What to Do if You Need Care
What You Need To Know
If you’re sick or injured, you don’t want to waste time trying to figure out how and where to get care under the plan. Review this information so you know what steps to take.
Need to Find a Medical Provider?
PPO Plan (Anthem Blue Cross Blue Shield Network)
The PPO plan has different networks for hospital and other types of medical care. To keep costs as low as possible for you and the Fund, choose the right network from the chart below.
If You Need…
Use This Network
Find an In-Network Provider
Appointments are necessary before visiting one of the Marathon Health locations.
HMO Plan (Health Plan of Nevada)
See the primary care physician (PCP) you chose when you enrolled. Your PCP will coordinate your care, including referring you to a specialist and managing a hospital admission if needed. You can change your PCP at any time. Visit myhpnonline.com for a provider directory.
Wellness Clinic
Visit a wellness clinic for convenient, no-cost primary/acute health care, preventive care, telemedicine visits, and medications.
Telemedicine
Connect in minutes, 24/7, to a U.S.-based, board-certified doctor by two-way video using your smartphone, tablet, or computer.
Use telemedicine for common, non-life-threatening health concerns, like allergies, colds, stomachaches, fevers, infections, pinkeye, rashes, and more.
If you’re in the HMO plan, you can also access behavioral health providers through NowClinic®️! You must make an appointment for a behavioral health visit. No appointment is necessary for other services.
Plan
Provider
Cost
Contact Information
Is It a True Emergency?
If you have a life-threatening emergency, call 911 or go to the nearest emergency room. But remember that for non-life-threatening emergencies, the PPO plan pays only $75 of emergency room charges, and you pay the balance. And the HMO plan pays nothing for nonemergency (non-life-threatening) ER visits. So, if you need nonemergency (non-life-threatening) help right away, visit an in-network urgent care center or health care clinic. In addition to saving money, you may avoid long wait times and exposure to illness and viruses.
If you’re in the PPO plan, see the lists of urgent care centers and convenience care centers in your enrollment packet. You can also use the Anthem mobile app to find an urgent care center or health care clinic near you, or visit anthem.com. Select Find Care, and under Use Member ID for Basic Search, enter “TDG” in the search bar, and click Continue to find in-network providers and facilities near you.
If you’re in the HMO plan, visit a Health Plan of Nevada-contracted urgent care facility listed at myhpnonline.com.
Need Fast Advice?
Not sure whether you have a true emergency? Or whether and how soon you need to see a doctor? Call your plan’s 24/7 nurse advice line:
- PPO plan: The nurse advice line is no longer available. Find information on urgent care and convenience centers above under Is It a True Emergency?
- HMO plan: Call 800-288-2264.
Need Surgery or Other High-Cost Services?
Under the PPO plan, certain services, such as elective hospitalization or surgery, require preapproval (also called precertification or prior authorization) before they are performed. For preapproval, call Innovative Care Management (ICM) at 800-862-3338. For details, read your Summary Plan Description. Or, if you have questions, call Zenith American Solutions at 855-462-5989.
Need to Fill a Prescription?
Use a Network Pharmacy
For both the PPO plan and HMO plan, you must obtain prescription drugs from a network pharmacy; otherwise, your prescriptions will not be covered.
Here’s how to find an in-network pharmacy:
- PPO plan: To access the pharmacy locator, use the MedImpact mobile app, visit medimpact.com or call MedImpact at 800-361-4542. For information about specialty medications, call 877-437-9012.
- HMO plan: To access the pharmacy locator, visit myhpnonline.com or call Health Plan of Nevada at 800-777-1840.
Use the Lowest-Cost Drug
Generic drugs are free under the PPO plan and half the cost of preferred brand drugs under the HMO plan. Since generic drugs use the same active ingredients and are proven to work the same way as their brand-name counterparts, they have the same risks and benefits.
However, doctors don’t always automatically prescribe generic drugs. Be sure to ask whether a generic is available.
Use the Mail-Order Service
If you take medications on a regular basis for chronic conditions, such as high blood pressure, arthritis, diabetes, or asthma, use the mail-order service to save money on prescriptions. Depending on which medical plan you’re in and the type of drugs you use, your copays for a 90-day supply may be lower than the same supply from a retail pharmacy, plus you get the convenience of home delivery.
Here’s how to get started with mail order:
- PPO plan: Visit birdirx.com/mail-order or call 855-247-3479.
- HMO plan: Visit myhpnonline.com or call 800-777-1840.
Know the Rules
Both the PPO plan and HMO plan have prescription drug preapproval requirements, quantity limits, and other rules for certain
Urgent Care That Comes to You!
(For PPO Plan Participants Only)
Request on-demand urgent care services where you need them—at your office, home, or anywhere else. You’ll see board-certified physicians, nurse practitioners, and physician assistants with experience in acute injuries and illnesses and even chronic conditions. If you’re enrolled in the PPO plan, you’ll only have a $15 copay for this service, subject to the deductible. For care services, contact:
Doctoroo: doctoroo.com or 888-888-9930