Choosing a primary care physician is an important decision. When you are enrolled in a Health Maintenance Organization (HMO) plan, you will be relying on that physician to guide you through all your health care needs.
Your Primary Care Physician is familiar with you and understands your health care needs. He/she will ensure you receive appropriate care in accordance with your health plan benefits.
If you are on a managed care plan, remember to contact your Primary Care Physician first for all your medical care.
If your Primary Care Physician feels you need to see a specialist or need a medically indicated procedure, he or she may discuss your treatment with the Clinic’s Patient Care Committee. The committee will review your medical record, established medical criteria and the guidelines of your health plan to determine whether to proceed with the service request or suggest an alternative treatment plan. This committee consists of several Clinic physicians, so in essence, it is like receiving a second opinion.
If you need urgent care after hours, call the Clinic’s main number for instructions. Most health plans recommend that you receive authorization from your Primary Care Physician before going to an emergency room, unless the situation is life-or-limb-threatening. If you do not receive this pre-authorization, your care may not be covered.
The rules regarding your health plan may seem confusing to you. If you have questions, call us or your health plan. Remember your Clinic physician and staff are here for you.