How Your Plan Works
Will My Insurance Pay For All of the Services My Doctor Orders?Benefit plans are tailored to individual employers; therefore, various employer groups will have different levels of benefits. It is difficult for your physician to know what services are covered for each individual employer, as such, it is necessary to verify your plan benefits should there be a question as to if a procedure or service is considered payable.
You need to see a SpecialistWhen you need to see a specialist, you are free to choose a provider in the network. No referral is required, but the doctor providing your primary care can make some helpful suggestions as to which type of specialist you need to see. A physician referral service is also available free of charge. Call the Doctor Network at , or 1-800-541-9592, for information on physicians from 8:30 a.m. - 5 p.m., Monday-Friday.
You should keep in mind that visiting an out-of-network provider could cost you more money. If you need a specialist that does not participate in the Health Partners network, you need to call your employee benefits representative.
Hospital Care
Should you need either in-patient or out-patient hospital care, you need to make sure that your visit has been authorized so you will receive the maximum amount of benefits under your plan.
Prior to admission, your doctor must call the number on your ID card to request a pre-admission certificate. This is an approval that your hospital visit is necessary and appropriate in your case.
Remember, it is in your best interest to confirm that a referral is secured prior to your admission.
What do I do in an Emergency?Should you have an emergency you would dial 911 or go to the nearest emergency room. Most plans expect you or someone such as a friend or family member to contact your insurance plan as soon as you are able or within 24 hours of your admission. This number should be listed on the front or back of your ID card.
What if I am Out of Town?
Health Partners is a local network; however, some employers have arranged for statewide coverage. Should this be the case, your employer will have this information available for you.
Should you need to see a doctor while you are away from home, you should first call the number on your ID card. You would advise them of your need to see a physician and verify you’re out of town coverage. The doctor’s office may offer to file a claim and bill you for the difference, if any, or they may require you to pay up front. If you pay the doctor’s bill directly, as in a traditional insurance plan, you will need to submit a claim for reimbursement.
Organ Transplant Services
Health Partners offers you access to today’s most innovative and technologically advanced options for organ transplants. Should you or a family member be in need of this service, you will be able to access the organ transplant network; a team of highly respected medical professionals in Atlanta. Please contact the number on your ID card if you have further questions.
What if I am dissatisfied?
You have a right to express dissatisfaction or concern about the services provided to you and your family and to receive answers to your questions. To ensure that your concerns receive our fullest attention, please call customer service at 770-219-6600. Let us know about your questions or concerns, and we will work to respond to you as quickly as possible.
What if my dependent or I also have Medicare?As a general rule, if a Medicare patient has other coverage, Medicare is the secondary payor. There are some exceptions to this rule and you should contact Medicare with further questions.