Obtaining Care After Normal Physician Office Hours Sample Clauses

Obtaining Care After Normal Physician Office Hours. Please refer to the Prior Most Physicians offer an after-hours answering service. For non-emergency situations, you should phone your Primary Care Physician. The name and address of your PCP appears on your Identification Card. You will also find the phone number of your PCP in the Provider Directory. If Emergency Health Care Services are needed, you should call 911, or seek treatment at an Refer to emergency room. If in need of Urgent Care, you may seek treatment at an Urgent Care Center that is available and open for business. Please note that some Urgent Care Centers are not open after 8:00 p.m. In such circumstances, it may be necessary to use an emergency room for care that is needed on an urgent basis. Please refer to the Benefits Section, Accidental Injury / Urgent Care / Emergency Health Services / Observation /Trauma Services Benefits Section of this Agreement for a detailed description of Coverage for Urgent and Emergency Health Care Services. In-Network Practitioners/Providers In-network Practitioners/Providers, including Primary Care Physicians, specialists, facilities and ancillary Health Care Professionals, must be utilized, except in cases of an emergency. Members are responsible for paying the appropriate Cost Sharing (Copayment and/or Coinsurance) directly to the Practitioner/Provider at the time services are rendered when such amounts are clearly specified by the Practitioner/Provider. Hospital Inpatient Admission and some other Health Care Services require our review and Prior Authorization before the services are provided. If you seek care from an In-network Practitioner/Provider, your In-network Practitioner/Provider will notify us and handle all aspects of your care. If that Practitioner/Provider fails to obtain a required Prior Authorization and the claim is denied, you will not be held accountable for those charges. Please refer to the Prior Refer to Authorization Section for complete details on Prior Authorization. Generally you will not have claims to file or papers to fill out in order for a claim to be paid. The Practitioner/Provider will xxxx us directly for the cost of services. Most services require Cost Sharing (Deductible, Coinsurance and/or Copayments) at the time of service. The amount of Cost Refer to
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