Important Information for Medicare Advantage HMO and HMO-POS Patients

At Ohio County Healthcare, we are committed to helping you receive the care you need when you need it. As part of that commitment, we want to share helpful information about Medicare Advantage HMO and HMO-POS plans so you can avoid delays and ensure your visits are covered.

Understanding Your Plan

• Medicare Advantage HMO Plans require you to use a defined network of doctors and hospitals. Your Primary Care Provider (PCP) coordinates your care and submits referrals when needed.
• HMO-POS (Point-of-Service) Plans function similarly but offer limited flexibility to receive care outside the network, typically at a higher out-of-pocket cost.

Why Your Primary Care Provider (PCP) Matters

Your PCP plays an important role in managing your health and coordinating specialty care. It’s important that the PCP listed on your insurance card is current and accurate. If it is not, referrals may be delayed and could impact your ability to receive timely care.

Referrals for Specialty Care

For most specialist visits, your insurance plan requires a referral from your PCP. This referral should be completed before your appointment to ensure coverage and prevent delays.

Coordinating Your Care

We’re here to support you every step of the way. Here are a few simple steps you can take:

• Confirm your PCP information on your insurance card to ensure it is current.
• Connect with your PCP’s office prior to scheduling specialist care so any required referrals can be coordinated.
• Allow 3-5 business days for your PCP’s office to submit referrals and communicate with specialists.
• Need a Primary Care Provider? If you do not currently have a PCP, please call 270-504-1300 and press 2 to speak with one of our patient service representatives. Our team will gladly assist you in establishing care with a provider who is accepting new patients and is conveniently located to serve you.
• Explore Available Providers: Click this link to view current providers accepting new patients and find the best fit for your care needs.

We understand that navigating insurance requirements can be confusing, and we are here to make the process as smooth as possible. Our goal is to partner with you to ensure you receive timely, coordinated, and high-quality care.

If you have any questions about your coverage, referrals, or establishing care, please don’t hesitate to contact our team at 270-504-1300 or reach out to your insurance provider’s member services.

Thank you for trusting Ohio County Healthcare with your care.