是的. 你应该让你的医生预先证明你的住院时间, 熟练护理, 康复治疗, 精神健康服务, 家庭健康服务, 耐用的医疗设备, 氧气设备和助听器.
如果你打算做选择性手术, 以下需要预先证明:器官移植, 肠道或胃旁路治疗肥胖, 小脑和背侧刺激器植入物, 为腭裂植入假体, 包括乳房成形术在内的整形手术, 乳房缩小成形术.
你的医生应该给你打电话 1-800-292-2288 预先认证服务.
的资金 has a Directory of Cooperating Providers that you should use for all medical services. These providers have a relationship with the Funds and will not balance bill you for services after the Funds’ payment, 适用的共同付款除外.
You may go to providers outside the Funds’ Cooperating 供应商目录, but those providers may attempt to balance bill you for amounts in excess of the Funds’ payments. 当这种情况发生时, 皇冠搏彩中心网站将保护您免于支付这些金额, but keep in mind that the providers may indicate an unpaid balance on your credit report.
的资金 also has a directory of Durable Medical Equipment (DME) and Hearing Aid providers that must be used for obtaining those services. Services from non-cooperating DME and Hearing Aid providers are not covered. If you are currently using items being supplied by a DME company not in the Funds’ DME Directory, 您将需要切换到我们的合作DME供应商之一.
*Note – If you are in the Funds’ 1993 Benefit Plan, there is a small listing of Non-PPL providers. If you have services from these providers you will incur a higher co-payment responsibility.
的资金 maintains a database of “Cooperating Providers” that have agreed to not balance bill you. 虽然您不需要使用此数据库中的提供程序, these providers have agreed to accept the Funds’ payment as payment in full, 减去你可能欠的任何适用的共同付款.
居住在宾夕法尼亚州西南部的受益人, 西弗吉尼亚北部和伯明翰, 阿拉巴马州, 可以选择参加PCP. 联络皇冠搏彩中心网站电话中心(800-291-1425)查询你所在地区的PCP.
There are several factors that need to be considered to make that determination. 请致电呼叫中心(800-291-1425，选项2)提供有关其他保险的资料. 的资金 will also periodically ask you to submit updated information about your other insurance coverage.
这是你自己的决定. If you decide to terminate your other coverage you will need to mail the Funds a copy of the termination letter from your other insurance plan to:
皇冠搏彩中心网站健康呼叫中心
160 Heartland博士.
贝克利，邮编25802
如果你保留其他保险, 请致电呼叫中心(800-291-1425)，选项2)提供有关其他保险的资料. 的资金 will also periodically ask you to submit updated information about your other insurance coverage.
No, the Funds is your 医疗保险 Part B payer for non-facility providers. When you go to a physician or other non-hospital type of provider (i.e. 放射科医生或实验室等.) you should present only your Funds ID card to those providers because the Funds is your 医疗保险 Part B payer. 如果你去医院, 熟练的护理机构, 或者有家庭保健, these providers must bill 医疗保险 Part A for all services and then bill the Funds’ plan as the secondary payer.
如果你符合医疗保险资格, and have signed up to have the Funds as your 医疗保险 Part B payer and 医疗保险 confirms that transition, your doctors will be required to bill the Funds for all 医疗保险 Part B services, 非设施提供者提供的资料除外(例如.g. 医院、专业护理机构、家庭保健机构等). Until it is confirmed that you are in the Fund’s 医疗保险 Part B plan, your doctors should continue to bill 医疗保险 Part B for all services. 您的医生可以皇冠搏彩中心的医疗服务部门 (888) 865-5290，如果他们有任何问题.
No, the Funds does not recommend that you enroll in a 医疗保险 Advantage plan. 的资金 plan is your 医疗保险 Part B plan and will pay your doctors’ bills and other non-hospital charges. You will need to present your Funds’ health card to your doctor the next time you go to his office. 医疗保险A部分会支付你的医药费, just present your 医疗保险 card to the hospital at the time of service.
是的. 然而，助听器必须通过其中一个 皇冠搏彩中心网站合作助听器供应商 and must be approved by the Funds’ Prior Authorization Department (800-292-2288).
A hearing aid purchased from a vendor not in the Funds’ directory will not be covered. 然而, if you already have hearing aids from a non-cooperating vendor and need repairs and the warranty is still in effect, 该供应商应执行任何维修. If the warranty has expired, the Funds will direct you to a cooperating vendor for the repairs.
是的, 该皇冠搏彩中心网站支付例行眼科检查, 眼镜, 隐形眼镜每24个月戴一次，付款有限制. The beneficiary will be responsible for a significant portion of the charges for routine vision care. Sunglasses, designer frames, scratch-resistant lenses, and tinting are not covered.
是的, if you need to schedule a medical appointment but do not have transportation, 你可能有资格享受非紧急交通福利. 呼叫 1-800-292-2288 然后按选项4寻求批准.
是的, 带着医嘱, 熟练护理, 物理治疗, and speech therapy may be provided by licensed personnel from a certified home health agency. 医疗保险受益人, 医疗保险 is the primary payer and 医疗保险 Part A must approve these services. Home health visits to assist with activities of daily living (bathing, 喂养, 打扫房间, 等.)不在保险范围内.
须经事先批准, coverage is provided for medically necessary 熟练护理 in a 熟练护理 facility. 医疗保险受益人, 医疗保险 Part A covers the first 100 days of skilled care. 的资金 can cover services in excess of 100 days if the Funds pre-certifies the services as skilled care. To pre-certify, the facility should call our Precertification Department at 1-800-292-2288. Nursing home stays for custodial care (personal care, 喂养, toileting, 等.)不在保险范围内.
为免疫接种提供保险, 检查高血压, 糖尿病, 以及其他条件, 以及医学上必要的癌症检测, 失明, 和耳聋.
**Note – the 1993 Benefit Plan and the 预支福利计划 do not cover preventive care office visits for non-医疗保险 beneficiaries between the ages of 6 and 55.**
虽然皇冠搏彩中心网站的计划不包括这些服务, 医疗保险确实包括一些脊椎按摩服务. If you are eligible for 医疗保险 and have elected the Funds as your 医疗保险 Part B payer, the Funds will pay any chiropractic services that are covered by 医疗保险 Part B. The beneficiary will be responsible for any copayments or coinsurance due after the 医疗保险 Part B payment is made.
