Nevada’s state exchange, NV Health Link, exclusively offers HMO insurance policies during the 2014 plan year.
Choosing the right facility for your medical needs can help you save both time and money. When you are seeking medical care on your NV Health Link HMO insurance policy, it is important to understand the differences between the available providers contracted with your insurance plan. The three types of providers used for day-to-day utilization are Primary Care Physicians, Urgent Care Facilities, and Emergency Rooms.
Before visiting any available providers, it is always a good habit to double check your insurance policy’s network list. To locate your plan’s network list and confirm participating providers, please refer to our instructional guide: Finding Doctors with Provider Directories.
Your Primary Care Physician (PCP) manages your healthcare needs ranging from a checkup to prior authorizations.
Your PCP administers your day-to-day medical needs and will guide you through the treatment process with the best care available. Then, your Primary Care Physician must preauthorize all specialist office visits if you have an HMO plan. Prior authorization is a rate-limiting or cost-containment step. This is in the provision of care and treatment to an insured patient. You run the risk of having your medical claims denied by the insurance company if you don’t get prior authorization.
Urgent Care Facilities provide walk-in or extended-hour access for illness and injury that does not require emergency treatment. Urgent Care Centers can treat ailments while saving you money. They are far less expensive than the emergency room. Unfortunately, Urgent Care Facilities do not have the ability to grant prior authorizations on behalf of your PCP in most situations.
In Emergency situations, please call 9-1-1 and visit your nearest Emergency Room. On HMO insurance policies, emergency situations within the borders of the United States are covered regardless of the facility’s network status. Emergency care should be utilized if your “life or limb” is in danger.
Please feel free to give us a call for more on this topic. We will help you understand the role of your insurance plan’s available providers.
Phone: (775) 828-1216