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How do you get the best care?

Know What Your Health Plan Covers and Does Not Cover

Ask your health plan or your employer for a copy of your Evidence of Coverage. This explains your benefits and rights and how your plan works. Call your health plan if you have any questions about your Evidence of Coverage. The customer or member services phone number is on your Membership Card.

Choose a Primary Care Doctor

Your primary care doctor gives you your basic care and oversees all your treatments and referrals. Ask your plan for a list of primary care doctors. If you want a doctor who speaks a language other than English, ask for a list of doctors who speak your language.

Tell Your Doctor All Your Health Concerns

Try to give your doctor as much information as you can about your health. Ask questions if you are not clear about your health problem or treatment plan.

Know How to Get a Referral and Prior Approval

You usually need a referral and prior approval when you need to see a specialist, such as a heart specialist (cardiologist) or a skin doctor (dermatologist), or you need a test such as an MRI or CAT Scan. Sometimes this is called an "authorization."

Keep Your Membership Card Handy

You need to show your Membership Card to get services. Your customer or member services phone number is on the card. You can call this number any time you have questions about your plan.

Keep Records

  • Keep records of your health care benefits and treatments in one place.
  • Keep a list of your appointments.
  • Keep records of bills or payment notices from your health plan or providers.

Make Healthy Lifestyle Choices

Health plans offer many services to help you stay well, like health education classes, weight management programs, and regular check-ups. Some plans may offer programs to help you quit smoking. Use these Preventive Care services. Ask your doctor for more information.

Speak Up for Yourself

The best way to make sure you get good health care is to be your own advocate. Ask for what you need.