Historical Newspapers of South Carolina

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Pages i Effect May 1,1986 ch Vice President of Human ajor providers of health care equests their cooperation and yl, 1986. TELEPHONE 833-5500 AREA CODE 603 ) respectfully request your cooperation and ent Life and Accident Insurance Company. , who use objective standards for medical lity of physicians. We realize your time is e program. All you need to do is make one toll-free number: 1-800-621-4309. If the i working days of the admission. If you are wing information: imber of patient and employee ist a possible alternative during the phone writing. :ed- Sincerely, Claude A. Crocker _ Who will be affected? All active and retired Clinton Mills employees and their eligible dependents covered by the company’s group health care plan who are to be admitted to the hospital for in-patient care. What is the purpose of hospital preadmis sion notification? PROVIEW, as the preadmission notification is known, determines if treatment could be performed on an out patient basis. PROVIEW may lower your costs for medical care in two ways: —It may reduce the total cost of treatment, so the amount you have to pay is less. —If you use PROVIEW, you are paid the regular benefit for hospital services covered under the Clinton Mills ben efits plan. If PROVIEW is not used, benefits may be reduced as much as $200. How does the program work? Anytime your doctor decides that you or your covered dependent should be admitted to the hospital for any non-emergency procedures, you should inform the doctor you and your Clinton Mills health care plan are participants in the PROVIEW program. Show your doctor your PROVIEW card which you will have received by May 1, 1986. Ask your doctor to call PROVIEW. Your doctor can call PROVIEW toll-free Monday through Friday between 8 a.m. and 4 p.m. in all time zones. The toll-free number is 1 - 800 - 621-4309. What happens after the doctor calls PROVIEW? PROVIEW evaluates the request using objective standar ds for medical care. Sometimes PROVIEW will recommend an alternate means of treatment. If this is done, your doctor and PROVIEW will discuss and decide what is most ben eficial for you. Many times there are other less costly means of treating a problem other than a hospital stay. PROVIEW wants to be certain you receive the best possible treatment. PROVIEW notifies you, your doctor, the hospital, and your group insurance claims office of PROVIEW’s recommenda tion regarding your hospitilization. Definition of admission type Scheduled — Patient’s condition requires non-urgent treatment which can be anticipated or scheduled in adv ance without posing a threat to patient’s health outcome. Under these conditions, PROVIEW must be called before admission. Emergency — Patient’s condition requires immediate hospital admission for treatment of a potentially life-threatening condition in which immediate medical treatment is required. When an emergency admission is necessary, your doctor has two working days to call PRO VIEW. What about maternity admissions? Your doctor may call PROVIEW within 30 days of the expected date of delivery. However, if hospitalization is required before this date and PROVIEW has not been notified, the doctor or doctor’s representative should call PROVIEW within two working days of the admission. Should PRO VIEW be notified for newborn admissions? If a newborn is unable to leave the hospital when the mother is discharged, the baby’s doctor should call PRO VIEW and provide the diagnosis and other necessary in formation so the review process can begin. What happens if I don’t use PROVIEW? If you use PROVIEW, you will qualify for regular coverage. If you don’t use PROVIEW, your benefits will be reduced by $200. This $200 will be treated as a non-covered expense. How can this program help me? Clinton Mills has retained Provident Insurance Company to provide PROVIEW. PROVIEW can help you decide wheth er or not hospitilization is the best choice of reviewing your doctor’s treatment plan before you go to the hospital. PRO VIEW will help you determine the necessity of a hospital admission. You may be spared the pain, discomfort and expense of an unnecessary hospital stay. Will PROVIEW delay my treatment or decrease my benefits? No. In no way is this program intended to delay the needed treatment you need or reduce any benefits you or your covered dependents are due. What must I or my covered dependents do in this program? You are not required to do anything except remind your doctor to make the toll-free call to PROVIEW and present your card to him. In the event of an emergency, remember your doctor should call within two working days. How will my doctor know about the program? A representative of Clinton Mills and Provident Insurance Company have contacted most area health care providers through personal visits and/or letters. What happens if my doctor doesn’t make the call? You have done your part when you present your PROVIEW card. Any further contacts necessary to process your claim will be made by Provident. In most instances, you will not be penalized for your doctor’s failure to contact PROVIEW. REMEMBER — The purpose of the PROVIEW program is to prevent unnecessary hospital admissions where alternate means of treatment are available. PROVIEW will save Clin ton Mills employees, their covered dependents, as well as the company money by reviewing the medical necessity for in-patient care. This program will in no way reduce your eligible benefits or delay appropriate medical treatment if you follow the PROVIEW procedures.