Frequently Asked Questions
Here are some frequently asked questions and answers regarding insurance.
Insurance Questions
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How do I know if my health plan includes MercyCare Community Physicians?
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How will MercyCare Community Physicians know which health plan I participate in?
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What is the difference between an HMO and a PPO?
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What does "in-network and out-of-network mean?
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How do I know if my health plan requires a referral or pre-certification for a service?
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What should I do if my health plan includes MercyCare Community Physicians as a participating provider, but I receive a notice saying I am out-of-network ?
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What if I have questions on my bill?
Q. How do I know if my health plan includes MercyCare Community Physicians?
A. MercyCare Community Physicians participates in most major health plans in our community. In addition, please review your health plan provider directory and/or consult with your health plan to confirm coverage.
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Q. How will MercyCare Community Physicians know in which health plan I participate?
A. Please present your current health plan identification card when you register for services at MercyCare Community Physicians.
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Q. What is the difference between an HMO and a PPO?
A. Health Maintenance Organizations (HMOs) require a patient to select a Primary Care Physician to coordinate his or her care. Most HMOs provide care through a network of hospitals, doctors and other medical professionals, that as a patient, you must use to be covered for that service. Preferred Provider Organizations (PPOs) provide care through a network of hospitals, doctors and other medical professionals. When patients utilize health care providers within the network, they receive a higher benefit and pay less money out of their pocket. Services received by a non-participating hospital or doctor may still be covered, but often at a reduced benefit level.
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Q. What does "in-network" and "out-of-network" mean?
A. If you receive your health care services from a hospital, physician or other health care provider that participates in your health plan, they are often referred to as "in-network." Hospitals, physicians or other health care providers who do not participate in your health plan may be referred to as "out-of-network."
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Q. How do I know if my health plan requires a referral or pre-certification for a service?
A. Your benefit book or provider directory should provide this for you. If not, call the customer service phone number listed on your insurance identification card.
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Q. What should I do if my health plan includes MercyCare Community Physicians as a participating provider, but I receive an explanation of benefits stating I am out-of-network?
A. Consult your health plan or call MercyCare Community Physician's business office, (319) 369-4505.
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Q. What if I have questions on my bill?
A. If you have questions about your MercyCare Community Physicians bill, or feel that it is incorrect, call (319) 369-4505, Monday-Friday, 8:30 a.m.- 4:30 p.m. Please have the patient's name and account number(s) listed on the bill or the patient's social security number ready when you call.
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