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Frequently Asked Questions
 I have a new baby. What do I need to do to enroll him or her?
Contact Arnett to let us know your new bundle of joys name, date of birth, and the name of the physician you have chosen as their Primary Care Physician. Next, contact your employer to complete an enrollment form to send to Arnett HealthPlans. We must receive a completed enrollment form within 31 days of your babys birth.
My child is going to college out of state. Can he/she still get care?
Your child may receive emergent or urgently needed services at a hospital or walk in urgent care facility. Services must meet the definition of urgent or emergent care as documented in your plan contract to qualify for coverage.
If your plan is a Point of Service plan (POS), which allows payment for services by providers not contracted with Arnett HealthPlans, your child may seek care at a facility or physician they choose at a reduced benefit level. This does not include preventive care. Charges will be subject to deductible, coinsurance and benefits as described in your plan contract.
Prescription medication may be purchased at one of our contracted national pharmacy chains.
Do I have to pay my urgent care or emergency room copayment if my doctor sent me there?
Yes, copayments represent your contribution to the cost of that care even when your doctor sends you. You need to be prepared to pay your specified copayment at the time of service.
Can my copayment be reduced if I can not take a generic prescription and am forced to purchased a Non-Preferred prescription?
Copayments cannot be changed. Arnett HealthPlan prescription benefit plans are legal documents that are filed with State agencies and are not designed to permit reductions to the copayment structure.
Who decides what prescriptions are on the Preferred Prescription Drug List?
The Pharmacy and Therapeutics (P&T) Committee that is comprised of pharmacists and physicians meet quarterly to recommend changes and updates to the Preferred Prescription Drug List based on national research data.
I'm going on vacation. Can I get my prescription filled early?
Before leaving for vacation, call the pharmacy to request a refill of your prescription. Advise the pharmacist that you would like to fill your prescription earlier than normal because you are going on vacation. The pharmacist will need to contact Arnett HealthPlans to get a special authorization number which, will allow the pharmacist to fill your prescription early.
Can I see a specialist who is not in the Arnett HealthPlans network?
To receive the highest available coverage for care by a physician who is not in the Arnett HealthPlans network or in the most recent Provider Directory, you must receive a referral from your Primary Care Physician or in plan specialist and a prior written approval from Arnett HealthPlans. Review of requests will take into account the availability of care in-plan.
Why must I inform you of any other insurance coverage my family may have?
Arnett HealthPlans reviews the total amount of money spent on health care claims paid for your employer group to help determine how much your premiums should be. Coordinating with other insurance companies may help reduce the overall cost of coverage.
What is Ingenix, formerly known as Advana and HCR?
Ingenix is an independent company contracted by Arnett HealthPlans to review claims that may have been caused by a possible accident or injury, which could require coordination with other liability insurance. Your prompt response to any phone calls or letters from Ingenix will help us to accurately process your claims.
Do I have routine vision coverage with Arnett HealthPlans?
Routine eye exams are only covered for children through age 17 with a participating physician. Glasses or contacts are not covered for any age.
When will my insurance coverage end if I leave my job?
Each employer has its own guidelines for effective dates of coverage. Please contact your Human Resources Department to find out your termination date. You may be eligible for continued coverage (COBRA) at your own cost. Again, please contact your employer for further information.
Can a doctor refuse to see me if I have not paid my copayments?
Yes, you may be required to pay your copayments at the time you receive service.
Do I have to get a referral from my Primary Care Physician to see an OB/GYN for my annual exam?
No, you may schedule an appointment with any contracted OB/GYN without direction from your Primary Care Physician (PCP).
I am going on vacation. What am I covered for?
You are covered for emergency care in a hospital or for urgent services at a walk-in urgent care center as defined in your plan contract. Pre-scheduled appointments and follow-up care is not covered out of the area.
What can I do if I am sick and my doctor cannot see me?
Always call your doctor. If a satisfactory appointment with the doctor is not available, ask if you can schedule an appointment with the nurse practitioner. If the nurse practitioner is not available for appointments, request to speak to the nurse so that she or your doctor can suggest what to do until an appointment can be scheduled. Based on the information you provide, the doctor may prescribe medication, a course of treatment, or may direct you to the Urgent Care or Emergency Room.
I plan to leave the country for a few weeks on business and will need special vaccinations to travel. Will they be covered?
No, unless specified otherwise in your plan contract, travel vaccinations are not covered.
I would like to quit smoking. Do you have any programs that would help?
Arnett does have a smoking cessation program designed to aid you in your quest to be smoke free (excludes Arnett Gold Members). Contact the Member Services Department to learn more about our program.
My child will soon be graduating. How long will he/she have insurance coverage after he/she graduates?
Each employer group has their own guidelines for coverage effective dates. You may contact the Arnett HealthPlans Member Services Department to find out when your childs coverage will end and what coverage may be available after their coverage under your plan ends.
Who can I call if I have questions about a doctor's education or experience?
You can contact the Arnett HealthPlans Member Services Department to learn more about the doctors we are contracted with.
I am a prepaid HMO member. Do you give my employer information about my medical care?
No, your medical care is confidential. Any information given to your employer would require a specific signed release by you. |
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