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Getting Care Quickly

Getting Care and Getting It Quickly

Doctors and patients may have very different expectations of what care is needed as well as how quickly it is needed. Don’t be afraid to ask questions. Your doctor can explain why they are recommending specific care and how long it will be for an appointment with another doctor.

Referral process

GlobalHealth uses a prior authorization process to ensure members get the right care, at the right time, in the right setting.

Your doctor will submit a referral to GlobalHealth with appropriate clinical documentation. The referral team reviews the referral and processes appropriate prior authorizations. You and your doctor receive letters telling you the next step.

Prior authorizations are typically processed within a few days and some on the same day. Others may take up to two weeks.

Access/timeliness expectations

Provider appointments may take up to 30 days, depending on the type of doctor you are going to see. Ask your PCP what to expect when you are getting a referral to a specialist – how soon does he or she expect you to be seen by the specialist.

Ask when to expect test results. If you don’t get the results, call.

Please remember to call your doctor’s office if you can’t make it to your appointment.

Getting Care

Action

What To Do

Choose a PCP
  • Each family member may choose a different PCP.
  • You may choose a pediatrician for your child (up to age 18).
  • You may change your PCP at any time during the year. Your PCP change starts the same day. If you need to see a PCP before you get your new member ID card, contact us.

See Your PCP

See your PCP first for all your medical care.

  • Your PCP will coordinate and manage your medical care.
  • Ask which preventive services are right for you.
  • For same-day urgent care, call your PCP's office for medical direction.
  • After-hours, you may self-refer to an urgent care center.
  • When it’s an emergency, go to the nearest hospital emergency room or call 911.

See a Specialist

To see a SPECIALIST, you need a referral (commercial members only, Medicare Advantage members may self-refer for an office visit).

  • If you need specialty care, your PCP will send us a referral.
  • Prior authorization from us is required, which is valid for a 90-day period.
  • When approved, we will send you a letter in the mail.
  • Make your appointment with the specialist as directed in the letter.
  • The specialist may submit additional Referrals for procedures and follow-up care related to the initial visit. Be sure to go back to your PCP for all other care.
  • In most cases, you will need to go back to your PCP after 90 days for follow up.
  • Behavioral health specialists do not require a referral.

Go to the Hospital

To go to the HOSPITAL, you need a referral.

  • A referral and prior authorization from GlobalHealth are required for scheduled stays.
    • When approved, we will send you a letter of authorization.
    • Go only to the hospital listed in the letter.
  • You do not need prior authorizations for stays in connection with childbirth or ER.

Self-refer

You may self-refer for the following care (no referral or prior authorization needed). See your member materials for covered benefits and cost-sharing information.

  • After hours or out-of-area urgent care
  • Behavioral healthcare
  • Case management
  • Chiropractic care
  • Emergency care
  • Eyeglasses or contacts
  • Physical therapy evaluations
  • Routine eye exams
  • Routine mammograms
  • Services within an obstetrician/gynecologist’s (OB/GYN) scope of practice

Go to the Pharmacy

See the Drug Formulary to check specific drug coverage information and prior authorization or other requirements. Be sure to view the Drug Formulary list that matches your Plan. See the Pharmacy Directory to find a pharmacy in the network.

Go to Urgent Care or ER
  • Your PCP is always your first contact for direction when you begin to feel you are becoming ill.
  • Urgent care is care for an illness, injury, or condition serious enough that you need care right away, cannot get into your PCP in a timely manner, and is not serious enough to go to the ER.
  • ER is for sudden symptoms that are life threatening, causing serious impairment/dysfunction of bodily and cognitive functions.