Q. My doctor said I should see a specialist.
Can I go to any doctor?
A. For most specialty services, your personal doctor (also called your Primary Care Physician or PCP or your Primary Care Clinic) will arrange specialty care for you. Your personal doctor will get clearance for you to see a specialty doctor. This is called getting an authorization.
Q. What if I want a second opinion?
A. You can ask Santa Clara Family Health Plan to assist you in receiving a second opinion. You should get the second opinion within 30 calendar days of the first opinion.
Q. Can I be reimbursed if I saw another
doctor and paid for my visit?
A. If you go to see a doctor on your own, before getting authorization, you may be responsible for paying for services you receive. This is why it is important to get authorization with the help of your personal doctor. You do not have to pay for authorized services.
Q. Am I responsible for emergency room
bills?
A. You are not responsible for paying for emergency services. This is described in detail in the Evidence of Coverage booklet you received in the mail.
If you feel you received a bill in error, contact the office that sent you the bill to make sure they have your correct insurance information. If you still need assistance, call our Member Services Department at 1-800-260-2055, Monday-Friday, 8:30 a.m.-6:00 p.m.
