Beginning January 1, 2006, the out-of-area provider network will change from the CCN Network to the Private Healthcare Systems (PHCS) Network. PHCS's network includes over 440,000 providers and over 4,200 facilities, located throughout the United States.
How Does This Change Affect Your Customers?
In our Premier PPO plans, when members travel nationwide, their health coverage goes with them. Members should follow these easy steps for health coverage when traveling throughout the United States:
- In an emergency, go directly to the nearest hospital or call 911.
- Always carry the current Optima Premier PPO Member ID card. To locate a participating provider visit www.phcs.com and select PPO providers, or call 1-888-817-7427.
- Obtain any necessary pre-certification or prior authorization by calling the number listed on the member ID card.
- When the member arrives at the participating provider's office or facility, the member should present his Optima Premier PPO ID card.
By displaying the new Optima Premier PPO member ID card to a PHCS provider, the PHCS provider will recognize that the member is an Optima Premier PPO member and will help to ensure that the member receive the in-network PPO level of benefits for covered services.
After the member receives care:
- There are no claim forms to file for covered services.
- There are no additional out-of-pocket expenses for medical services other than the usual in-network out-of-pocket expenses (non-covered services, deductible, copays, and coinsurance).
The member will receive a complete Explanation of Benefits (EOB).
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HMO and POS members can use the PHCS network if they have an urgent or emergent care need while traveling outside of the service area.
Members should keep the following in mind when using the PHCS network:
- In an emergency, go directly to the nearest hospital or call 911.
- Members still need to follow all health plan policies and procedures to ensure coverage. Refer to health plan document for details.
- To research PHCS participating providers visit www.phcs.com and select the Healthy Directions network, or call 1-888-972-7427.
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Additional Information
Want to nominate a physician that is not currently part of the PHCS network? Simply fill out the Provider Nomination Form on www.phcs.com.
Questions?
Contact us or call PHCS at 1-888-817-7427(PPO Members) or 1-888-972-7427(HMO Members).