PROVIDER MANUAL - Sendero Health Plans

Sendero Provider Manual Page 19 of 184
3.3 OB/GYN Physician
Sendero Members are allowed to self-refer to a network OB/GYN for any of the well-woman services stated
below. This information is clearly communicated to the Members in the Member Handbook. No referral is
required.
Sendero allows you to pick an OB/GYN but this doctor must be from within the same network as your
Primary Care Provider.
ATTENTION FEMALE MEMBERS: You have the right to pick an OB/GYN without a referral from your
Primary Care Provider. An OB/GYN can give you:
One well-woman check-up each year
Care related to pregnancy
Care for any female medical condition
Referral to specialist doctor within the network
The female STAR or CHIP Member may designate the OB/GYN physician as her primary care provider. The
OB/GYN physician must agree to being designated as the primary care provider and must agree to abide by all
the primary care provider requirements, including but not limited to, being available 24 hours a day, seven (7)
days a week. A referral from an existing primary care provider is not required for the female Member to
designate an OB/GYN physician as a primary care provider. The OB/GYN physician must be part of the
Sendero network of providers, because Sendero limits a Member’s selection of OB/GYN providers to innetwork
providers.
OB/GYN Responsibilities
Once the obstetrical services provider diagnoses a Member’s pregnancy, the provider must notify Sendero
Health Plans by using one of the following methods:
completing the Sendero Pregnancy Notification Form (see Appendix A)
completing a similar form containing the required information
Notifying WPHS Case Management with the required information by calling 1-855-297-9191 or faxing
Sendero at 512-275-2862.
Providers are not required to use the Sendero Pregnancy Notification form itself, but may provide the same
information via some other form, such as the American College of Obstetricians and Gynecologists (ACOG) or
Hollister high risk forms or other similar forms. If a health condition develops or is discovered during the selfreferral
episode of care that is likely to have an ongoing effect on the Member’s health and/or the Member’s
relationship with or care from her primary care provider, the OB/GYN provider should provide a written report
to the Member’s primary care provider unless the Member specifically requests that no such report be made.
Sendero Customer Services 1-855-526-7388 Network Management 1-855-895-0475
Health Services Dept.: 1-855-297-9191 (FAX 1-512-275-2862)