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Originally Posted by jecochrane Hmmm...thanks I didn't know that. I took a look at my providers FAQ: [url]http://www.sagamorehn.com/main.asp?view=sagamore&page=faq-ppo[/url].
"Q. What if I need Specialty Care? Can I choose the specialist? Must it be a Sagamore physician?
A. The decision is yours. Sagamore physicians should refer you to other Sagamore providers. If you choose to use an out of network physician or provider, however, bear in mind you will be subject to OUT of network benefits and will likely have to pay more out of your pocket.
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So it says the decision is mine, but a physician should refer me? I'm taking that as I can do what I want, but they'd prefer me be referred...
*Edit* Also, how do I choose a primary care physician?
Thanks.
Josh |
It really depends what plan you have. If you have the PPO, you can refer yourself to a specialist, and you're not required to select a PCP. The POS plan requires referrals to specialist to get the highest benefits. If you're still not totally sure, consult with a customer service representative before making any appointments. You don't want to get slapped with a hefty bill because the necessary steps weren't taken.
As far as PCP selection, it doesn't appear that your insurance company makes you formally select a PCP. It looks like you can just go to whatever participating PCP you'd like. However, I'd suggest asking customer service if they suggest that you formally elect a PCP for their records. If referrals are needed, sometimes things can get sticky if you've never really selected a PCP.
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