MANAGED CARE PARTICPATIVE COMPANY LIST 1199 National Benefit Fund Aetna U.S. Healthcare Amerihealth Amerihealth 65 Anthem Beech Street CHA Cigna Comed Consumer Health Network Empire Blue Cross Family Choice Health First Health First Option/PHS First Option Medicare Health Source Heritage HMO Blue Horizon Horizon Medicare JFK Horizon MagnaCare Mastercare Medicare Medicare Blue Medichoice Multicare New Jersey Blue Cross New Premier Plus One Health Plan Oxford PHCS Physicians Health Services Preferred Health Strategies Premier Plus Premier Preferred Care Qualcare Railroad Medicare Total Plan Insurance Unicare United Healthcare University Health Plan U.S. Healthcare U.S. Healthcare Medicare U.S. Healthcare To Our HMO Patients Welcome to our practice. We look forward to helping you to stay healthy, and we hope that we will have a long and mutually rewarding physician - patient relationship. As a member of an HMO, you must be aware that your insurance coverage is based on the concept of managed care. Under this type of health plan, your primary care physician is responsible for determining the most effective way to diagnose and treat you, while responsibly allocating the resources of your plan. We will never restrict your access to necessary healthcare, but the reality of managed care is that many simple problems can be cared for by your primary care physicians, and do not need specialty evaluation. Many patients, particularly those that are new to managed care, still demand a specialist referral when such a referral is not indicated. It is important to remember that you selected this type of healthcare coverage. Our physicians are bound by the rules of the plan that you have selected. Problems that can be managed by the primary care physician must be managed by the primary care physician. We would also like to enlist your help in letting us know when special tests and consultations are completed, so that we may obtain the results in a timely fashion. Since we are attempting to optimize your healthcare within the rules of your selected plan, we ask you to be considerate of our doctors and staff. In order to facilitate the care that you receive, there are several guidelines that we ask you to follow. Your understanding and cooperation are greatly appreciated. You must have either a valid I.D. card. Some HMOs do not have the primary care physician's name on the card. For those that do list the primary care physician, your card should name one of the Pulmonary Internists Physicians (Dr. Smith, Goldstein, Wolf, Sheehy, Casale, or Shinder) as your primary care physician. If you are being seen in consultation, you must have a valid referral from your primary care physician to our group. All problems must initially be evaluated by one of our physicians before a referral may be considered. If a referral is issued, our office needs 48 - 72 hours (No Exception!) to obtain the necessary pre-authorization from your insurance company. Referrals cannot and will not be backdated. All requisite information must be provided to our office staff or your referral may not be able to be completed. All paper referrals must be picked up at the office before your appointment with a specialist. Do not go to a specialist without your referral. If you do, the specialist may either refuse to see you, or you will be responsible for the bill. Once a specialist has evaluated your problem, follow up visits may or may not be needed. Although a specialist may perform initial blood work, routine monitoring or blood work follow up will be done in our office. Routine refills of prescriptions that were initially recommended by a specialist may be done in our office. Specialists are responsible for communicating their findings and care plan to us. No follow up visits will be permitted if these care plans are not forthcoming. It is your responsibility to remind the specialists of this. We understand that even a simple problem is anxiety provoking when it involves either yourself or a member of your family. We will always try our best to get urgent problems seen on an expedited basis, but we ask that you understand the practical limitations on our time. Please let us know if we are meeting your needs and expectations. Thank you once again for selecting our practice for your care. Sincerely, Pulmonary Internists, P.A. Home - Bios - Directions - Asthma - Sleep Office Schedules - Contact Us - Managed Care - Patient Intake Form Pulmonary Internists Suite 301, Levinson Plaza 2 Lincoln Highway Edison, NJ 08820 Phone: (732) 549-7380 created by: