Expert care, close to home

If you’re looking for a wide range of specialists, renowned primary care and advanced technology that are also close to home, then you’ll want a health plan that gives you access to the World of Healing that is Scripps Health.

For more information on plans that include Scripps, or a referral to a Scripps physician, visit our online doctor finder or call our referral specialists at 1-800-SCRIPPS (1-800-727-4777).

Consider the following when choosing a health plan:

What type of plan do I want?
In San Diego, managed care plans have all but replaced traditional fee-for-service insurance. Most employers have turned to managed care plans, which include health maintenance organizations (HMO), preferred provider organizations (PPO) and point of service (POS) systems.

Most managed care plans require you to choose a primary care physician who will provide most of your care. If you receive care from other providers, your share of the cost will vary according to the plan. Generally, HMOs have the lowest co-payments, but place the greatest restrictions on who can provide your care. PPO and POS plans allow you more choice in providers, but at a greater cost.

Choose a physician, then choose a plan
Before you choose your plan, choose your physician. He or she will be directly caring for you, and referring you to specialists if needed.

If you already have a personal physician, ask which plans he or she accepts.

If you need a physician, think about what you want from your doctor. You may prefer a younger or older doctor, or one who speaks your native language. If you have a specific health concern such as allergies, diabetes or sports injuries, look for a primary care physician specially trained in that area. Find out whether family members on your plan can each choose a different doctor.

Make sure the plan you select includes a comprehensive physician referral service to help you find a doctor who is right for you. If your health plan includes Scripps, you can easily learn about a doctor’s education, background, experience and interests by calling our physician referral service at 1-800-SCRIPPS.

Finally, make sure you can change your physician at any time if you are not satisfied. Most plans will allow you to switch.

What if I need a specialist?
Most managed care plans require a referral from your primary doctor before you can receive care from a specialist, such as a dermatologist or allergist. The same may be true for laboratory tests, physical therapy and other services.

Find out what your plan requires and what happens if you choose to receive care without a referral. Talk with your physician and other plan members about their experiences with referrals.

Where will I receive care?
Make sure your plan covers care at a convenient location, or several. You may prefer to see a physician near your home or work. Should you need hospital care, make sure your physician can and will admit you to the hospital of your choice. Most physicians affiliated with Scripps, for instance, have admitting privileges at several hospitals within the county.

Who pays for my prescriptions?
Check whether your medications are covered and at what cost to you. Most plans cover generic prescriptions with a small co-payment. If you want a brand name, or there is no generic equivalent, your co-payment may be higher.

What other services can I receive?
Look for a plan that reinforces your efforts to stay healthy through preventive screenings, education and support groups. You may only see your doctor once a year, but you might attend a low-fat cooking class or stress management seminar every month, for example.

If your plan includes Scripps, you can choose among hundreds of health education classes, wellness programs and support groups on nearly every health issue. Fitness centers at Scripps hospitals enable patients to enjoy the latest exercise classes and equipment at a reduced cost.

Planning to have a baby? Consider prenatal and maternity care. Ask about special programs for women, seniors and people with chronic conditions like asthma, diabetes or Parkinson’s disease. Also, consider whether you want access to health care advice over the telephone via a nurse triage service.

Increasingly, health plans are starting to cover complementary services such as chiropractic, acupuncture and massage if you go to a therapist in their network. If you use these therapies, look for a plan that includes them.

What’s Important to You and Your Family?

The “right” health plan depends on you and your family. Make sure you choose a plan that offers excellent quality and compassionate care, plus the programs and services you and your family need to achieve the best possible health.