Understanding the Referral Process
As a member of Senior Care Plus, you are enrolled in an HMO Medicare Advantage Plan. That means that your Primary Care Physician (PCP) acts as your “Care Coordinator”, coordinating all of your care. This includes coordinating specialty care, diagnostic tests, imaging and reconciling all of your prescribed medications.
If you are a Senior Care Plus Member living in Northern Nevada:
Senior Care Plus may require a referral as a condition of paying your claims. To determine if the service you are seeking requires a referral, see Chapter 4 of your Evidence of Coverage. In some situations, Senior Care Plus may not require a referral, but the specialist may require one before they will schedule your appointment. In addition, your PCP may want to see you before writing you a referral, so they can make sure they are referring you to the right kind of specialist.
When you and your PCP decide together that you require treatment from a specialty provider, your PCP will write the referral and send it to the specialist’s office.
Once the specialist’s office receives the referral, they will review it and may call you to schedule the appointment. If you have not heard from the specialist office to schedule the appointment within seven (7) business days, you may call the specialist to facilitate scheduling. Please be aware that it can take the specialist’s office a few days to review the referral. Each office processes the referrals they receive in a slightly different time frame.
If you are a Senior Care Plus Member living in Southern Nevada:
A referral and/or authorization is required for most services. Please see your Evidence of Coverage to determine the unique requirements for each service and work with your PCP to fulfill any requirements.
A few important things to remember:
- Plan requirements change from year to year. The information provided here is referring to Plan Year 2022
- As an HMO member, you do not have out-of-network benefits. This makes the role of your PCP coordinating your care especially important because they are able to make sure you are referred to a contracted (In-Network) specialist. We do not recommend scheduling an appointment with a specialist directly without consulting your PCP first.
- If you have a Renown PCP, we recommend using MyChart to message your provider if you think you need a test, or you want to see a specialist. They will walk you through the process. Learn more about MyChart here.
Other Important Benefit Information
COVID-19 Vaccine Information
Senior Care Plus is partnering with Renown Health to administer the COVID-19 vaccines.
Mail Order Pharmacy
Using your mail order pharmacy benefit can help you save money, time and ensure your safety with your prescriptions.
Learn more about this member experience survey we use to develop quality improvement plans to enhance your overall service and quality of care.
Renown Preferred Plan
This plan provides access to all that Renown Health has to offer and thousands of dollars in extra benefits like dental, vision and hearing for a $0 premium.
Senior Care Plus has partnered with DispatchHealth to deliver high-quality medical care to the comfort of your home as a convenient, cost-effective emergency room alternative.
Senior Care Plus members have two options when it comes to accessing virtual care.