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UNDERSTAND
YOU AND YOUR HMO DOCTOR
 
INDIVIDUAL FAMILY

Specific information for individual family coverage

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SMALL BUSINESS

Specific information Small Group coverage for 2-50 employees
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SENIOR

Specific information for Seniors eligible for Medicare Supplement


 

You and Your Arizona health insurance HMO Doctor

Your primary care doctor gives you your basic care and oversees your treatments. In most HMOs, you must choose a primary care doctor. You can change doctors if you do not like the doctor you have.

Your Rights

  • Your doctor should help you get the services you need and understand your care.
  • Your doctor should tell you all of your treatment choices, even if they are not all covered by your plan.
  • Your doctor should make sure that you give informed consent when you have a treatment.
  • You may be able to change doctors if you want.   It can take up to a month to get a new doctor.
  • If your doctor or medical group leaves your health plan, you must be told so you can get another doctor.

Choosing a Doctor

  • Your primary care doctor can be a family doctor, an internist, a pediatrician (children's doctor), a gynecologist (women's doctor), or a nurse practitioner who works with a doctor.
  • Your primary care doctor's office should be easy for you to get to. You can usually ask for a doctor within 15 miles or 30 minutes of your home or work.
  • Ask your health plan for a list of primary care doctors. You may have to call more than one doctor before you find a doctor who is taking new patients.
  • Ask friends and co-workers for the names of doctors they like.

Make the Most of Your Visit

  • Bring a list of your questions and concerns.
  • Bring a list of all your medicines (including over-the-counter medicine and supplements) and how much (the dose) you take of each one.
  • Repeat what your doctor tells you in your own words, to make sure you understand.
  • Take notes.
  • Ask how to reach your doctor between visits.
  • Bring someone with you for support.

Medical Groups

A medical group is a group of doctors who have a business together and have a contract with a health plan to give services to the plan members. Your primary care doctor and most of the specialists you see will usually be a part of your medical group.

You may receive your care through a medical group, but it is your health plan that is responsible for covering your health care. This means your plan must make sure you get the same level of health care no matter who your doctor is or what happens to his or her medical group

 

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