From Coverage to Care

A Roadmap to Better Care

And a Healthier You

Roadmap to Health

Put Your Health First

• Maintain a healthy lifestyle • Get your recommended health screenings and

manage chronic conditions.• Keep all of your health information in one place.

You may be able to receive an annual visit or some recommended preventive services for free like the flu vaccine, obesity screening and depression screening.

• Check with your insurance plan to see what services are covered.

• Be familiar with your costs.

• Know the explanation of some key health insurance words.

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Understand Your Health Coverage

Key Health Insurance Words

• Network• Deductible• Co-insurance• Copayment• Premium• Out of Pocket Maximum• Explanation of Benefits

Your Insurance Card or Other Document

• Membership Package or Benefit Package

• Insurance card or other document as Proof of Insurance

• Prevent Health Care FraudDon’t let anyone use your insurance card.

Keep your personal information safe.

Call your insurance company immediately if you lose your insurance card or suspect fraud.

Know Where to Go for Care

• Private Medical Group• Your Community Care Clinic• VA Outpatient Clinic• Urgent Care/Walk In Clinic

OR• Emergency Room

» Need Help?» Call 9-1-1 if you have an

emergency or life-threatening

situation.

Choose the Right Provider

• A Primary Care Provider for adults.

• Your child or teenager’s provider may be called a Pediatrician.

• If you’re elderly, your provider may be called a Geriatrician.

• A Specialist will see you for certain services or to treat specific conditions.

Find a Provider

• Identify providers in your network.

• Ask Around.

• Choose a Provider – Call the Provider’s Office.

• Give Them a Try!

Make an Appointment

• Demographic information• New or Established Patient• Reason for Appointment• Type of Insurance• Name of Provider

Be Prepared for Your Visit

• Show up early for your appointment!

• Check in with the front office staff.

• Complete additional forms.

• Read privacy policy. It is required by the law.

If you need to change your appointment contact your provider’s office as soon as possible.

Many providers charge a fee if you’re late, don’t show up,, or cancel less than 24 hours before it starts.

Follow UP the Next Step….

• Ask questions

• Schedule future appointments, tests and procedures

• Concerns between visits, call provider’s office

Insurance

• Insurance Claim

• Insurance Determination

• Explanation of Benefits (EOB)

• Appeals and Grievances

Thank You

EnrollMO at PCRMCPhone: 573-458-3676

Email: enrollmo@pcrmc.com