When selling a plan that uses network providers, make sure you explain to your clients that providers may join or leave the network at ANY time – without notice to the members. Before they seek care, it’s a good idea to contact the provider’s office directly to make sure they accept the specific plan your client chooses. And make sure they are in-network for that plan at that location. Some providers with multiple offices may only accept certain networks at some of their locations.
To help your clients locate in-network providers:
- Agents must use the Find a Doctor tool located on the Shop Medicare plans website listed below. The website is updated weekly: ABCBS Medicare Shop
- When searching for in-network providers, it would be helpful to select a specific plan first, and then select the other search criteria to narrow your results list down.
- Ensure to use the ‘Advance Search’ option, or use as many filters as possible when searching for specific in-network providers, hospitals and specialists. Some doctors and facilities are in-network for some locations and out-of-network at other locations.
- Enter the PCP ID # in the Find a Doctor tool to confirm the specific provider at that specific office participates in the selected plan.
- Once you select a PCP in the Find a Doctor tool, click on the ‘Details Link’ to find a list of all hospitals for which the physician is associated.
Remember that HMO plan members should coordinate their care with their primary doctor before seeing other providers. HMO members who use non-network providers in non-emergency situations will pay for the full cost of their care. Encourage your clients to contact Customer Service at the number on their ID cards if they have any questions you can’t answer for them.
Contact your Cornerstone senior service representative for more information