FREQUENTLY ASKED QUESTIONS (FAQs)
Here are some commonly asked questions and answers about GlobalHealth plans and benefits. If your question is not answered here, please call or email Customer Care
Do I need to select a Primary Care Physician?
How do I get the most from my health plan?
- As a GlobalHealth member, you must use plan providers to receive your covered services. This starts with choosing a Primary Care Physician from the list of physicians in the Provider Directory or the Provider Search tool.
- Each family member may choose a different PCP, including a pediatrician for children.
- You may change your PCP selection at any time throughout the year. Your PCP change will be effective the same day.
- If you do not choose a PCP, one will automatically be assigned to you.
What do I do if I need Urgent Care?
- See or call your Primary Care Physician (PCP) first for all your medical care. Your Primary Care Physician will see that you get the care you need, whether in his/her office or from another doctor.
- If you or a covered member of your family needs same-day urgent care, call your Primary Care Physician's office for medical direction. After hours, you may self-refer to an in-network Urgent Care Center.
- If you need emergency care, go immediately to the nearest medical facility. Call your Primary Care Physician within 48 hours of receiving the care. Emergency care is covered when it is for a medical emergency. An emergency is based on your presenting symptoms arising from any injury, illness or condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a reasonable and prudent layperson could expect the absence of medical attention to result in serious jeopardy to the patient's health (or in the case of a pregnant woman, serious jeopardy to the health of the fetus); serious impairment to bodily function; or serious dysfunction of any bodily organ or part.
- Follow-up care after an emergency is also covered when provided or arranged by your Primary Care Physician.
How do I change my Primary Care Physician?
How do I access my Behavioral and Mental Health Benefits?
1. If you need urgent medical care, call your PCP’s office and inform them that you are a GlobalHealth Member.
2. Inform your PCP or office personnel that you have an urgent medical problem and need assistance, and describe your condition or symptoms.
3. During office hours, your call will be given to your PCP or a medical staff person who will give you instructions.
4. After office hours
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- Call the number on your Member ID card for your PCP. Your PCP’s answering service will take your name and phone number. Your PCP or an on-call physician will call you back. You will be given medical direction at that time, which may include directing you to an Urgent Care Facility.
- After your PCP’s office hours or on the weekend, you may self-refer to an in-network Urgent Care Facility. For a list of in-network Urgent Care Facilities nearest you, please refer to the GlobalHealth Physician & Health Providers Directory, or utilize the Provider Search tool.
If you are traveling and require Urgent Care that cannot be delayed until you return to the GlobalHealth Service Area, contact your PCP for medical advice and direction, and/or self-refer to an Urgent Care Facility.
An Urgent Care Facility is not to be used in place of accessing your PCP for routine services and continuity of care. Use of Urgent Care services are only for an unforeseen illness, injury, or condition that requires immediate, Medically Necessary care. All follow-up care must be provided by your PCP, or arranged by your PCP, and prior authorized by GlobalHealth.
What do I do if a claim or referral request has been denied?
- Members may access mental health services directly by calling Mental Health Network (MHNet) at 866.904.5234 (toll-free).
- MHNet will manage and arrange all inpatient and outpatient mental health and substance abuse services to assure that you and/or your family members receive timely and appropriate care.
- You do not need to go through your Primary Care Physician.
- You must call MHNet at 866-904-5234 to receive a referral for any inpatient or outpatient behavioral health services. MHNet is available 24 hours a day, 7 days a week to assist you.
Do I need a referral to see a specialist?
- If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you have the right to appeal or file a grievance.
- GlobalHealth will reconsider the claim or service denial.
- Send your written request to GlobalHealth's Customer Care within six months of the day of the denial.
- For your convenience, you may access an Appeals and Grievance Request Form by clicking on Find a Form.
- If you have any questions, call Customer Care.
May I self-refer for any services?
- Yes, a referral and prior authorization from GlobalHealth are required.
- See your PCP first. When appropriate, your PCP will process a referral on your behalf for specialty care.
- When approved, you will receive a letter of authorization in the mail.
- Make your appointment with the Specialist as directed in the letter.
- The Specialist may process referrals for procedures and follow-up care after initial visit.
- Contact Customer Care for assistance.
How can I find out about my benefits?
You may Self-Refer for the following services:
- In-Network Well Woman Exams
- In-Network Routine Mammograms
- Behavioral & Mental Health/Chemical Dependency Services. Call Mental Health Network (MHNet) directly at 800-904-5234 (toll free)
Can I refer to a non-network specialist?
How long does it take to receive authorization on a referral request?
- As a general rule, GlobalHealth authorizes referrals to in-network specialists only. However, if we are not able to provide for specific services within our network, we will authorize a referral to a non-network specialist. In that case, a recommendation by the referring physician will be considered.
Who makes the final determinations on medical necessity?
- By regulation, GlobalHealth has five days to process a referral request. However, most requests are typically processed within 24 hours. Please refer to the GlobalHealth Provider Manual for more information.
How can a specialist be added to your network?
How can I find out what laboratories or facilities are in your network?
- The final determination for medical necessity is made by the GlobalHealth Medical Director.
Do you sell directly to employer groups or utilize brokers?
Do you do in-house underwriting?
- GlobalHealth sells business through brokers and directly to employer groups.
How many days does it take to get a quote?
- Yes, GlobalHealth has in-house underwriting.
Can you provide a GlobalHealth representative to conduct enrollment meetings?
- GlobalHealth requires a minimum of seven days to process a quote.
Can you get a plan without a prescription benefit?
- Yes, GlobalHealth will provide a representative to conduct enrollment meetings for large groups upon request.
