Frequently Asked Questions About Group Health

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Getting Care
Coverage
Billing
Membership
Consumer Rights
Services for Persons With Disabilities

Below are the most frequently asked questions fielded by Customer Service. If you do not see answers to questions you have, contact Customer Service.


Getting Care

How do I choose a doctor? Can I switch if I decide I want someone else?
You can use our online Provider Directory to select your personal physician or a self-referral provider, or to change your personal physician selection. See Choosing Your Personal Physician for more information.

Once you've selected your physician, you can request an appointment using our MyGroupHealth for Members online services.

Note: Some areas may have limits on when you can change doctors.

Who can I call if I am ill after hours?
In a life-threatening situation, always call 911.

If you need medical advice after your doctor's office has closed for the day, call our Consulting Nurse Service. The consulting nurse will give you advice on how to best treat your condition and, when necessary, recommend that you come in to an Urgent Care Center or an emergency room. If your question or concern is not urgent, you can use our online services to send a secure e-mail message to your health care team or the consulting nurse. You should get a reply by the end of the following business day.

What do I do in case of an emergency?
In a life-threatening situation, always call 911 and the medics will take you to the nearest hospital.

If you or a family member are admitted to a hospital outside our network, you must call our Emergency Notification Line at 1-888-457-9516 within 24 hours to notify us or to request follow-up care (the exception is Medicare members, who do not need to notify us). This number also appears on the back of your Group Health member ID card.

For urgent medical needs other than emergencies, call your regular Group Health clinic or doctor. After hours, contact the Consulting Nurse Service.

What's the difference between urgent care and emergency care?
See Emergency and Urgent Care for a thorough discussion of when you should use emergency care versus urgent care. When in doubt, contact the Consulting Nurse Service.

How do I get a referral to a specialist?
Group Health members can make appointments directly with most specialists at Group Health-owned or -operated clinics without a referral from their personal physician. Referrals are needed for contracted or network specialists. Specialists are listed in the Provider Directory.

For mental health or chemical dependency (alcohol and drug problems) services, contact Behavioral Health Services. For other specialties, contact your personal physician, who will discuss your health care needs with you and decide if referral to a specialist is appropriate.

Many Options and Alliant members may also choose to see an out-of-network provider without a referral and be covered at a lower benefit level.

How do I get a second opinion about a medical condition?
For primary care issues, call your medical center and request an appointment with another primary care provider in your medical center.

For specialty issues, call the specialty clinic where you had your first appointment and request a second opinion. An appointment will be made with another specialist.

I've been trying to get through to my doctor's office all day and get either a busy signal or put on hold. Can you help me?
We apologize for the trouble. If you call Customer Service, we can check the number to make sure it's correct (numbers sometimes change) and can also check to make sure there is no technical trouble.

Some times of day are busier than others. Monday is the busiest day of the week, and morning is the busiest time of every day. If you call in the late afternoon, you'll find it easier to get through.

If you have a life-threatening emergency, call 911. However, if it's another urgent matter, you can call Customer Service; the staff will try to get you through.

For communication that is not urgent, try our secure e-mail service to send online messages to your health care team. To use this service, you must register with MyGroupHealth for Members online services.

I've had an on-the-job injury. What should I do?
If you are injured on the job, tell your employer immediately and complete any necessary internal forms.

When you first visit your doctor for this injury, tell the medical receptionist that you have a work-related injury. Be sure to complete workers' compensation forms, including a report of the accident. This will help us bill the appropriate insurance carrier.

If you have questions about on-the-job injury claims, contact Customer Service.

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Coverage

How do I know what my plan covers?
When you enrolled, you received a benefit summary (also called a certificate of coverage) that lists most covered services. If you have a coverage question that is not answered in the benefit summary, contact Customer Service.

Are prescription drugs part of my coverage?
Most plans cover prescription drugs. Check your certificate of coverage or other coverage agreement for your prescription coverage.

If you have questions about whether a prescription you are currently taking will be covered, check our online Drug Formulary.

I am expecting a baby. How do I add my child to my Group Health policy?
You have 60 days after a baby's birth to register your child for coverage. If you receive coverage through your employer, contact the benefits or personnel department where you work to add your child.

If you're on an individual plan through Group Health, contact Customer Service.

Enrollees who receive their coverage through the Washington Basic Health Plan should contact Basic Health at 1-800-660-9840.

My family has a vacation planned. What medical coverage do we have while we're away?
Group Health enrollees are covered for emergency and urgent care while traveling anywhere in the world. This coverage is described in your Group Health certificate of coverage or medical coverage agreement.

