Managed Care

To My Patients Who Participate In A Managed Care Organization (MCO)

You have become a member of a managed care organization and have selected me as your primary care physician. This letter will explain to you some of my responsibilities as your physician and some of your responsibilities as a patient (member).

It is my responsibility to diagnose and treat most of your health problems and to provide preventative medical care. If I am unavailable for any reason, there will always be a physician "on call" to assist you with your medical needs. If you have an unusual or complicated problem, I may send you to another participating specialist for further evaluation.

Your plan may specify that I can only authorize a certain number of visits to the specialist. After those visits, the specialist and I will decide whether your condition requires additional specialist care or if you can return to me for continued care. If certain tests or procedures are required, I may have to obtain approval from the MCO before they agree to pay for them. If the MCO believes that a test, treatment, or a procedure is unnecessary or is not covered by your contract, they refuse to approve it and, of course, will not pay for it. However, in those rare circumstances , failure to approve the test would not deter me from a recommendation if it was necessary. Denials can be appealed by you the member and me as your physician. If an appeal is unsuccessful, you can always obtain the medical service at your own expense.

If you have what you consider a life-threatening emergency, you should call 911 or go directly to the Emergency Room at St. Luke's-Roosevelt Hospital (either 428 West 59th Street between 9th and 10th Avenues or 113 Street between Amsterdam and Morningside Drive) or any other emergency room if it is closer! If you are in doubt about your condition being an emergency, please call. If you go to an emergency room and it is deemed not an emergency (such as a cold, sore throat, chronic joint pains, etc.), there is a possibility that your MCO will not pay the bill and you will be held responsible. However, when in doubt, always seek the care you think you require.

If any unexpected problem arises, do not hesitate to call, even if it is after hours, on a weekend, or on a holiday. Physician coverage is always available. It is your responsibility to follow my medical advice, to keep follow-up appointments, and to notify me if you are having difficulties.

You and I have entered a new form of medical care by joining a Managed Care Organization. The key to its success is establishing a strong, open relationship with your physician. If you have any questions, please feel free to speak with me. The only silly question is the one not asked. Managed care may not be for everyone and you may eventually decide to return to a prior plan. For now, let's work together to keep you in good health.

I participate in the following managed care programs:
(as of 03-14-99)

 

Insurance Company	My Provider Number	Phone Number
Amerihealth	#720828	800-923-6283
Anthem Health Network	#1764	800-692-6846
BC/BS Blue Choice PPO, HMO & POS	#26A131	800-342-9816
Cigna Health Plan	#432767N	800-345-9548
Magnacare	#133034318	800-624-6263
Medi Choice	#16701	800-640-6708
Oxford Health Plan /Oxford Liberty Plan	#P368783	800-444-6222
Physicans Health Services	#926739	800-441-5741
Prucare	#133034318	800-624-2293