How do you calculate your annual Maximum Out of Pocket (MOOP) for each plan?
- GlobalHealth is in compliance with the Essential Benefits as outlined by HHS. All medical plans must be paired with a GlobalHealth Prescription Drug Supplement.
Do your plans have a life-time maximum?
- Member co-payments and/or co-insurance are applied toward the MOOP and are tracked within our system. Prescription costs do not apply toward the MOOP.
What are the Preventive Services covered by your plan?
- GlobalHealth does not have a life-time maximum on any plans.
Are employees allowed to change their PCP throughout the plan year?
- GlobalHealth is in full compliance with the provisions of the Affordable Care Act (PPACA) and offers the recommended Preventive Services at no cost share to the member. For a complete list, go to www.healthcare.gov.
Can an employee request case management?
- Yes, members may change their PCP selection at any time throughout the year. The PCP change will be effective the same day. Each family member may choose a different PCP, including a pediatrician for children.
- Yes, an employee may request case management by calling Customer Care or filling out an online request form.
Is my prescription drug covered on GlobalHealth's formulary?
How do I request a prescription prior authorization?
- If you are a potential member of a covered employer group and have questions concerning coverage of your prescription medications, you may contact GlobalHealth Customer Care at firstname.lastname@example.org.
What is a formulary and how does it impact my copayment?
- Prior Authorization is required on certain drugs before coverage is available. If your formulary states that Prior Authorization is required, your doctor should submit a prior authorization request to GlobalHealth for approval. If the request is not approved, you still have the option to pay for the drug at your expense. To find the right form, please have your doctor visit the pharmacy prior authorization forms page.
Where can I find common drug interactions, side effects and generic substitutions?
How do I find the form I need?
What are generic drugs? Can generic drugs reduce my out-of-pocket expense?
- Click Drug Formulary to find out more about the GlobalHealth Prescription Drug Formulary.
Where can I find a list of Low-Cost Generics (LCG)?
- Click Generic Drugs to learn how to save with generic medications.
How do I start using Mail Order?
- Certain benefit plans may have a reduced copayment for certain generic drugs. Click here for a complete list of eligible products. Refer to your Schedule of Benefits to confirm whether your benefit plans offer this program or you may contact GlobalHealth Customer Care at email@example.com.
What is a maintenance drug? How do I find out if I am taking a maintenance drug?
I need to find a local pharmacy that is in my network. How do I find a list of participating pharmacies?
Is there a list of medications that may require my doctor to provide more information before payment is approved?
My physician stated that my prescription may be a Specialty Medication.
- Click Mail Order to learn how to receive your maintenance prescription drugs delivered to your home using Express-Scripts Member Choice pharmacy.
What is a drug recall?
- Click on Specialty Pharmacy to find a list of specialty drugs. Click on Accredo to learn more on how to get my specialty prescription filled and delivered to my home.
- A recall is when a product is removed from the market or a correction is made to the product because it is either defective or potentially harmful. Sometimes a company discovers a problem and recalls a product on its own. Other times, a company recalls a product after FDA raises concerns. If you have a medicine or device that has been recalled, talk to your health care professional about the best course of action. For other products, such as foods, dietary supplements and cosmetics, take them back to the place of purchase and ask for a refund. Stores generally have a return and refund policy when a company has announced a recall of its products. Please click here to be routed to the FDA website to see the most recent drug recalls.
What is an Advance Directive for Health Care?
Who can sign an Advance Directive for Health Care?
- An Advance Directive for Health Care is a written legal document which allows you to instruct your attending physician whether or not you wish to be given life-sustaining treatments and artificially administered nutrition (food) and hydration (water) and to give other medical directions that impact the end of life. Its purpose is to recognize your right to control some aspects of your medical care and treatment primarily including the right to decline medical treatment or direct that it be withdrawn even if death ensues. An Advance Directive for Health Care may include a living will, the appointment of a health care proxy (a person you authorize to make medical treatment decisions for you in the event you are unable to make such decisions).
Does the signing of an Advance Directive require witnesses and a notary public?
- Any person of sound mind who is 18 or older.
Does my physician have to comply with my wishes?
- An Advance Directive must be signed before two witnesses who are 18 or older. The witnesses cannot be beneficiaries under your will nor may they be persons who would inherit your property if you died without a will. An Advance Directive is not required to be notarized.
Can I revoke my Advance Directive?
- If you have completed an Advance Directive and been diagnosed as terminally ill or persistently unconscious by two physicians as defined in the Advance Directive and your attending physician does not want to comply with your wishes, that physician must act promptly to arrange for your care by another physician or health care provider.
Should I have an Advance Directive?
- After you complete an Advance Directive, you may revoke it in whole or in part at any time and in any manner, without regard to your mental or physical condition. A revocation is effective upon your communication to your attending physician or other care provider or a witness to the revocation.
Other Important Information Concerning Advance Directives
- Thinking about end-of-life decisions is not something we like to talk about. But, it is important to plan ahead and let your loved ones know your wishes should the unexpected happen.
- Be sure and make copies of your Advance Directive for your personal records, your family, your physician, your attorney, your Health Care Proxy and alternate Health Care Proxy.
- If you signed a Directive to Physicians or other Advance Directive for Health Care under Oklahoma law prior to 2006, it is recommended that you complete a new Advance Directive because of additional options under existing law.
- Oklahoma's Advance Directive for Health Care law allows you, if you are 18 years of age or older, to inform physicians and others of your wishes to provide, decline or withdraw life-sustaining medical care and to donate specified organs when you have been diagnosed by your attending physician and another physician to be in a terminal condition, a persistently unconscious state, or an end-stage condition.
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