider’s office accessible for individuals with disabilities? Tip: If you have a disability, find out if both the office and the office equipment meet your needs for accessibility. Think about your access needs from the parking lot to the examination room. Tell the physician's office your specific accommodation needs. Also, you should make sure the physician's office understands if you have a visual or hearing impairment so that you can arrange appropriate methods of communication. |