What Physicians are Available?
Common Questions About Participating Providers
This information was adapted from information provided by The Hospital Association of Pennsylvania. You can contact the Association at (570) 564-9200.
Traditional insurance plans will pay for services you receive from any doctor. Managed care plans do not do business with all physicians. Many managed care plans, such as HMOs, will pay only for services you receive from a participating physician.
Other managed care plans, such as PPOs, will pay part of the cost if you go to a non-participating physician. To find out if your doctors participate in the plans available to you, ask to see each plan's participating provider directory. Since these lists change fairly regularly, it's a good idea to confirm that the information is current.
Does your family doctor participate in the plan?
Your family doctor is the physician you see for common ailments, such as colds, the flu, mild allergies, etc. Family doctors may be listed as family practice physicians, internists, or general practice physicians in the plans' provider directories.
Managed care plans call these doctors "primary care physicians" or "primary care providers" or "PCPs," for short. HMOs will require you to see or call your primary care physician before you go to a specialist or to the hospital, unless it is an emergency.
Primary care physicians serving in this role are called gatekeepers, because they must approve or pre-authorize any services you receive from another doctor, a hospital or other healthcare professionals.
Does your pediatrician participate in the plan?
In many managed care plans, pediatricians are considered "primary care physicians."
Does your obstetrician/gynecologist participate in the plan?
Some managed care plans will let you see a gynecologist as a primary care physician. Other managed care plans will consider your gynecologist to be a specialist.
Do your current specialists participate in the plan?
Specialist providers are all those providers not considered primary care providers (e.g., cardiologist, orthopedic surgeon, dermatologist, ophthalmologist, allergist, podiatrist, psychiatrist).
Does Evangelical Community Hospital participate in the plan?
If you prefer Evangelical, check to see if we participate in the plan. This information should be listed in each plan's provider directory. If it is not listed, you can call the customer service department at the health insurance plan in question. If you prefer, you can check the current list of plans in which Evangelical participates. If your plan does not show up on that list, please e-mail or call the Managed Care department at (570) 522-2748 for more information.
Other Common Questions: