Other Important Information for Provider Online Search
- Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide health care services.
- We also use the term Practitioners to refer to people who provide health care services.
- The term Providers also includes Facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term services and supports.
- Providers that are a part of our plan’s network are called network providers.
- Services include medical care, long-term services and supports, supplies, prescription drugs, equipment, and other services.
- Network Providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.
- A Primary Care Provider (PCP) is a doctor, physician assistant, or nurse practitioner who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time.
- Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
- Oncologists care for patients with cancer.
- Cardiologists care for patients with heart conditions.
- Orthopedists care for patients with certain bone, joint, or muscle conditions.
- You also have access to a Care Coordinator. A Care Coordinator helps you manage your medical providers and services.
When you become a member of our plan, you will choose a primary care provider who is part of our plan network. This provider will be your primary care provider/PCP.
If you did not choose a PCP or would like to make a change to your PCP, look for and choose a provider:
- who you use now, or
- who has been recommended by someone you trust, or
- whose offices are easy for you to get to.
In our search, primary care provider specialties in the drop down include Family Medicine, Internal Medicine, General Medicine, Obstetrics & Gynecology, Pediatrics, Nurse Practitioner, and Midwife.
If you want help in choosing a PCP, please call Member Services. If you have questions about whether we will pay for any medical service or care that you want or need, call Member Services and ask before you get the service or care.
You may be able to get long-term services and supports, such as services provided by the Elderly Waiver (EW) program as a SeniorCare Complete member. Long-term services and supports are help for people who need assistance to do everyday tasks, including taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital. Talk with your care coordinator about accessing these services.
You must have a Long-Term Care Consultation (LTCC) done and be eligible to get additional services or support. You can request to have this assessment in your home, apartment, or facility where you live.
Your care coordinator will meet with you and your family to talk about your care needs if you call to ask for a visit.
Your care coordinator will give you information about community services, help you find services to stay in your home or community, and help you find services to move out of a nursing home or other facility.
If you need transition planning and coordination services to help you move to the community, you may be eligible to get Moving Home Minnesota (MHM) services. MHM services are separate from EW services, but you must be eligible for EW.
To find out more about these services, see your Member Handbook or Evidence of Coverage. Call Member Services to get more information on how to access these services.
The exceptions to this rule are when you need urgent or emergency care or dialysis, and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if the plan gives you permission first.
You may change providers within the network at any time. If you have been going to one network provider, you do not have to keep going to that same provider.
South Country Health Alliance works with all the providers in our network to accommodate the needs of people with disabilities. If you need to see a provider and are not sure if they offer the accommodations you need, South Country Health Alliance can help you. Talk to your care coordinator for assistance.
How do you access out-of-network providers?
If you need a covered service that you cannot get from a plan network provider, you must get a service authorization from us to see a non-network provider. Exceptions to this rule are Open Access Services and emergency and post-stabilization care. (Open access services are: family planning, diagnosis of infertility, testing and treatment of sexually transmitted diseases, and testing for AIDS or HIV-related conditions.)
If you visit an out-of-network provider and receive a bill that has not been sent to us, you should send it to us for processing and determination of liability. Call Member Services if you have questions.
How do you access specialty providers?
You can see any provider in our network without referral, including specialists. This search shows specialties in a drop down menu. You can search by specialty and by city or zip code to find a specialist in your area.
You can get additional information on how to access specialty care by calling Member Services.
How do you get more information about personal care provider organizations (PCPO) and home care agencies?
A listing of personal care providers and home care agencies is available on the Provider and Pharmacy Directory page (find the Home Care Service Provider Directory). It is also available upon request. See your Member Handbook or Evidence of Coverage, or call Member Services for more information on how to access these services.
How do you find a network pharmacy?
How do you determine if a facility is accessible?
If you require special access to obtain services from a provider, you can obtain information by calling Member Services or viewing the provider accessibility surveys on this site. This could include, but is not limited to, access for services such as availability of flexible hours, wheelchair access, or parking lot access.
How do you access interpreter services?
Hearing and language interpreter services are available to help you get services. Oral interpretation can be given to you in your language. You may be able to get written information in your language. For assistance, call Member Services.
H2419, H5703_3116, Approved
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