Provider & Pharmacy Directory - Soundpath Health

2011 Provider & Hospital Directory
Introduction
This directory provides a list of Puget Sound Health Partners’ network providers. To get
detailed information about your health care coverage, please see your Evidence of Coverage.
If you enroll in Puget Sound Health Partners you will have to choose one of our network
providers that are listed in this directory to be your Primary Care Provider (PCP). The term
“PCP” will be used throughout this directory. Generally, you must get your health care
coverage from your PCP. Your PCP is a physician, nurse practitioner, or physician-assistant with
postgraduate training in primary care programs, such as family medicine, general medicine,
or internal medicine. For routine care, your PCP is your first level of medical contact and
he or she will provide basic diagnosis and non-surgical treatment of common illnesses and
medical conditions. If your needs are beyond the scope of your PCP, he/she will refer you to
the appropriate specialist. Your PCP will 1) act on your behalf to collaborate with specialists, 2)
coordinate care by hospitals or clinics, 3) act as a repository for your medical records, and 4)
provide long-term management of chronic conditions.
The “network providers” listed in this directory have agreed to provide you with your health
care and vision coverage. You may go to any of our network providers listed in this directory,
however, some services may require a referral. If you have been going to one network provider,
you are not required to continue going to that same provider. In some cases, you may get
covered services from non-network providers. Other Providers may be available in our Network.
As a member of Puget Sound Health Partners you have access to our contracted providers.
However, if your PCP is part of a larger organization, that organization may limit your PCP’s
referrals to specialists within that organization. Some of these organizations have taken on the
responsibility, with Puget Sound Health Partners oversight, of providing prior authorization for
services.
If you enroll in Summit Plus Rx you have a Point-of-Service (POS) benefit that allows you to
access certain out-of-network providers and/or services. This benefit provides the flexibility to
self refer to out-of-network providers for a higher co-payment. For emergent and urgent care
benefits, you will not be required to pay the higher POS copayment. For additional information
see your evidence of coverage (EOC).
In certain circumstances, such as emergency or urgent care needs, you may receive care from
a non-contracted provider or facility. In that case, the provider of service may bill you directly
instead of billing Puget Sound Health Partners. If this occurs, you should not pay the facility
directly, but should instead retain a copy of the bill and then forward the original to Puget
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