March 10, 2010

Frequently Asked Questions

Who determines the providers that are in the network?
Center Care:  Healthcare providers can be nominated by members calling us and requesting that an agreement form be sent to the provider. Based on credentialing criteria and availability of the services, Center Care’s credentialing committee will determine admission.

Do I need a referral to see a specialist?
Center Care:  No, you can self refer to in-network providers.

What if I am on vacation and need to see a doctor, but the doctor is not in the network?
Center Care:  For true emergency care, as defined by the plan administrator, claims will be processed with an in-network benefit; non-emergency care will be processed toward the member’s out-of-network deductible.  This is all subject to the plan design.

Non-emergency care will be processed as a non-network benefit, unless provisions had been made through the member’s primary care physician.

In all instances when treatment is needed away from home, or the member has received emergency care, the member’s primary care physician should be contacted within 24 hours for further guidance for proper referral or authorization.

How can I find out if my doctor is in the network?
Most members receive directories during their open enrollment period.

You can also check for updates on our website, or contact Member Services at 1-800-972-7038.