Health Plan Information
St. Elizabeth Healthcare and the doctors who practice here participate in many health insurance plans. Please keep in mind that not all services may be covered under certain health plans, and many services require a referral or preauthorization. Most insurance companies offer several levels of plans and products. It is always a good idea to call your insurance company for verification to make sure the service and insurance product you are enrolled in is accepted.
Understanding Your Health Plan
Don’t wait until you need healthcare to understand your health plan coverage. Consult your health plan’s coverage booklet for information about your health plan and the benefits it covers. There are certain things you need to keep in mind when choosing a health plan.
- Do you need a plan that covers preventive care?
- Are there pre-existing conditions that might limit your options?
- Do you want to stay with your current doctor?
- At which hospital do you prefer to receive your care?
- Have you considered the premium costs?
- Are you likely to need any physical therapy, home care or other services, treatments or therapies?
- Does your plan cover mental health services or complementary therapies?
It is important to ask yourself these questions and weigh your options carefully before choosing a health plan. Pick one that best suits your needs and lifestyle. Most importantly, make sure the plan gives you access to St. Elizabeth Healthcare.
Preferred Provider Organization (PPO)
A PPO is a form of managed care, but it is similar to a traditional “fee-for-service” type of plan. A PPO will contract with doctors, hospitals and other care providers to provide services for an agreed upon charge. Unlike an HMO (Health Maintenance Organization), where a primary care physician directs all of your care, a PPO allows you to select a provider and a specialist without a referral. Generally, there are annual deductibles to meet before the plan will pay benefits. You are responsible for a certain percentage of the charges (co-payments), and the plan pays the balance up to the agreed upon amount.
Health Maintenance Organization (HMO)
HMOs offer members a range of health benefits, including preventive care, for a monthly fee. They also set co-payments for the care you receive. The HMO will give you a list of doctors for your use in choosing a primary care physician. The primary care physician coordinates all of your care, including referrals to a specialist. If you go outside of the HMO without a referral from the plan, you will be responsible for the total cost of services, except for emergencies or urgent care services.
