Frequently Asked Questions
How do you get medical care?
When you join Keystone Mercy Health Plan, you choose a Primary Care Practitioner (PCP). Your PCP oversees your health care. He or she is responsible for taking care of your health and, when necessary, arranging care for you from other health care providers. This is called "coordination of care." Coordination of care by your PCP helps to make sure you are getting the type of care you need.
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How do you get information about your Primary Care Practitioner (PCP)?
You may call Member Services to get more information about your PCP.
How do you choose or change a PCP or other health care provider?
When you join Keystone Mercy Health Plan, you choose a Primary Care Practitioner (PCP). Your PCP oversees your health care. He or she is responsible for taking care of your health and, when necessary, arranging care for you from other health care providers. This is called "coordination of care." Coordination of care by your PCP helps to make sure you are getting the type of care you need his answer links to the sectin on PCP which does answer the question.
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How do you request a list of participating providers?
Member Service Telephone Number
1-800-521-6860
What do you do if you get a bill from a health care provider?
As a Keystone Mercy Member, you are not responsible to pay for medically necessary, covered services. You may, however, be responsible for a co-pay.
You can be billed for health care services if one of the following situations happens:
- A service is provided without prior authorization in cases when prior authorization is required; or
- A service is provided by a provider who is not in Keystone Mercy's network and prior authorization was not given to see the provider; or
- A service provided is not covered by Keystone Mercy and your health care provider told you before you received the service.
Your health care provider can also bill you for co-pays that were not paid at the time you received the service.
If you receive a bill from a health care provider, you should call the health care provider listed on the bill and make sure they have all your insurance information. If you still feel you were billed in error, you should call Keystone Mercy Member Services.
How do you solve a problem about your health care?
Member Service Telephone Number
1-800-521-6860
How do you find out about Special Needs services?
Sometimes members have special medical conditions that require coordination with many healthcare providers or with other organizations and services. Case managers in the Keystone Mercy Special Needs Unit work closely with health care providers, community organizations and social service agencies to help our members get care. If you think you or a member of your family needs this kind of help from the Special Needs Unit, call Member Services to ask for someone in the Special Needs Unit.
How do you make suggestions on improving health care services for you?
Member Service Telephone Number
1-800-521-6860
How do you know Keystone Mercy is providing you with quality care?
Take a look at our Quality Improvement Program. |
