Care Counseling Program
Care Counseling
Before you get any kind of non-emergency treatment outside of your primary doctor’s office (including any procedure or test), you need to call the Care Counseling program. Primary doctors include family/general practice physicians, internists, pediatricians, and OB-GYNs. The Care Counseling program is provided through the company listed on the Quick Reference Chart.
Your conversations with a Care Counselor are completely confidential. You will talk with your Care Counselor about the different PPO providers who offer the services you need and their costs. The costs for the same service may be very different among providers. You can still visit any provider, but we think most of you will choose a lower cost option if you know about it. If desired, your Care Counselor may make your appointment for you.
You will also discuss the recommended treatment for your injury or illness. Note that you must call the Care Counseling Service prior to receiving the following services in order to qualify for a copay waiver:
- All outpatient surgeries and procedures;
- Ancillary testing (e.g. MRI, PET and CT scans);
- Physical therapy visits;
- Durable medical equipment; and
- Chemotherapy or radiation.
The Care Counseling Service typically completes its outpatient review within one business day. You or your doctor can call for you to begin the preauthorization process at the number of the Care Counseling Service listed below.
MedExpert
Toll Free: 1-800-999-1999
7:00 AM to 7:00 P.M. (PST)
Health Risk Questionnaire:
https://smartchoice.medexperthealth.com/
When you call prior to receiving these services and you receive your care from a PPO provider, your outpatient copay will be waived.
Calling a Care Counselor can help you learn more about your illness or injury. Your call helps to make sure you are receiving the appropriate care.
It also can save the Trust Fund thousands of dollars for your care. If you have questions, contact the Trust Fund Office at the number listed on the Quick Reference Chart.
Nurse Line
A nurse line is available from 7am to 7pm Pacific Time, seven days a week. Through the nurse line, you can connect with a registered nurse who will answer any questions you have about your health. You can also discuss your Physician’s recommended treatment for your injury or illness. The nurse will be able to answer any questions you may have and let you know what to expect as you proceed with treatment. Please call the Care Counseling Service at the number listed above to speak with a nurse.