Getting Care
Coverage
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Billing
Membership
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Getting Care
How do I choose a doctor, and can I switch if I decide I want someone else?
You can use our searchable online Provider Directory to find and choose a personal primary care physician or self-referral provider, or to switch to a different personal physician. To learn about the process, read about Getting Care at Group Health.
To register your choice of personal physician, select a provider online or call Customer Service before making an appointment.
Once you've registered your choice with our Customer Service Center, call your doctor's office directly to make appointments. Let them know you're a Group Health member.
If you want to change doctors - for any reason - use the online provider directory or call Customer Service. Some areas may have limits on when you can change doctors.
Who can I call if I am ill after hours?
In a life-threatening situation, always call 911. If you need medical advice after your doctor's office has closed for the day, call our Consulting Nurse Service. The consulting nurse will give you advice on how to best treat your condition and, when necessary, recommend that you come in to an urgent care facility or the emergency room. If your question or concern is not urgent, you can use our enhanced online services to send a secure e-mail message to your health care team or the consulting nurse. You should get a reply by the end of the following business day.
What do I do in case of an emergency?
In a life-threatening situation, call 911 and the medics will take you to the nearest hospital. If you or a family member are admitted to a hospital outside our network, you must call within 24 hours to notify us or to request follow-up care (exception: Medicare members do not need to notify us).
The number to call appears on the back of your Group Health member ID card. Here are the numbers, listed by health plan:
Group Health, Options, Alliant, and other plans
Options Prime First Choice Network |
1-888-457-9516
1-800-231-6935 |
For urgent medical needs other than emergencies, call your regular Group Health medical center or doctor. After hours, call the Consulting Nurse Service.
What's the difference between urgent care and emergency care?
A life-threatening emergency is the sudden onset of a condition which requires immediate medical attention to prevent death or permanent injury. Examples of life-threatening emergencies include stroke, unstoppable bleeding, heart attack, and convulsions.
Urgent care is treatment for a condition that requires prompt attention, but does not pose an immediate, serious health threat. Ear infections and sprained ankles are examples of conditions that urgent care staff can treat.
How do I get a referral to a specialist?
A. Group Health members can make appointments directly with most Group Health specialists at Group Health-owned or -operated medical centers without a referral from their personal physician. Referrals are needed to see contracted specialists.
To get a specialty consultation from Group Health doctors at Group Health-operated medical centers, call the specialist's office directly or call Customer Service for assistance. Specialists are listed in the Provider Directory.
For mental health or chemical dependency (alcohol and drug problems) treatment, contact Behavioral Health Services. For other specialties, contact your primary care provider, who will discuss your health care needs with you and decide if referral to a specialist is appropriate. Many Options and Alliant members may also choose to see an out-of-network provider without a referral and be covered at a lower benefit level.
How do I get a second opinion about a medical condition?
For primary care issues, call your medical center and request an appointment with another primary care provider in your clinic.
For specialty issues, call the specialty clinic where you had your first appointment and request a second opinion. An appointment will be made with another specialist.
I've been trying to get through to my doctor's office all day and get either a busy signal or put on hold. Can you help me?
A. We apologize for the trouble. If you call the Customer Service Center, we can check the number to make sure it's correct (numbers sometimes change) and can also check to make sure there is no technical trouble.
You might find it helpful to know that some times are busier than others. Monday is the busiest day of the week, and morning is the busiest time of every day. If you call in the late afternoon, you'll find it easier to get through. Remember, if you have a life-threatening emergency, call 911. However, if it's another urgent matter, you can also call the Customer Service Center; the staff will try to get you through.
For communication that is not urgent, try our secure e-mail service to send online messages to your health care team. To use this service, you must register with MyGroupHealth for Members, then upgrade your account for access to our enhanced online services. You'll find instructions on how to register on the main home page of this Web site. After you register and log in, you'll find instructions on how to upgrade your account on your member home page.
Coverage
How do I know what my plan covers?
When you enrolled, you received a benefit summary (also called a certificate of coverage) that lists most covered services. If you have a coverage question that is not answered in the benefit summary, contact the Customer Service Center.
Are prescription drugs part of my coverage?
Most plans cover prescription drugs. Check your certificate of coverage or other coverage agreement for your prescription coverage. Just present your prescription and your Group Health membership card to any of the designated pharmacies listed in your Provider Directory.
If you have questions about whether a prescription you are currently taking will be covered, call a Group Health pharmacist or check our online Drug Formulary. You also may call Customer Service; they can tell you what medications are covered on your plan.
I am expecting a baby. How do I add my child to my Group Health policy?
If you're on an individual plan through Group Health, contact the Customer Service Center.
My family has a vacation planned. What medical coverage do we have while we're away?
Group Health enrollees are covered for emergency and urgent care while traveling anywhere in the world. This coverage is described in your Group Health certificate of coverage or medical coverage agreement. If you or a family member are admitted to a hospital while traveling, you must call within 24 hours to notify us or to request follow-up care (exception: Medicare members do not need to notify us).
The number to call appears on the back of your Group Health card. Here are the numbers, listed by health plan:
Group Health, Options, Alliant, and other plans
Options Prime First Choice Network |
1-888-457-9516
1-800-231-6935 |
While traveling outside the Group Health coverage area, members of Group Health Cooperative, Options, and Alliant health plans may get care at any facility of Kaiser Permanente. Check When You Are Traveling to learn more.
