SelectHealth | Total Fitness | Winter 2016

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When you are traveling, peace
of mind is priceless. It’s important
to know where to go if you need
medical care.
OUTSIDE THE STATE
If you have an emergency or need
urgent care outside of Idaho or Utah,
participating benefits apply to services
you receive in a doctor’s office, urgent
care facility, or emergency room. In an
effort to reduce your medical out-of-
pocket expenses incurred while traveling,
SelectHealth is contracted with the
MultiPlan and Private Healthcare Systems
(PHCS) networks of healthcare providers
and facilities. They have agreed to accept
an allowed amount for covered services,
which means you will not be responsible
for excess charges when using these
providers. In addition, they will bill us
directly. Always present your ID Card
when visiting providers or facilities. The
logos on the card give you access to these
networks. To find MultiPlan or PHCS
Out-of-area coverage
providers and facilities, call MultiPlan at
800-678-7427 or visit .
OUTSIDE THE COUNTRY
If you are traveling outside the country
and need urgent or emergency care, visit
the nearest doctor or hospital. You may
need to pay for the treatment at the
time of service and submit a claim to
SelectHealth that includes the following:
• A printed receipt with the provider’s
address and phone number
• The date of service
• A description of the
treatment received
• The amount charged
With the exception of urgent and
emergency situations, care provided
outside of the United States for ongoing
or chronic issues must be preauthorized.
For more information or
help finding a provider,
call Member Services at
800-538-5038 or visit
.
Dealing with urgent or ongoing
medical needs can be overwhelming.
We’ll make sure you don’t have to
do it alone. Our care managers are
registered nurses who are specially
trained in all areas of healthcare. They
can help you navigate the system and
follow doctors’ recommendations—
answering questions about health and
benefits and coordinating the best
care possible.
Whether you’re dealing with a major
trauma, a new diagnosis, or managing
a condition you’ve had for a while,
care managers provide expertise and
a listening ear so you can focus on
getting better. Our care managers
are local and familiar with area
providers, hospitals, and healthcare
services. There is no additional cost to
consult with a care manager, and the
information shared is confidential. A
Our care managers are here to help
SelectHealth representative often contacts
members immediately following certain
diagnoses to see if they would like help.
However, we invite you to contact us
if you have questions or feel you or
someone you know would benefit from
these services.
WE’VE GOT SUPPORT FOR
DISEASE MANAGEMENT
We offer ongoing care management
support for those with chronic health
conditions. You may receive educational
materials, follow-up phone calls, and one-
on-one access to a nurse as you learn to
manage your condition long term.
We specialize in the following conditions,
among others:
• Allergies and rhinitis
• Asthma
• Cancer
• Chronic obstructive pulmonary disease
• Depression
• Diabetes
• Heart disease
• High blood pressure
• High-risk pregnancy
• Migraines
COVERAGE DECISIONS
Our Utilization Management
department makes coverage decisions
based only on appropriateness of
care and service existence. We do not
reward providers or other individuals
for issuing denials of coverage or care.
The financial incentives for utilization
management decision makers do
not encourage decisions that result
in underutilization.
If you have questions or feel
you or someone you know
would benefit from these services,
call 800-442-5305 .
Total Fitness | Winter 2016 |
safe & sound