Here are some commonly asked questions and answers about GlobalHealth plans and benefits. If your question is not answered here, please call or email Customer Care.
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- As a GlobalHealth member, you must use plan providers to receive your covered services. This starts with choosing a Primary Care Physician from the list of physicians in the Provider Directory or the Provider Search tool.
- Each family member may choose a different PCP, including a pediatrician for children.
- You may change your PCP selection at any time throughout the year. Your PCP change will be effective the same day.
- If you do not choose a PCP, one will automatically be assigned to you.
- See or call your Primary Care Physician (PCP) first for all your medical care. Your Primary Care Physician will see that you get the care you need, whether in his/her office or from another doctor.
- If you or a covered member of your family needs same-day urgent care, call your Primary Care Physician's office for medical direction. After hours, you may self-refer to an in-network Urgent Care Center.
- If you need emergency care, go immediately to the nearest medical facility. Call your Primary Care Physician within 48 hours of receiving the care. Emergency care is covered when it is for a medical emergency. An emergency is based on your presenting symptoms arising from any injury, illness or condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a reasonable and prudent layperson could expect the absence of medical attention to result in serious jeopardy to the patient's health (or in the case of a pregnant woman, serious jeopardy to the health of the fetus); serious impairment to bodily function; or serious dysfunction of any bodily organ or part.
- Follow-up care after an emergency is also covered when provided or arranged by your Primary Care Physician.
- If you need urgent medical care, call your PCP’s office and inform them that you are a GlobalHealth Member.
- Inform your PCP or office personnel that you have an urgent medical problem and need assistance, and describe your condition or symptoms.
- During office hours, your call will be given to your PCP or a medical staff person who will give you instructions.
- After office hours, you have two options:
- Call the number on your Member ID card for your PCP. Your PCP’s answering service will take your name and phone number. Your PCP or an on-call physician will call you back. You will be given medical direction at that time, which may include directing you to an Urgent Care Facility.
- After your PCP’s office hours or on the weekend, you may self-refer to an in-network Urgent Care Facility. For a list of in-network Urgent Care Facilities nearest you, please refer to the GlobalHealth Physician & Health Providers Directory, or utilize the Provider Search tool.
If you are traveling and require Urgent Care that cannot be delayed until you return to the GlobalHealth Service Area, contact your PCP for medical advice and direction, and/or self-refer to an Urgent Care Facility.
An Urgent Care Facility is not to be used in place of accessing your PCP for routine services and continuity of care. Use of Urgent Care services are only for an unforeseen illness, injury, or condition that requires immediate, Medically Necessary care. All follow-up care must be provided by your PCP, or arranged by your PCP, and prior authorized by GlobalHealth.
- Members may access mental health and substance abuse services directly by calling or emailing Customer Care.
- Behavioral health staff will manage and arrange all inpatient and outpatient mental health and substance abuse services to assure that you and/or your family members receive timely and appropriate care.
- You do not need to go through your Primary Care Physician, behavioral health services are self-referral.
- Always contact GlobalHealth prior to services to ensure that the provider is an in-network provider so that you will not be balance billed.
- If you have a complaint or are dissatisfied with a denial of coverage for claims under your plan, you have the right to appeal or file a grievance.
- GlobalHealth will reconsider the claim or service denial.
- Send your written request to GlobalHealth's Customer Care within six months of the day of the denial.
- For your convenience, you may access an Appeals and Grievance Request Form by clicking on Find a Form.
- If you have any questions, call Customer Care.
- Yes, a referral and prior authorization from GlobalHealth are required.
- See your PCP first. When appropriate, your PCP will process a referral on your behalf for specialty care.
- When approved, you will receive a letter of authorization in the mail.
- Make your appointment with the Specialist as directed in the letter.
- The Specialist may process referrals for procedures and follow-up care after initial visit.
- Contact Customer Care for assistance.
You may Self-Refer for the following services:
- In-Network Well Woman Exams
- In-Network Routine Mammograms
- Behavioral & Mental Health/Chemical Dependency Services. Call Mental Health Network (MHNet) directly at (800) 904-5234 (toll free)
- Visit our Benefits and Coverage Page or Member Materials page within your plan.
- Medicare Advantage Benefits and Coverage
- Medicare Advantage Member Materials
- State of Oklahoma Retiree Medicare Advantage Benefits and Coverage
- State of Oklahoma Retiree Medicare Advantage Member Materials
- State Employee Benefits and Coverage
- State Employee Member Materials
- Federal Employee Benefits and Coverage
- Federal Employee Member Materials
- Group Plan Benefits and Coverage
- Group Plan Member Materials.
- Call Customer Care. Language assistance is available.
- As a general rule, GlobalHealth authorizes referrals to in-network specialists only. However, if we are not able to provide for specific services within our network, we will authorize a referral to a non-network specialist. In that case, a recommendation by the referring physician will be considered.
- By regulation, GlobalHealth has five days to process a referral request. However, most requests are typically processed within 24 hours. Please refer to the GlobalHealth Provider Manual for more information.
- The final determination for medical necessity is made by the GlobalHealth Medical Director.
- GlobalHealth sells business through brokers and directly to employer groups.
- Yes, GlobalHealth has in-house underwriting.
- GlobalHealth requires a minimum of 10 days to process a quote.
- Yes, GlobalHealth will provide a representative to conduct enrollment meetings for large groups upon request.
