Women’s Health Care Direct Access Providers. Female Members may see a general and family practitioner, physician’s assistant, gynecologist, certified nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered nurse practitioner who is unrestricted in your KFHPWA Network to provide women’s health care services directly, without Preauthorization, for Medically Necessary maternity care, covered reproductive health services, preventive services (well care) and general examinations, gynecological care and follow-up visits for the above services. Women’s health care services are covered as if the Member’s Network Personal Physician had been consulted, subject to any applicable Cost Shares. If the Member’s women’s health care provider diagnoses a condition that requires other specialists or hospitalization, the Member or the chosen provider must obtain Preauthorization in accordance with applicable KFHPWA requirements. For a list of KFHPWA providers, contact Member Services or view the Provider Directory located at xxx.xx.xxx/xx.
Women’s Health Care Direct Access Providers. Female Members may see a general and family practitioner, physician’s assistant, gynecologist, certified nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered nurse practitioner who is contracted by KFHPWA to provide women’s health care services directly, without Preauthorization, for Medically Necessary maternity care, covered reproductive health services, preventive services (well care) and general examinations, gynecological care and follow-up visits for the above services. Women’s health care services are covered as if the Member’s Network Personal Physician had been consulted, subject to any applicable Cost Shares. If the Member’s women’s health care provider diagnoses a condition that requires other specialists or hospitalization, the Member or her chosen provider must obtain Preauthorization in accordance with applicable KFHPWA requirements.
Women’s Health Care Direct Access Providers. Female Members may see a participating General and Family Practitioner, Physician’s Assistant, Gynecologist, Certified Nurse Midwife, Licensed Midwife, Doctor of Osteopathy, Pediatrician, Obstetrician or Advanced Registered Nurse Practitioner who is contracted by GHC to provide women’s health care services directly, without a Referral from their Personal Physician, for Medically Necessary maternity care, covered reproductive health services, preventive care (well care) and general examinations, gynecological care and follow-up visits for the above services. Women’s health care services are covered as if the Member’s Personal Physician had been consulted, subject to any applicable Cost Shares, as set forth in the Allowances Schedule. If the Member’s women’s health care provider diagnoses a condition that requires Referral to other specialists or hospitalization, the Member or her chosen provider must obtain preauthorization and care coordination in accordance with applicable GHC requirements. Second Opinions. The Member may access, upon request, a second opinion regarding a medical diagnosis or treatment plan from a GHC Provider. Emergent and Urgent Care. Emergent care is available at GHC Facilities. If Members cannot get to a GHC Facility, Members may obtain Emergency services from the nearest hospital. Members or persons assuming responsibility for a Member must notify GHC by way of the GHC Emergency Notification Line within twenty-four (24) hours of admission to a non-GHC Facility, or as soon thereafter as medically possible. Members may refer to Section IV. for more information about coverage of Emergency services. In the GHC Service Area, urgent care is covered only at GHC medical centers, GHC urgent care clinics or GHC Provider’s offices. Urgent care received at any hospital emergency department is not covered unless authorized in advance by a GHC Provider. Members may refer to Section IV. for more information about coverage of urgent care services. Outside the GHC Service Area, urgent care is covered at any medical facility. Members may refer to Section IV. for more information about coverage of urgent care services.
Women’s Health Care Direct Access Providers. Female Members may see a general and family practitioner, physician’s assistant, gynecologist, certified nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered nurse practitioner who is contracted by Group Health to provide women’s health care services directly, without Preauthorization, for Medically Necessary maternity care, covered reproductive health services, preventive services (well care) and general examinations, gynecological care and follow-up visits for the above services. Women’s health care services are covered as if the Member’s Network Personal Physician had been consulted, subject to any applicable Cost Shares. If the Member’s women’s health care provider diagnoses a condition that requires other specialists or hospitalization, the Member or her chosen provider must obtain Preauthorization in accordance with applicable Group Health requirements.
Women’s Health Care Direct Access Providers. Female Members may see a general and family practitioner, physician’s assistant, gynecologist, certified nurse midwife, licensed midwife, doctor of osteopathy, pediatrician, obstetrician or advance registered nurse practitioner who is contracted by Group Health to provide women’s health care services directly, without Preauthorization, for Medically Necessary maternity care, covered reproductive health services, preventive services (well care) and general examinations, gynecological care and follow-up visits for the above services. Within the Network, women’s health care services are covered as if the Member’s Personal Physician had been consulted, subject to any applicable Cost Shares. Women’s health care services obtained from a Community Provider are covered at the Community Provider benefit level. If the Member’s women’s health care provider diagnoses a condition that requires other specialists or hospitalization, the Member or her chosen provider must obtain Preauthorization in accordance with applicable Group Health requirements.
