Managed Healthcare

 

How does my family physician fit in?
Your family physician is your main source of healthcare, treating 90% of your family’s medical needs. We will guide you through the complicated healthcare system. Call us first, because we know your medical history and overall medical status. Think of your family physician as your partner.

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Who handles the insurance?
The Village Medical Centers participate in many Managed Healthcare plans. If you participate in any of these programs, please notify the receptionist before being seen. If you are uncertain, give the receptionist your insurance information and she will be happy to check it for your. Participation in certain insurance plans dictates criteria for lab and referrals. Notifying us before your visit with the doctor will help us work within the framework of your plan, ensuring insurance coverage for you. It also allows us to properly file your charges with your company and prevent possible embarrassing situations caused by misinformation at the cashier’s desk.

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What if I need a specialist?
Your family physician is a specialist; we specialize in caring for the whole family. But if your problem requires additional advice, we will consult a specialist in that type of problem. Similarly, if you have a problem we do not take care of, we will ask another specialist to take over that part of your care. As your family physician, we coordinate the work of the other specialists and continue to care for the rest of your medical needs.

Your Managed Healthcare plan may require that we complete various forms and supply them with additional information before they will approve certain types of referrals. Sometimes, even after we supply them with all of this information, it may take a few days for their review team to get back to us with your approval. Please do not wait until the day of the specialist appointment to make the request for the referral.

In most plans, if you see another doctor without a referral from your family physician, you may have to pay for those services out of your own pocket. (Family physicians cannot approve referrals after you have already been to a specialist.)

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What are my responsibilities?
When you signed up for your Managed Healthcare plan, you agreed to follow its rules, which you must know and obey. (Like you, your family physician must follow the plan’s rules.) It is also your responsibility to work with your family physician. Remember, you will receive the care you need when you cooperate with your family physician and your healthcare plan.

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