FAQ's

What is Managed Care?
Managed Care is a system whereby a primary care provider coordinates your health care services. A single provider, with knowledge of your entire healthcare portfolio, is in a better position to ensure that the services you receive are medically necessary and appropriate. Your single provider with New West is your designated Primary Care Provider (PCP).

PRIMARY CARE PROVIDERS

Who can be a Primary Care Provider (PCP)?
Any participating Internal Medicine Physician or General Practice Physician can be a PCP. In some instances OB/GYNs and Mid-level Practitioners ( Physician Assistant or Nurse Practitioner) may also function as a PCP. See your New West Provider Directory for additional information.

How often may I change my PCP?
You are free to change your PCP at any time by contacting Member Services at 1-800-290-3657.

How can I receive covered services if I am unable to see my PCP?
If your PCP is in a clinic with other participating providers and you are able to schedule an appointment with one of them, you may do so and New West will treat your visit as if you saw your PCP. You are also free to schedule appointments with a mid-level practitioner (Physician Assistant or Nurse Practitioner) who is associated with your PCP’s office.

URGENT AND EMERGENT CARE

When can I use an Urgent Care Facility?
You are free to use an Urgent Care Facility after hours, on weekends and holidays, or when traveling outside of the New West service area. A referral is not necessary.

What care is available to me while I am outside of the New West service area?
Your benefits include coverage for urgent and emergent care while you are outside of the New West service area. A referral is not necessary. If you have an emergency, dial 911 or seek care at the nearest Hospital Emergency Room or Urgent Care facility. This coverage is also available to your dependent children while attending college outside of the New West service area.

REFERRALS

How do I obtain a referral for specialty care?
If you require specialty care, we encourage you to coordinate with your PCP first however, as long as the specialty care is received from a participating New West provider, no referral is necessary. New West must precertify referrals to non-participating providers prior to services being rendered.

PREVENTIVE CARE

What preventive services does New West offer?
Preventive benefits are included with all managed care plans. Preventive benefits include: physicals, well-women exams, well child care, immunizations, flu shots, prenatal and postpartum care, and mammograms.


Are sports physicals and job-related physicals included as a preventive benefit?
Sports physicals and any other physical specifically required by an employer are not a covered benefit through New West. If you are able to combine these services with a scheduled preventive visit and there are no additional costs associated, your normal preventive benefit will apply.