Frequently Asked Questions
We want to make it easy for you to use your health plan. We understand that you may have questions and we want to help by giving you answers to those that we hear most.
How do I know what providers I can see?
You have access to two tiers of benefits, Tier 1 – Volusia Health Network (VHN) (and Employers Health Network (EHN) for those on the Orlando 1A plan) and Tier 2 – Extended and Specialty networks.* If you choose a participating VHN provider, you can minimize your out-of-pocket expenses. To see if your provider participates in your networks, visit your provider search tools, or call Member Services at 866-393-2303.
How do I use my VHN Provider Network?
When you need medical care, call a VHN participating physician´s office or hospital to make an appointment and identify yourself as a VHN, powered by HPI, member. When you arrive at your appointment, present your member ID card. Depending on your benefit plan, you may be responsible for an office visit co-payment at the time of service. Co-payment information is listed on your member ID card.
Why do I have a member ID card?
Your member ID card contains important information for you, your providers and your pharmacies, such as addresses and phone numbers necessary for claims´ payment, hospital admissions and co-payments. We encourage you to carry your ID card with you at all times and present the card whenever you receive medical services or pick up a prescription.
What is pre-certification?
Before an elective admission to the hospital or surgical or outpatient procedure, you or your physician must call the pre-certification number listed on the back of your member ID card. The utilization review staff will review the treatment plan with your physician to determine medical necessity of your admission or procedure. This process is called pre-certification. If your hospital stay is not pre-certified, your plan benefits may be reduced or denied.
How and when do I need to pre-certify services?
Pre-certification of care is the responsibility of the employee or covered person, but providers often request pre-certification on their behalf. You should check your plan details to see which procedures/care require pre-certification and work with your provider to obtain authorization for proposed care.
Pre-certification of scheduled inpatient, outpatient surgery, or other deemed procedures should be pre-certified at least 10 working days prior to receiving care. Emergency inpatient admissions must be reported within 24 hours of the next business day after an emergency admission. Please note that pre-certification is not a guarantee of payment, only medical necessity; benefit payments are subject to plan provisions.
Am I required to have surgical procedures performed on an outpatient basis?
Some surgical procedures must be performed on an outpatient basis to obtain the maximum coverage. Certain outpatient testing may also require pre-certification. Please contact the pre-certification number listed on the back of your member ID card, or refer to your summary plan description, for more information.
Do any other services require pre-certification?
Review the list of services requiring pre-certification or call the pre-certification number listed on the back of your member ID card. All hospital inpatient services must be authorized prior to the date of admission.
What should I do in an emergency?
If you have an emergency medical problem, if possible, go to the nearest participating VHN hospital. Pre-certification is not required prior to an emergency admission. In a life-threatening emergency, go to the nearest hospital emergency room. Call the number listed on your member ID card within 24 hours after an emergency admission. Contact may be made by the attending physician, a hospital representative or the patient´s family.
Will I have to file claims?
Most providers will automatically file your claim for you. If the provider submits the claim for you and you receive a balance-bill, contact the Member Services number on the back of your member ID card. There may be some situations where you will need to submit a claim form with corresponding documentation such as receipts.
Who do I call if I have additional questions?
If you should experience a service problem with the network or if you have any questions, please contact Member Services at 866-393-2303.
*Refer to your summary plan description for an up-to-date list of providers in the extended and specialty networks.