If you or a family member are admitted to a hospital while traveling, you must call our Emergency Notification Line at 1-888-457-9516 within 24 hours to notify us or to request follow-up care (the exception is Medicare members, who do not need to notify us). The number to call also appears on the back of your Group Health member ID card.

While traveling outside the Group Health coverage area, members of Group Health Cooperative, Options, and Alliant health plans may get care at any Kaiser Permanente facility. See When You Are Traveling to learn more.

You are also covered for medically necessary outpatient services (except outpatient prescription drugs) when these are provided by a participating health maintenance organization (HMO). You can also call our Consulting Nurse Service to determine a course of care.

Use our online services to send secure e-mail messages to your health care team or to refill prescriptions while you are traveling. You must register with MyGroupHealth for Members and to use these online services.

Customer Service can tell you if there is a participating HMO where you are visiting and more about your coverage. Some questions to ask the Customer Service representative include:

  • Does my coverage include a travel benefit?
  • Am I covered for prescription drugs while traveling?
  • Am I covered for any routine or follow-up care while traveling?
  • What is my emergency room deductible while traveling?

How do I add dental benefits to my coverage?
If you receive your coverage from your employer, contact your benefits or personnel department at work to see if you are eligible for dental benefits. Consumers on certain individual and Medicare plans have a dental option available to them. Contact Customer Service to find out if you are eligible for dental coverage.

I recently left my job. How long will I be covered?Your employer determines the end date of your coverage and notifies Group Health. Contact your employer for information about any continuation of benefits (such as COBRA) that may be available to you.

You may also enroll in our individual and family plans once your employer's coverage has expired. Contact our marketing department at 206-448-4141 or 1-800-358-8815 for more information.

My daughter will be attending college out of the area next year. Will she continue to be covered under my policy?
Group Health enrollees who attend school in Central and Eastern Washington are covered through Group Health Cooperative services in Eastern Washington and North Idaho. Enrollees attending schools in other states are covered for urgent and emergency care only. Check your certificate of coverage, because the age for qualifying as a dependent varies between plans.

Note: Dependents covered under the Washington State Employees (PEBB) policy are covered for routine care anywhere in the United States as long as they are at school.

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Billing

What is a copayment?
A copayment is the amount the member is required to pay at the time services are rendered. Refer to your benefit summary for the copayments that apply to you.

I have a question about a bill I received. Who do I call?
There are three types of bills for Group Health services:

  • Patient Financial Services bills both for copayments that were not paid at the time of service and for services you received that are not covered in your contract. For questions about these bills, contact Customer Service.
  • Individual members of Group Health (not covered through an employer or other group plan) receive a monthly dues billing. If you have a question, contact Customer Service.
  • Services from non-Group Health providers (such as an emergency where you were taken to the nearest care facility) may be billed by the outside provider. If you receive such a bill, send a copy to:

    Group Health Claims Administration
    P.O. Box 34585
    Seattle, WA 98124-1585

If you have any questions about where to call, contact Customer Service.

How do I pay a Group Health bill? Can I pay online?
See Billing Statements and Payments for information about how to pay bills for Group Health medical services and premiums, including how to pay online.

Where do I send a bill for reimbursement from an outside provider?
Members with Group Health, Options, and Alliant health plans should send a copy of the bill to:

Group Health Claims Administration
P.O. Box 34585
Seattle, WA 98124-1585

How are bills handled when I owe money?
Group Health's Patient Financial Services will generate a fully detailed bill and send it to you. If the account is not paid in full at the time of the first mailing, a second bill will be sent 30 days later. Subsequent bills will be sent every 30 days until the balance is paid in full. Unless the account is in dispute, the bill will be turned over to a collection agency after four mailings.

Why did I receive a bill from Pathology Associates Medical Laboratory (PAML)?
When a patient is treated at a clinic in Eastern Washington and blood is drawn, the blood work is processed at PAML. The lab does its own billing for the processing fees.

Why did I receive a bill from Inland Imaging?
When a patient is treated at a clinic in Eastern Washington and an X-ray is taken, the results are read by Inland Imaging, which does its own billing for the reading of the X-rays.

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Membership

How do I join Group Health?
Your employer may offer Group Health coverage — check with your company's benefits or personnel department. Employers may contact our group marketing department at 206-448-4140 or 1-800-542-6312.

For individual policies, review our individual and family plans. For more information, contact Group Health's marketing department at 206-448-4141 or 1-800-358-8815.

