Common use of Network Providers Clause in Contracts

Network Providers. To find out more about HMO contracting providers, refer to the website at xxx.xxxxxx.xxx for Provider Finder®, an Internet-based provider directory. It has important information about the locations and availability of providers, restrictions on accessibility and referrals to specialists, and information about limited provider networks. You may also request a hard copy or electronic copy of the provider directory, which is updated quarterly, by calling or writing Customer Service. The directories can also be found at xxx.xxxxxx.xxx. Upon admission to an inpatient facility, (e.g. hospital or skilled nursing facility), a participating physician other than your primary care physician may direct and oversee your care. Your (PCP) will be the one you call when you need medical advice, when you are sick and when you need preventive care such as immunizations. Your PCP may also be part of a "network" or association of medical professionals and facilities that work together to provide health care services in a timely, efficient and cost-effective manner. That means when you choose your PCP, you are also choosing a network and in most instances you are not allowed to receive services from any physician or health care professional, including your obstetrician-gynecologist (OB-GYN), that is not also part of your PCP's network. You will not be able to select any physician or health care professional outside of your PCP's network, even though that physician or health care provider is listed with your health plan. If you see any physician or provider outside of that network, even if the name of such physician or provider is listed in the provider directory, the cost of such services will not be covered under your health plan. Your PCP will play a key role in the delivery of your health care. The network to which your PCP belongs will provide or arrange for all of your care, so make sure that your PCP's network includes the specialists and hospitals that you prefer. If your PCP changes networks, you will be notified and will receive an updated ID card. You and your covered dependents may select the same or a different provider network, and the same or a different PCP within the network. You must go to an OB/GYN who is within the same provider network as your PCP. It is not required that you select an OB/GYN; you may choose to receive your OB/GYN services from your PCP. If you need help in locating a participating OB/GYN in your area, refer to the online provider directory (an Internet-based provider directory available on our website at xxx.xxxxxx.xxx), or to your provider directory, or call Customer Service at the telephone number on the back of your ID card for assistance.