Navigating your healthcare plan is crucial for ensuring you receive the timely and appropriate care you need. SCAN Health Plan is committed to providing its members with access to a comprehensive network of healthcare professionals. Understanding how to utilize this network, especially for primary care, is a key aspect of your SCAN membership. This guide outlines the essentials of accessing your Scan Health Prime Care network to help you manage your healthcare effectively.
Understanding Your SCAN In-Network Care
SCAN Health Plan operates with a network of doctors, specialists, hospitals, and various healthcare providers designed to offer coordinated care. For routine healthcare services, it’s important to receive care from providers within the SCAN network. This in-network requirement ensures that your care is covered under your plan benefits.
There are specific situations where out-of-network care is permissible. These exceptions include:
- Emergency or Urgent Care: In emergency or urgent situations, you can seek care from the nearest available provider, whether in or out of the SCAN network.
- Out-of-Area Renal Dialysis: If you require renal dialysis while outside your plan’s service area, you are not restricted to in-network providers.
It is important to note that for routine healthcare received from out-of-network providers, neither Medicare nor SCAN will be responsible for covering the costs. Certain SCAN plans, like VillageHealth (in Riverside and San Bernardino counties, CA) and Embrace (in San Bernardino county, CA, and Maricopa and Pima counties, AZ) HMO-POS SNP plans, may have different rules. For specific details about your plan’s coverage, it’s best to consult your plan’s Evidence of Coverage (EOC) document or contact SCAN directly. Keep in mind that SCAN’s provider network, formulary, and pharmacy network are subject to change, and you will receive appropriate notification should changes occur.
Checking Plan Availability and Contacting SCAN
SCAN Health Plans are not available in every county. To verify if a SCAN plan is offered in your area, utilize the online Plan Search Tool. You can also contact SCAN directly to confirm plan availability and address any questions you may have.
For Current SCAN Members:
Contact SCAN Member Services to verify information or get assistance 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, hours are 8 a.m. to 8 p.m., Monday through Friday.
For Prospective SCAN Members:
If you are considering joining SCAN, please contact SCAN Telesales at (877) 452-5898 (TTY: (888) SCAN-TTY) to learn more about available plans and coverage options.
Messages left on holidays or outside of business hours will be addressed on the next business day.
Understanding Wait Times for Primary and Behavioral Health
SCAN is dedicated to providing timely access to healthcare services. You can expect the following access standards for primary care and behavioral health services:
- Immediately: For emergency services or situations requiring urgent attention.
- Within 7 Days: For healthcare needs that are not emergencies or urgent but still require prompt medical attention.
- Within 30 Days: For routine and preventative care appointments.
By understanding your SCAN health prime care network and access guidelines, you can confidently manage your healthcare needs and ensure you receive the benefits and services available to you as a SCAN member.