I just joined Group Health. How do I get started using my coverage?
New Group Health members should receive new member materials, including an identification card, a benefits booklet (certificate of coverage), a "Your Guide to Group Health" manual, and a print provider directory. If you have not received these items, contact Customer Service.

One of your first steps as a new member is to select a personal physician, who will provide your primary health care. You can find and select a personal physician by using our online Provider Directory.

In addition, you will want to register with MyGroupHealth for Members to get access to a wealth on health information and other online services, including prescription refills, secure messaging with your doctors, appointment requests, and access to parts of your medical record.

I am thinking about joining the Washington Basic Health plan. Can I choose Group Health as my provider?
In some counties, you can choose Group Health. We are one of the providers for Washington Basic Health (a state-administered health plan). Contact Basic Health at 1-800-826-2444 for information about enrolling.

I'm a Medicaid Healthy Options member. What does "GHC" mean on my medical coupon?
It means you have Group Health as your health care provider. You should have received a letter explaining you had 30 days to choose a medical plan. If you did not choose, you automatically became a Group Health member. If you want to remain a Group Health member, you need to choose a personal physician. If you do not want to be a Group Health member, call Healthy Options at 1-800-794-4360.

What Medicare plans does Group Health offer?
Under our Medicare plans, seniors can enjoy the low-cost, comprehensive coverage of an HMO and the freedom to use our network of Group Health and community doctors. For more information and to find out how to join, please call the Medicare Sales department at 206-448-4142 or toll-free 1-800-446-8882.

How do I get a copy of my medical records?
To protect patient confidentiality, Group Health is required to obtain a medical release form — signed and dated by the member/patient — for the release of all medical records (including X-rays). For release forms, see Frequently Requested Forms.

If you are a current enrollee or it has been fewer than six months since you have disenrolled, send the request to the medical center where you received your care. If it has been more than six months since you were a Group Health enrollee, send the request to our archives location:

Group Health Records
7859 S. 180th St.
Kent, WA 98032
Fax: 206-901-3960

Please include:

  • Your full name
  • Your name at time of membership (if different)
  • Date of birth
  • Group Health member ID number
  • Your mailing address
  • A current phone number

There is no charge for medical records sent directly to another physician. There is a fee (based on number of pages) for records requested for personal use or by an attorney or insurance company.

If you have any questions regarding the location of your medical records, contact Customer Service.

In addition, parts of your medical record, including lab results and immunization and allergy history, are available online. You must register with MyGroupHealth for Members to use these online services.

I lost my Group Health member ID card. How can I get another one?
You can order a new ID card online if you are registered and logged in to MyGroupHealth. You will receive a new card in the mail in approximately 10 business days.

If you have not yet done so, log in or register with MyGroupHealth for Members to access the ID card order form.

Meanwhile, you can still receive medical care from your medical center if you need care.

What do all those numbers on my card mean?
Your card lists your name, the name of your insurance plan, your unique member identification number, and two columns of numbers below.

The numbers on the left side of the card help us process your pharmacy claims. The numbers on the right side of the card list your copay amounts for office visits, pharmacy, inpatient services, and emergency room visits.

What is Group Health's relationship with Kaiser Permanente?
Group Health and Kaiser Permanente work together so that our members can receive care from both networks when they are traveling or visiting in our respective service areas. For more information about this agreement, contact Customer Service.

How does Group Health support diversity?
Human resources staff oversee hiring practices and cultural competency training efforts. Our Diversity Council promotes understanding of diversity among employees and holds special events. Interpretive services are provided for effective communication with members whose English is limited.

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Consumer Rights

How do I resolve a complaint or pass along a compliment?
If you can't resolve a complaint with the person involved, contact Customer Service. The staff will assist you directly or work with service quality coordinators in the medical centers to resolve your complaint. If you are not satisfied with the complaint resolution, contact a service quality coordinator within 30 days to discuss the appeals process.

Customer Service also records and relays compliments about outstanding service or care that you have received.

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Services for Persons With Disabilities

What services are available for members with physical impairments?
Mobility-impaired members will find that architectural barriers have been removed from facilities where it has been readily achievable. Newly constructed medical centers, hospitals, and other facilities are built to be accessible.

We work closely with Lighthouse for the Blind to provide services to sight-impaired members. Also, this Web site strives to meet industry standards for access by people with disabilities.

I have a hearing impairment. What do I do if I have questions about my policy?
Contact the state relay service for interpretive assistance.

Does Group Health have rules about bringing a pet to a doctor's appointment?
Other than trained service animals, we ask that you leave your animals at home.

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