- GlobalHealth is in compliance with the Essential Benefits as outlined by HHS. All medical plans must be paired with a GlobalHealth Prescription Drug Supplement.
- Member co-payments and/or co-insurance are applied toward the MOOP and are tracked within our system. Prescription costs do not apply toward the MOOP.
- GlobalHealth does not have a life-time maximum on any plans.
- GlobalHealth is in full compliance with the provisions of the Affordable Care Act (PPACA) and offers the recommended Preventive Services at no cost share to the member. For a complete list, go to www.healthcare.gov.
- Yes, members may change their PCP selection at any time throughout the year. The PCP change will be effective the same day. Each family member may choose a different PCP, including a pediatrician for children.
- Yes, an employee may request case management by calling Customer Care or filling out an online request form.
- Prior Authorization is required on certain drugs before coverage is available. If your formulary states that Prior Authorization or Step Therapy is required, your doctor should submit a prior authorization request to GlobalHealth for approval. If the request is not approved, you still have the option to pay for the drug at your expense.
A formulary is a list of covered drugs selected by our plan in consultation with a team of healthcare providers, which represents the prescription therapies believed to be a necessary part of a quality treatment program.
Our plan will generally cover the drugs listed in our formulary as long as the drug is medically necessary, the prescription is filled at a plan network pharmacy, and other plan rules are followed. For more information on how to fill your prescriptions, please review your Evidence of Coverage.
- http://www.webmd.com/interaction-checker will allow members and prospective members to look up potential drug interactions.
- http://www.webmd.com/drugs/index-drugs.aspx will allow members and prospective members to look up potential drug side effects.
- http://www.drugs.com/availability/ will allow members and prospective members to look up the most common brand and generic substitutions.
- Visit the Pharmacy Forms and Resources page to find the form you need.
- Visit the Generic vs Branded Drugs page to learn how to save with generic medications.
- Visit the Generic vs Branded Drugs page to learn more about Low-Cost Generics.
Visit the Mail Order Prescription Drugs page to learn about mail order.
Maintenance drugs are prescriptions commonly used to treat conditions that are considered chronic or long-term. These conditions usually require regular, daily use of medicines. Examples of maintenance drugs are those used to treat high blood pressure, heart disease, asthma and diabetes.
For commercial members: In order to be eligible for a 90-day supply at a participating extended supply retail pharmacy, a drug must be designated for maintenance use. Click here for the list of most commonly prescribed maintenance drugs.
Visit the Find a Pharmacy page to locate a local in-network pharmacy.
Please refer to your Prescription Drug Formulary to determine if a drug requires prior authorization.
Specialty medications are identified in your drug formulary. For Medicare Advantage members, these medications are on tier 5. For State, Federal, and Commercial members, these medications are on tier 4. Specialty medications can be filled at any network pharmacy.
A recall is when a product is removed from the market or a correction is made to the product because it is either defective or potentially harmful. Sometimes a company discovers a problem and recalls a product on its own. Other times, a company recalls a product after FDA raises concerns. If you have a medicine or device that has been recalled, talk to your health care professional about the best course of action. For other products, such as foods, dietary supplements and cosmetics, take them back to the place of purchase and ask for a refund. Stores generally have a return and refund policy when a company has announced a recall of its products. Please click here to be routed to the FDA website to see the most recent drug recalls.
- An Advance Directive for Health Care is a written legal document which allows you to instruct your attending physician whether or not you wish to be given life-sustaining treatments and artificially administered nutrition (food) and hydration (water) and to give other medical directions that impact the end of life. Its purpose is to recognize your right to control some aspects of your medical care and treatment primarily including the right to decline medical treatment or direct that it be withdrawn even if death ensues. An Advance Directive for Health Care may include a living will, the appointment of a health care proxy (a person you authorize to make medical treatment decisions for you in the event you are unable to make such decisions).
- Any person of sound mind who is 18 or older.
- An Advance Directive must be signed before two witnesses who are 18 or older. The witnesses cannot be beneficiaries under your will nor may they be persons who would inherit your property if you died without a will. An Advance Directive is not required to be notarized.
- If you have completed an Advance Directive and been diagnosed as terminally ill or persistently unconscious by two physicians as defined in the Advance Directive and your attending physician does not want to comply with your wishes, that physician must act promptly to arrange for your care by another physician or health care provider.
- After you complete an Advance Directive, you may revoke it in whole or in part at any time and in any manner, without regard to your mental or physical condition. A revocation is effective upon your communication to your attending physician or other care provider or a witness to the revocation.
- Thinking about end-of-life decisions is not something we like to talk about. But, it is important to plan ahead and let your loved ones know your wishes should the unexpected happen.
- Be sure and make copies of your Advance Directive for your personal records, your family, your physician, your attorney, your Health Care Proxy and alternate Health Care Proxy.
- If you signed a Directive to Physicians or other Advance Directive for Health Care under Oklahoma law prior to 2006, it is recommended that you complete a new Advance Directive because of additional options under existing law.
- Oklahoma's Advance Directive for Health Care law allows you, if you are 18 years of age or older, to inform physicians and others of your wishes to provide, decline or withdraw life-sustaining medical care and to donate specified organs when you have been diagnosed by your attending physician and another physician to be in a terminal condition, a persistently unconscious state, or an end-stage condition.