Coverage Information - SunCoast Physicians Health Plan Inc. ("SunCoast Physicians Health Plan")
Do I have health care coverage now?
Yes. Please refer to the letter you received from Humana for additional information regarding their Humana Gold Plus Plan.
I have been authorized for medical service. Will the authorization be honored?
The Receiver has been advised that all medical authorizations issued to or for the SunCoast subscribers prior to August 10, 2007, will be honored by
Humana.
If I need to go to the hospital or need to seek other emergency care, who will authorize my medical treatment?
If you have a medical emergency (you believe your health is in serious danger):
Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room. You do not need to get permission or authorization from your Primary Care Physician, other plan provider, or the HMO.
Make sure that your HMO and your Primary Care Physician know about your emergency so that they can be involved in following
up on your emergency care. You or someone else should call to tell your Primary Care Physician about your emergency care as
soon as possible, preferably within 48 hours. Starting August 11, 2007, you should follow the instructions which are provided
in the letter you receive from Humana.
I need to fill a prescription. Which pharmacy should I use?
Continue to use the pharmacy you used as a subscriber of SunCoast until further notice from Humana regarding their Humana Gold Plus Plan.
My doctor is refusing to treat me or is demanding immediate payment from me prior to providing medical services. What should I do?
You should follow the instructions which are provided in the letter you receive from Humana.
Can Providers seek payment from former subscribers for debt owed by SunCoast for medical services received prior to August 1, 2007?
No. Under Section 641.315, Florida Statutes, HMO subscribers are not liable to any provider of health care services for any services covered by the HMO. Additionally, health care providers and their representatives are prohibited from attempting to collect payment from the HMO subscribers for such services. If you are contacted by a health care provider for such payment, you should inform the provider of this law. You may also want to send a letter regarding this issue, with a copy of any bills you receive from such providers, to the Receiver of SunCoast Physicians Health Plan, Inc., at P.O. Drawer 10280, Tallahassee, Florida 32302-2280. If the provider or his representative continues to pressure you for payment, please contact the Receiver at 1-850-413-3081
. Although the Receiver cannot represent you against the provider, we can assist you in informing the provider of the relevant laws.
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