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Important Disclosure Information We appreciate the trust you have placed in us by selecting the Centre For Health Care as your health care provider. The Centre For Health Care contracts with a number of health insurance plans to provide your care. The health insurance plans require that the Centre to provide you with various types of information. For your convenience, we have included this information here on our website. If you have any questions, or would like a printed copy, please call (858) 613-8910. Advance Directive Policy The Advance Health Care
Directive became the legally recognized format for a living will in
California on July 1, 2000. An Advance Health Care Directive is the
best way for a patient to make sure their wishes are known and
considered in the event they are unable to speak for themselves. The
Centre For Health Care will provide patients interested in learning
more about Advance Directives with referrals to information sources. A
patient with an Advance Directive shall not be refused treatment nor
discriminated against. . Utilization Management decision-making is based on the appropriateness of care and service. · Park Terrace Medical Associates/Centre For Health Care does not specifically reward practitioners or other individuals conducting utilization review for issuing denials of coverage or service. . Financial incentives for utilization management decision makers do not encourage decisions that result in under- or over-utilization. Communication Regarding Utilization Management Issues Centre For Health Care has processes in place to provide access to staff for members and practitioners seeking information about the Utilization Management (UM) process and the authorization of care. Utilization Management Member Services staff are available at least eight (8) hours a day during normal business hours ( 8 am – 5 pm Monday through Friday) to receive inbound communication regarding UM issues. They can be reached at 1-858-824-7177. Member services staff are authorized to accept collect calls from members regarding UM issues. The UM Department has a voice mail box to accept after hour messages. Calls are returned the following business day during the week. Weekend messages are returned on Monday morning.Cultural Competency Statement Provision of health services is not influenced by member race, ethnicity, national origin, religion, sex, age, mental or physical disability, sexual orientation, genetic information, or source of payment. Physician Compensation The Centre’s goal is to fairly compensate physicians for care that meets high professional standards. Physicians are strongly encouraged to discuss all health care options with their patients. There are no incentives to withhold such information nor are their incentives to withhold medically necessary services. A combination of physician compensation methods are used at the Centre. Physicians are paid a base salary for their services, and can receive additional compensation based on their workload as well as the achievement of specific quality and customer satisfaction goals. Prior Authorization Rules All health plans require that the Centre have an evaluation process in place before a patient can receive certain types of services. This is called prior authorization. The types of service that must undergo the prior authorization process will vary according to the terms of your individual health plan. You can obtain this information from your health plan’s member guide. When required by your health plan, the Centre must make a determination as to whether certain care is medically appropriate before it is delivered. In general, this process is required for non-emergency care and certain procedures and treatments. Your Primary Care Physician (PCP) is responsible for providing primary care services to you. When services of a specialty provider are deemed medically necessary, the PCP is responsible for referring you in accordance with the Centre For Health Care’s referral procedure. Review of certain referral requests (based on the terms of your health plan contract) will be the responsibility of the Utilization Management Department and the Utilization Management Physician. PCPs may directly refer you for consultation with a contracted specialty physicians who may perform, without prior authorization, specific services in the office and services covered under your health plan. Physicians are required to refer you to the Centre for Health Care’s contracted providers for laboratory, radiology, physical therapy, home health, durable medical equipment, and other medical services. Requests for specific procedures will require your PCP or specialist to submit a referral request to the Utilization Management Department. Referral requests should be submitted with all available pertinent data and documentation. Referral requests are reviewed for medical necessity by qualified medical professionals. When needed, physician consultants from the appropriate specialty areas will be used for the review of complex cases. Only a licensed physician may determine that a request for medical care should be denied because it is not medically necessary. The Utilization Management Department will confer with your health plan as needed in ambiguous cases, as well as cases involving benefit policy determinations. Review of requests involving new medical technologies (i.e., new medical procedures, drugs, devices) will be the responsibility of your health plan. When our Care or Service Does Not Meet Your Needs At the Centre For Health Care, we strive to meet or exceed your expectations for quality health care and service. Should we fail somehow, please let our physicians and staff know what your concern is. Our staff and physicians want to take care of problems and concerns in a timely manner, and should communicate with you regarding the status of the concern if it cannot be resolved right away. If you are still dissatisfied with our care or service, please contact the Member Services department at your health plan. The phone number is usually provided on your health insurance card. Once the issue is documented, your health plan’s Member Services will notify our Quality Management Department. The Quality Management Department will work together with your health plan to assist in the resolution of your concern. When Urgent or Emergency Care is Needed We know that you may sometimes have an unexpected injury or acute illness that requires prompt medical attention to avoid complications and unnecessary suffering. We also know that your physician is sometimes not available when this occurs, such as after business hours or on a holiday. We are proud to offer our Urgent Care Centre as an alternative in these situations. Our Urgent Care Centre is located in our Poway office location. It is open seven days a week from 9 am – 9 pm, with modified hours on holidays. Here are some examples of medical problems that could be treated in our Urgent Care Centre: • Abdominal pains Some medical problems are considered emergencies, however, and they require that you call 911 or go to the nearest hospital emergency room immediately. In general, an emergency is a sudden, serious, and unexpected illness, injury or condition which may result in permanent injury or loss of life if not treated immediately. Member Rights and Responsibilities You have the RIGHT to: You have the RESPONSIBILITY to: Primary and Specialty Care Locations In addition to the specialists
located at our Poway locations, the Centre For
Health Care contracts with a number of additional specialists. Prior
authorization is required to receive care from these specialists.
Their addresses can be obtained from your health plan’s provider
directory, or by calling Client Services at Southern
California Physician's Managed Care Services at 858-824-7177. |
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15611
Pomerado Road, Poway, CA 92064 |
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