MANAGED
CARE
What
is Managed Care?
Managed Care is a system whereby a primary care provider coordinates
your health care services. A single provider, with knowledge of your
entire healthcare portfolio, is in a better position to ensure that
the services you receive are medically necessary and appropriate. Your
single provider with New West is your designated Primary Care Provider
(PCP).
PRIMARY
CARE PROVIDERS
Who
can be a Primary Care Provider (PCP)?
Any participating Internal Medicine Physician or General Practice Physician
can be a PCP. In some instances OB/GYNs and Mid-level Practitioners
( Physician Assistant or Nurse Practitioner) may also function as a
PCP. See your New West Provider Directory
for additional information.
How
often may I change my PCP?
You are free to change your PCP at any time by contacting
Member Services at 1-800-290-3657.
How
can I receive covered services if I am unable to see my PCP?
If your PCP is in a clinic with other participating providers and you
are able to schedule an appointment with one of them, you may do so
and New West will treat your visit as if you saw your PCP. You are also
free to schedule appointments with a mid-level practitioner (Physician
Assistant or Nurse Practitioner) who is associated with your PCP’s
office.
URGENT
AND EMERGENT CARE
When
can I use an Urgent Care Facility?
You are free to use an Urgent Care Facility after hours, on weekends
and holidays, or when traveling outside of the New West service area.
A referral is not necessary.
What
care is available to me while I am outside of the New West service area?
Your benefits include coverage for urgent and emergent care while you
are outside of the New West service area. A referral is not necessary.
If you have an emergency, dial 911 or seek care at the nearest Hospital
Emergency Room or Urgent Care facility. This coverage is also available
to your dependent children while attending college outside of the New
West service area.
REFERRALS
How
do I obtain a referral for specialty care?
If you require specialty care, we encourage you to coordinate with your
PCP first however, as long as the specialty care is received from a
participating New West provider, no referral
is necessary. New West must precertify referrals to non-participating
providers prior to services being rendered.
PREVENTIVE
CARE
What
preventive services does New West offer?
Preventive benefits are included with all managed care plans. Preventive
benefits include: physicals, well-women exams, well child care, immunizations,
flu shots, prenatal and postpartum care, and mammograms.
Are
sports physicals and job-related physicals included as a preventive
benefit?
Sports physicals and any other physical specifically required by an
employer are not a covered benefit through New West. If you are able
to combine these services with a scheduled preventive visit and there
are no additional costs associated, your normal preventive benefit will
apply.