You are also covered for medically necessary outpatient services (except outpatient prescription drugs) when these are provided by a participating health maintenance organization (HMO). You can also call our Consulting Nurse Service to determine a course of care.
You can also use our enhanced online services to send secure e-mail messages to your health care team or to refill prescriptions while you are traveling. You must register with MyGroupHealth for Members and upgrade your account to use these enhanced online services.
The Customer Service Center can tell you if there is a participating HMO where you are visiting and more about your coverage. Some questions to ask the Customer Service representative:
- Does my coverage include a travel benefit?
- Am I covered for prescription drugs while traveling?
- Am I covered for any routine or follow-up care while traveling?
- What is my emergency room deductible while traveling?
How do I add dental benefits to my coverage?
Consumers on certain individual and Medicare plans have a dental option available to them. Contact the Customer Service Center to find out if you are eligible for dental coverage.
My daughter will be attending college out of the area next year. Will she continue to be covered under my policy?
Group Health enrollees who attend school in Central and Eastern Washington are covered through Group Health Cooperative services in Eastern Washington and North Idaho. Enrollees attending schools in other states are covered for urgent and emergency care only. Check your certificate of coverage, because the age for qualifying as a dependent varies between plans.
Note: Dependents covered under the Washington State Employees (PEBB) policy are covered for routine care anywhere in the United States as long as they are at school.
Billing Questions
What is a copayment?
A copayment is the amount the member is required to pay at the time services are rendered. Refer to your benefit summary for the copayments that apply to you.
I have a question about a bill I received. Where do I call?
There are three types of bills for Group Health services:
- Patient Financial Services bills both for copayments that were not paid at the time of service and for services you received that are not covered in your contract. For questions about these bills, contact the Customer Service Center.
- Individual members of Group Health (not covered through an employer or other group) receive a monthly dues billing. If you have a question, contact the Customer Service Center.
- Services from non-Group Health providers (e.g., an emergency where you were taken to the nearest emergency room) may be billed by the outside provider. If you receive such a bill, send a copy to:
Group Health Claims Administration
P.O. Box 34585
Seattle, WA 98124-1585
If you have any questions about where to call, contact the Customer Service Center..
Where do I send a bill for reimbursement from an outside provider?
Members with Group Health, Options, and Alliant health plans should send a copy of the bill to:
Group Health Claims Administration
P.O. Box 34585
Seattle, WA 98124-1585
Membership Questions
I just joined Group Health. How do I get started using my health care?
New Group Health members should receive new members materials, including an identification card, a benefits booklet/certificate of coverage, a "Your Guide to Group Health" manual, and a provider directory. If you have not received these items, contact the Customer Service Center..
One of your first steps as a new member is to select a personal physician, who will provide your primary health care. You can find and select a personal physician by using our online provider directory or by contacting the Customer Service Center..
In addition, you will want to register with MyGroupHealth for Members to get access to a wealth on health information and other online services, including prescription refills, secure messaging with your doctors, appointment requests and access to parts of your medical record.
How do I get a copy of my medical records?
To protect patient confidentiality, Group Health is required to obtain a medical release form - signed and dated by the member/patient - for the release of all medical records (including X-rays). You can get a release form from our Customer Service Center..
If you are a current enrollee or it has been fewer than six months since you have disenrolled, send the request to the medical center where you received your care. If it has been more than six months since you were a Group Health enrollee, send the request to our archives location:
Group Health Records
7859 S. 180th St.
Kent, WA 98032
fax: 206-901-3960
Please include:
- Your full name
- Your name at time of membership (if different)
- Date of birth
- roup Health number
- Mailing address
- Current phone number
There is no charge for medical records sent directly to another physician. There is a fee (based on number of pages) for records requested for personal use or by an attorney or insurance company.
If you have any questions regarding the location of your medical records, contact our Customer Service Center..
In addition, parts of your medical record, including lab results and immunization and allergy history, are available online. You must register with MyGroupHealth for Members and upgrade your account to use these enhanced online services.
I lost my Group Health member ID card. How can I get another one?
You can order a new ID card online if you are registered and logged in to MyGroupHealth. Or you can contact the Customer Service Center.. You will receive a new card in the mail in approximately 10 business days.
If you have not yet done so, log in or register with MyGroupHealth for Members to access the ID card order form.
Meanwhile, you can still receive medical care from your medical center if you need care.
What do all those numbers on my card mean?
If your membership card was issued after June 2003, it lists your name, the name of your insurance plan, your unique identification number, and two columns of numbers below. The numbers on the left side of the card help us process your pharmacy claims. The numbers on the right side of the card list your copay amounts for office visits, pharmacy, inpatient services, and emergency room visits. Group Health is phasing out cards that contain other information, such as subscriber name and number, birth date, and Web access number.
What is Group Health's relationship with Virginia Mason?
Virginia Mason Medical Center and Group Health formed an alliance in 1993. They contract with each other for shared Seattle hospital services and the Alliant health plan.
What is Group Health's relationship with Kaiser Permanente?
Kaiser Permanente, the nation's largest nonprofit health care system, and Group Health created an alliance in 1997. Both remain independent and separate, but collaborate on regional and national marketing and share best clinical and administrative practices, full-service reciprocity, and some shared purchasing contracts.
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