HMO REFERRALS AND YOU!

HMO REFERRALS AND YOU!
Coordination, Communication, and Care for You
COORDINATION OF CARE
As we age, our medical issues can become more
complicated. MetroHealth is a primary care practice
devoted specifically to geriatrics. We realize that
care physician (PCP), but also medical specialists,
ROLE OF YOUR PATIENT
COORDINATOR
caretakers and other health professionals. Coordinated
The role of the Patient
medical care brings your health care team together to
Care Coordinator is
improve your health and well-being. At MetroHealth,
to collaborate with
our goal is to ensure you receive the best and most
clients by assessing,
comprehensive coordinated care possible.
facilitating, planning
seniors often need medical care not just from a primary
and advocating
health needs on an
individual basis. In
the unfortunate event
of a hospitalization,
MetroHealth Patient
Care Coordinators work diligently to transition our
patients back into their home and assist in their
Some aspects of coordinated care are:
recovery.
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Care and medication management
A Patient Care Coordinator typically acts as a liaison
Communication with specialists
between our medical staff and our patients to ensure
Assistance with care transition
that they receive the best possible care. MetroHealth
Identifying patient needs and goals
Patient Care Coordinators build positive and lasting
Patient monitoring and follow-up
client relationships, perform critical analysis, plan
Accountability and responsibility
and organize effectively, and promote client
Linking to community resources
and family autonomy.
THE HMO MODEL AND
WHY PATIENTS NEED
• If you are enrolled in a health maintenance
• If you need care from a physician specialist in
HOW IT WORKS
A REFERRAL
organization (HMO), you will need to receive
the network, or a diagnostic service such as a lab
your health care from a network provider.
test or x-ray, MetroHealth will provide you with a
• HMOs require that you select a primary care
physician (PCP) who is responsible for managing
referral.
• If you do not have a referral or you choose to go to
and coordinating all of your health care.
a doctor outside of your HMO’s network, you will
• As your PCP, MetroHealth will serve as your
most likely have to pay all or most of the cost for
personal doctor to provide many of your health
that care.
care services.
• In the event we determine the need for an
evaluation from a specialist regarding your
medical condition or need further diagnostic
testing, we will send you to a network provider.
WHAT IS A PREFERRED PROVIDER
ORGANIZATION?
• A preferred provider organization (PPO) is a
type of health care plan that contracts with
WHY THE HMO REFERS
certain medical providers to create a network of
participating providers.
PATIENTS TO A CERTAIN
• You are encouraged to select from
GROUP AND NOT OTHERS
• MetroHealth has established relationships with
preferred providers within the
• These providers work with our offices to coordinate
medical services for MetroHealth patients and
consistently provide the utmost patient care.
• MetroHealth also has open lines of communication
with these preferred providers, which enhances
of care.
doctors.
• PPO plans allow you to visit an in-network
HMO network.
your quality
your insurance company’s network of preferred
physician or health care provider of your choice
without a referral from a PCP.
• You will typically have to pay an annual deductible
before your insurance company begins covering
your medical bills.
• PPO medical plans may also have a co-payment
due at the time of your doctor visits.
• If you select a provider that is not in your insurance
company’s preferred network, you will pay a higher
amount. You will need to pay the doctor directly
and file an insurance claim to get reimbursed.
MetroWest Location
6150 MetroWest Blvd. Suite 307
Orlando, FL 32835
(407) 294-1014
Downtown Orlando Location
1106 Lucerne Terrace
Orlando, FL 32806
(407) 316-8898
East Orlando Location
10244 E.Colonial Dr. Suite 101
Orlando, FL 32817
(407) 382-4218
CALL OR VISIT US AT WWW.METROHEALTHINC.COM