Frequently Asked Questions
Frequently Asked Questions
You have questions about your insurance. Here are answers to questions we get asked frequently.
How do I choose a provider?
Choose a participating provider to minimize your out-of-pocket expenses. You are encouraged to choose a participating provider to minimize your out-of-pocket expenses. The difference in cost to you can be substantial. Refer to your employee benefits manual for the explanation of coverage specific to your plan. If you need help in selecting a provider, please contact Volusia Health Network at 386.425.4VHN (386.425.4846) for assistance.
Do I need to use my member ID card?
In order to expedite processing, we encourage you to carry your health plan´s ID card with you at all times. Present the card whenever you receive medical services. The card contains important information including addresses and phone numbers necessary for claims´ payment, hospital admissions and co-payment information.
Who do I call with service issues?
If you should experience a service problem with the network or if you have any questions, please contact us at 386.425.4VHN (386.425.4846).
Which procedures require outpatient services?
Some surgical procedures must be performed on an outpatient basis to obtain the maximum coverage. Contact the Utilization Management/Pre-certification number listed on your ID card for information about procedures which require outpatient services. Some health plans require pre-certification of certain outpatient testing. Review the employee benefits manual supplied by your employer for specific utilization review requirements.
How do I use my Volusia Health Network Provider Network?
When you need medical care, simply refer to the attached listing and select a provider. Call the physician´s office or hospital you select to arrange for an appointment and identify yourself as a Volusia Health Network member. When you arrive at your appointment, be sure to present your group identification card. Depending on the benefit plan determined by your employer, you may be responsible for an office visit co-pay at the time of service. Co-payment information is generally listed on your member ID card.
What must I do in case of a hospital admission?
Before an elective admission to the hospital, you or your physician must call the Utilization Management/Pre-certification number on your ID card. Advanced notice requirements vary according to benefit plans. Call your benefit administrator or your employer´s Personnel Office for information. The utilization review staff will review the treatment plan with your physician to determine medical necessity of your admission. This process is called pre-certification. If your hospital stay is not pre-certified, your plan benefits may be reduced.
What services require prior authorization by the Utilization Management Department?
The procedures that require pre-certification will vary by health plan. All hospital inpatient services must be authorized prior to the date of admission. The Utilization Management Department must be contacted no later than two 2 working days after any emergency admission. To contact Volusia Health Network´s Utilization Management Department, call 386.425.4846 or 1.800.741.2198.
What should I do if a medical emergency occurs?
If you have an emergency medical problem, if possible, go to the nearest participating Volusia Health Network 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 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. If you fail to call, your benefits may be reduced.
Will I have to file a claim?
Most Volusia Health Network providers will automatically file your claim for you. If the provider submits the claim for you, simply pay your part of the bill and for any service or procedures not covered under your benefit plan. There may be some situations where you will need to submit a claim form with corresponding documentation such as receipts.