Pulse

Fall 2016

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8 | PULSE Fa l l 2 0 1 6 H E A LT H L I N KS T orrance Memorial Medical Center has been your hospital for years—for routine checkups, for care when you're ill. But let's say you've just changed employers, you're choosing your own health insurance for the first time, or you're joining Medicare or Covered California. How can you be sure you'll be able to keep your family doctor and continue to receive care at Torrance Memorial? First, the good news: there is no bad news. Torrance Memorial has agreements with most major health insurance plans. Now the other news. It's still not bad news: you may have several different health insurance plans from which to choose. at can be a positive, but choosing the best plan for you can be a complicated process. ere are several factors to consider, but as far as ensuring you will be able to receive care at Torrance Memorial, the difference between health insurance plans lies in their provider networks. Receiving care from a provider in your insurance plan's network—that is, an in- network provider—generally is easier and costs less than receiving care from an out-of-network provider. Different types of health insurance coverage have different rules. Exclusive Provider Organizations (EPOs): Generally limit coverage to care from in-network providers, except in emergencies. Health Maintenance Organizations (HMOs): Generally limit coverage to care from providers who work for or contract with their organization, except in emergencies. HMOs usually require their covered members to have a primary care physician (PCP); you will need a referral from your PCP to see a specialist. When you enroll in an HMO, the primary care physician you choose will affect where you are referred for inpatient and outpatient hospital services. Physicians with Torrance Memorial refer patients to Torrance Memorial Medical Center. Preferred Provider Organizations (PPOs): Allow you to receive care from in-network and out-of-network providers, although you will pay more to receive care from out-of- network providers. Point-of-Service Plans (POSs): Allow you to receive care from in-network and out-of-network providers. You'll choose a primary care physician from your POS plan's network. You'll be able to visit any provider without first receiving a referral, but you will pay more to receive care from an out-of-network provider. If you select a physician in one of the following groups, you can be assured that you will have access to Torrance Memorial: • Torrance Hospital IPA • HealthCare Partners South Bay • HealthCare Partners IPA, South Bay When you're choosing a health insurance plan, there are a few questions you should ask the insurance company and/or your chosen primary care physician to ensure you'll be able to receive care from Torrance Memorial physicians, specialists and facilities. > Does this plan include Torrance Memorial Medical Center physicians and facilities? > Are Torrance Memorial physicians and facilities in-network or out-of- network providers for this plan? > If Torrance Memorial physicians and facilities are not part of this plan's network, will I still be able to receive care from them as out-of-network providers? Will I need a referral first ? How much will it cost ? > Will I be able to choose a Torrance Memorial physician as my primary care provider ? > If I select a particular Torrance Memorial physician as my primary care physician, to which hospital will I be referred for inpatient and outpatient services? > Is the Torrance Memorial physician I want to select as my primar y care physician currently accepting new patients? CHANGING HEALTH INSURANCE, KEEPING TORRANCE MEMORIAL WRITTEN BY JOHN FERRARI

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