In the Heritage Premier plan, members are encouraged (but not required) to choose a Primary Care Physician (PCP) who will help coordinate their care and advise them when a specialist’s care is required. The Heritage Premier network includes many of the providers that participate in the Heritage Choice network, including specialty care, mental health, transplant services, durable medical equipment, and ancillary service providers.
With Heritage Premier, a member may see network specialists without a referral from his or her PCP. That means a member can go to any specialist that’s included in the Heritage Premier Provider Directory. If members seek non-emergency care from a non-network provider without a preauthorized referral, they will have higher out-of-pocket expenses if they have a Point-of-Service option. The care may not be covered if they do not have Point-of-Service benefits.
It’s important for members to make sure that the Primary Care Physician, specialist, facility, pharmacy, or other provider they intend to visit is a Heritage Premier network participant before they make arrangements to see that provider. Any plan member can do this by checking a printed Heritage Premier Provider Directory, searching our online Provider Directory, or calling the Customer Service number on the back of his or her ID card.