At least one state has passed a law which require plans to notify members when a provider leaves the network. To lessen the impact of turnover, a plan should allow patients to complete any current treatments with that doctor, then assist them in locating a new doctor. A. Ask the plan to provide lists and locations of specialized facilities. A. Most plans limit or deny payment for visits to an emergency room for illness or injury that the plan does not consider urgent or life-threatening. Plans have developed several ways of handling emergencies.
Some large plans provide emergency services around the clock at their own clinics and hospitals.
Some plans have a telephone call-in service with doctors or nurses who advise patients as to whether their condition is an emergency. Some look at the patient s symptoms, rather than the diagnosis, to determine whether the patient could have perceived the situation to be urgent or life-threatening. A number of states have passed laws which require plans to pay for emergency room services if a prudent layperson would have considered the condition an emergency. A. One of the advantages of managed care plans is that they cover preventive care, typically not covered by traditional indemnity health plans. Many HMOs are even beginning to cover alternative therapies, such as acupuncture and biofeedback.