Role of the Medical Group or IPA Sample Clauses

Role of the Medical Group or IPA. Most Blue Shield Personal Physicians contract with Medical Groups or IPAs to share administrative and authorization responsibilities with them. (Of note, some Personal Physicians contract directly with Blue Shield.)Your Personal Physician coordinates with your designated Medical Group/IPA to direct all of your medical care needs and refer you to specialists or hospitals within your designated Medical Group/IPA unless because of your health condition, care is unavailable within the Medical Group/IPA. Your designated Medical Group/IPA (or Blue Shield when noted on your identification card) ensures that a full panel of specialists is available to provide your health care needs and helps your Personal Physician manage the utilization of your health plan benefits by ensuring that referrals are directed to providers who are contracted with them. Medical Groups/IPAs also have admitting arrangements with hospitals contracted with Blue Shield in their area and some have special arrangements that designate a specific hospital as “in network.” Your designated Medical Group/IPA works with your Personal Physician to authorize services and ensure that that service is performed by their in network provider. The name of your Personal Physician and your designated Medical Group/IPA (or, “Blue Shield Administered”) is listed on your identification card. The Blue Shield HMO-G Member Services Department can answer any questions you may have about changing the Medical Group/IPA designated for your Personal Physician and whether the change would affect your ability to receive services from a particular specialist or hospital.
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