WHEN YOU VISIT
THE PHYSICIAN'S OFFICE |
The physician's staff may ask you to sign a form to "assign benefits" the first
time you visit the office. This is a simple procedure that allows the physician to collect
his or her fee directly It also helps ensure that you will not receive a bill for any balance
due except for your share of coinsurance or deductibles (if any) for certain covered services.
Following these easy steps when you first arrive at the provider's office will help the
physician's staff verify your eligibility, ensure that they bill your visit correctly
and that you receive panel level benefits for covered services.
| WHEN YOU ARE REFERRED TO
A SPECIALIST |
To ensure that you receive panel benefits for covered services, it is your responsibility
to make certain your physician refers you to specialists and other healthcare providers
a participate in PHS. The same is true if your physician admits you to the hospital or
refers you to a specialty facility.
Before the referral is made, ask your physician to check the current directory of PHS
panel providers. You can call PHS
to make certain the referral physician, hospital or specialty facility is a PHS panel
provider (see below for further details).
When you call to make your appointment, make sure the physician's staff or facility
knows you are a PHS subscriber. Also, be sure to show your PHS card
when you arrive for your appointment.
If your physician refers you to tertiary providers in the PHS network, a referral
by PHS is required. It is important to obtain the appropriate referral by calling
(814) 946-7793 or 1-800-422-8929.
|   || WHAT TO DO ABOUT...|
LOST ID CARDS|
It is easy to get a new identification card if you lose yours. Just contact your employer's benefit office or PHS for help in getting a replacement.
| QUESTIONS ABOUT ELIGIBILITY OR COVERAGE|
Call your employer's benefits office or the number listed on your ID card to resolve
questions about eligibility and specific coverage under your plan.
| QUESTIONS ABOUT CLAIMS OR BENEFITS|
Call the telephone number listed on your ID card for answers regarding specific
claims or benefits provided by your employer's health plan.
| QUESTIONS ABOUT HEALTHCARE PROVIDERS|
Call PHS for information about healthcare providers. The status of each PHS
provider can change throughout the year. Therefore,
before you make an appointment with a provider, call PHS at 814-317-5063.
to determine if they are a panel provider or if your
physician has recently joined the network.