Navigating the landscape of healthcare can be complex, especially when it comes to understanding your health plan’s provider network. If you are a SCAN Health Plan member or considering joining, it’s crucial to understand how their network of health care providers operates to ensure you receive the best possible care and manage your healthcare costs effectively. SCAN offers a comprehensive network of primary care physicians, specialists, hospitals, and various other healthcare professionals dedicated to serving its members. This article will guide you through the essentials of the Scan Health Care Providers network, ensuring you have the information you need to make informed decisions about your healthcare.
Navigating In-Network and Out-of-Network Care with SCAN
SCAN Health Plan operates with a network of providers, meaning they have agreements with specific doctors, hospitals, and other healthcare facilities to provide services to their members at negotiated rates. For most SCAN plans, particularly HMO plans, receiving routine care within this network is a key aspect of your coverage. This means for all your regular check-ups, specialist visits, and planned medical services, you should seek care from providers who are part of the SCAN network.
There are exceptions to this rule, primarily for situations that require immediate attention. In the event of an emergency or urgent care situation, you are not restricted to in-network providers. Similarly, if you require out-of-area renal dialysis, you can seek care outside the network. However, for all routine healthcare needs, utilizing in-network SCAN health care providers is essential. If you choose to receive routine care from providers outside of the SCAN network without prior authorization, neither Medicare nor SCAN will be responsible for covering the costs. It’s important to note that specific plans like VillageHealth (in Riverside and San Bernardino counties, CA) and Embrace (in San Bernardino county, CA, and Maricopa, Pima counties, AZ), which are HMO-POS SNP plans, may have different rules. For detailed information regarding these exceptions and specific plan rules, always refer to your plan’s Evidence of Coverage (EOC) or contact SCAN directly.
How to Find SCAN Health Care Providers and Check Plan Availability
Ensuring you can easily access and verify the availability of SCAN health care providers is a priority. SCAN provides resources to help both prospective and current members find providers and confirm plan availability.
For prospective members looking to join SCAN, it’s important to verify if the plan and its network of providers are available in your county. You can easily check plan availability by using the online Plan Search Tool on the SCAN website. This tool allows you to enter your zip code and explore the SCAN plans available in your area. Alternatively, you can contact SCAN Telesales directly at (877) 452-5898 (TTY: (888) SCAN-TTY) to speak with a representative who can assist you with verifying plan options and provider network details in your location.
Existing SCAN members can verify specific provider information or address any network-related questions by contacting SCAN Member Services. You can reach them at 1-800-559-3500 (TTY: 711). Member Services is available from 8 a.m. to 8 p.m., seven days a week between October 1 and March 31. From April 1 to September 30, their hours are 8 a.m. to 8 p.m. Monday through Friday. Whether you need to confirm if a provider is in-network, understand your plan’s coverage details, or have general questions about your SCAN health care providers network, Member Services is your primary point of contact.
Messages left on holidays or outside of business hours will be returned on the next business day, ensuring you receive timely assistance.
Understanding Wait Times for Accessing Care
SCAN is committed to ensuring timely access to healthcare services for its members. Understanding the standard wait times for different types of care can help you plan your healthcare needs effectively. SCAN has established specific timeframes within which you can expect to receive care:
- Immediately: For services needed urgently or in an emergency, you will receive immediate access to care.
- Within 7 Days: For services that are not emergencies or urgently needed but still require prompt medical attention, you can expect to receive care within 7 days. This could include situations where you need to see a doctor for a health issue that needs relatively quick attention but is not life-threatening.
- Within 30 Days: For routine and preventative care services, such as annual check-ups or routine screenings, you can expect to schedule appointments and receive care within 30 days. This ensures you have access to regular health maintenance and preventative services in a timely manner.
These timeframes apply to both primary care and behavioral health services, ensuring comprehensive and timely access to a range of healthcare needs through SCAN health care providers.
Conclusion
Understanding your SCAN health care providers network is essential for maximizing the benefits of your health plan. By utilizing in-network providers for routine care, knowing how to verify provider and plan availability, and being aware of the access standards for care, you can navigate your healthcare journey with confidence. Whether you are a prospective member exploring your options or a current member seeking to optimize your healthcare experience, SCAN provides the resources and network necessary to support your health and well-being. Always remember to consult your plan’s Evidence of Coverage for the most detailed and specific information about your benefits and network rules.
