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Frequently Asked Questions
We are a health plan management company serving members throughout the New York and New Jersey region. Our main goals are to understand your health benefit needs and requirements - and then offer high-quality solutions that are also cost-effective. We want to be your advocate for the best healthcare solutions at the best possible price. As a new member of the MagnaCare health plan management network, you may have some questions about how MagnaCare works for you. Following are answers to many of the questions you may have concerning your health plan benefits. The most frequently asked questions. If you have any additional questions, please call MagnaCare's toll-free Customer Service Center at 1-800-235-7267.
PPO stands for Preferred Provider Organization. It is the network of physicians and other healthcare providers that work with employers and health and welfare funds to provide access to high quality healthcare while controlling costs. The PPO that your plan has selected is called MagnaCare Access.
What are the advantages of using MagnaCare Access? MagnaCare Access offers a vast choice of doctors, hospitals and ancillary providers in the Tri-State area who are carefully reviewed and credentialed. The advantages of using the MagnaCare Access provider network include:
How are MagnaCare Access physicians selected? MagnaCare selects only the most qualified physicians to join our network. Our demanding credentialing process includes careful examination of each physician's license, professional training, malpractice insurance history and professional references.
How can I find out which providers are included in the MagnaCare Access Network? A directory of MagnaCare Access providers is available at www.magnacare.com. You may also receive a printed directory through your employer or administrator. Both directories list participating network providers. Additionally, you may call Customer Service at 1-800-235-7267 to find a network provider in your area or for network updates.
Do I have to select a Primary Care Physician? Although not required, it is a good idea to select a primary care physician who can coordinate all of your care or recommend a specialist when necessary. There are several different categories of primary care physicians to choose from, such as family practice, pediatrics, internal medicine, and obstetrics and gynecology. MagnaCare recognizes that the healthcare needs of your individual family members can vary. That's why we offer you the freedom to choose different physicians for each member of the family - even specialists.
Do I need a referral to see a specialist? With MagnaCare, referrals are never required. You may consult any specialist of your choosing. If you have a primary care physician, he or she can help direct you to the type of specialist most appropriate for you.
What if I need help selecting a physician? With MagnaCare's strict screening process, you can select any of our physicians with confidence, however, if you need additional help, please call Customer Service at 1-800-235-7267.
If my physician is not listed in the MagnaCare Access Directory, why should I change? Because we negotiate significantly reduced fees with our physicians, it is likely that using a MagnaCare physician will save you money. Also, using a MagnaCare Access physician will make managing your health easier and more effective in the long run. As we are always adding new, qualified physicians to our network, your physician may have recently joined. Check periodically with MagnaCare Customer Service for directory updates.
When I get sick, how do I use MagnaCare Access? First, if you have selected a primary care physician, consult with him or her. If you have not selected a physician, use your MagnaCare Access directory to select a physician or other healthcare provider. Then, call the provider's office and identify yourself as a MagnaCare Access participant and make an appointment. When you go for your appointment, show your MagnaCare ID card to the receptionist. You must show the ID card in order to receive benefits at the MagnaCare Access discount rate.
Do I have to bring a claim form with me? No. MagnaCare providers have claim forms in their offices. After you complete the patient information section, our providers will then file the claim on your behalf to receive reimbursement directly from the claims payer.
Will I have any out-of-pocket expenses with MagnaCare? The only time you will be billed by the provider is for any co-payment, annual deductible, or co-insurance, if these are required by your plan. If you use a MagnaCare provider, however, your out-of-pocket expenses will generally be significantly lower. Refer to the back of your ID card for specific information on your plan's co-payments, annual deductibles or co-insurance requirements.
Is my family covered by MagnaCare? Coverage for family members varies with individual health benefit plans. If your MagnaCare ID card does not specify family coverage, check with your Plan Administrator or your Certificate of Insurance.
If possible, you should consult with your primary care physician for assistance. If that is not practical, you may go to any hospital and show your MagnaCare ID card. If hospitalization is required or recommended and you require the name of a MagnaCare physician in that hospital, contact MagnaCare's toll-free Customer Service number as soon as possible. Remember MagnaCare cannot certify or authorize eligibility for hospital admission. For further information, contact your Plan Administrator.
Is pre-certification required for hospitalization? Most plans require pre-certification. However, pre-certification requirements vary according to your individual health benefit plan. Check the back of your MagnaCare ID card or contact your Plan Administrator.
Which hospitals are affiliated with MagnaCare? MagnaCare's hospital network includes most hospitals in New York and New Jersey. Your MagnaCare physician can refer you to a hospital that is convenient for you or you can refer to your MagnaCare Access directory for additional locations.
How do I get lab work or x-ray studies done? The MagnaCare Access network includes the area's best diagnostic facilities, covering a complete range of laboratory and x-ray testing. Your MagnaCare physician can refer you to a facility that is convenient for you or you can refer to your MagnaCare directory for additional locations.
How do I get more information? MagnaCare's Customer Service Center is available during business hours (9 a.m. to 5 p.m. EST) to help you with any questions or problems concerning your MagnaCare program. Call toll-free: 1-800-235-7267 Online you can log on at: www.magnacare.com This information does not guarantee that all service or all providers will be covered under your Medical Benefit Plan. You must consult your health benefit booklet or Certificate of Insurance for complete details of your coverage, including limitations and exclusions. If you have questions, contact your Plan Administrator or personnel office directly. |
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