12 / 20
12
|
Group Insurance Plan Book
Care for
Special Circumstances
You may be wondering why we ask you to select a primary care provider (or location) within the Dean Health Plan network
when you enroll. It’s because we emphasize a proactive, preventive approach to care—one in which a primary care
provider oversees all aspects of your health care needs. This keeps you and your family well, decreases the duplication
of services and provides you with better health care value for your dollar. Your primary care provider should be your first
choice for care whenever possible, but know that when a more immediate need arises, you do have other options.
If you’re unsure where to get care, call Dean On Call, our 24-hour nurse hotline for help. See page 3 for more
information about Dean On Call. Making the right choice when it comes to the care you need ensures you receive the
right care in the right place without unnecessary costs.
Out-of-Area Care
With Dean Health Plan, there’s no need to take health insurance worries on vacation. Both urgent and emergency
care are covered by Dean Health Plan if you or your covered family member are unable to return to the service area
for immediate treatment. It’s also a good idea to familiarize yourself with the types of ailments that can be treated as
urgent care vs. emergency care. Visit
deancare.com/rightcarefor details.
Prior Authorization
There are certain medical services or provider visits that must be authorized by Dean Health Plan before claims
payment can be provided. These authorizations are required so our Medical Affairs team can make sure you are getting
the appropriate care.
Getting Help with Care Decisions
When you have questions related to using health care services, such as prior authorization, Dean Health Plan is
available to help. Simply contact the Customer Care Center at
(800) 279-1301
TTY users dial 711. A staff member
will connect you to our Medical Affairs Department if he or she is unable to address your questions. Customer Care
Specialists can also assist those members who do not speak English. Staff members are available Monday through
Friday, 8 a.m. to 4:30 p.m. If you have an urgent need outside those hours, leave a message with the Customer Care
Center and your call will be returned within one business day.
PRIMARY
CARE
URGENT
CARE
EMERGENCY
CARE