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Types of Providers

Types of Providers

If you have complicated health issues or your doctor has called another doctor an industry term you’ve never heard before, you may be left wondering what all these health care names really mean. We can help you make sense of the different types of providers.

Your Doctors

Primary Care Provider (PCP)

A primary care provider, or PCP, is your main doctor. It’s who you visit for routine checkups, preventive care, and general health problems. Each person in your family can have a PCP, or you can all see the same one.

If you’re on an HMO or POS plan, you have to choose an in-network PCP who will oversee your care and refer you to specialists. If you’re on a PPO plan, you don’t have to choose a PCP to get referrals, but you can to get personalized care and savings.

And if you’re a woman, you can set a doctor as your PCP or choose another in-network doctor, like an OB-GYN, to oversee free preventive care, your yearly well-woman visit, or a pregnancy.

Setting and changing your PCP is easy. Just log in to Your Health Alliance to update your PCP.

Specialist

A specialist is a doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.

Usually, you’ll be referred to a specialist when your personal doctor wants you to check on specific issues or problems. You’ll also be sent to a specialist when you’re diagnosed with something serious, like a heart condition or cancer, or if you find out you’re pregnant. 

Surgeon 

A surgeon is a doctor who is qualified to perform surgery, and they have their own specialties. If you have a heart attack and need surgery, your surgeon will be an expert in heart surgery.

If you’re sent to the ER because of an emergency or diagnosed with a condition or disease, you might be sent into surgery. But if you need a minor procedure, like having your wisdom teeth out, you’re seeing a surgeon too. 

Hospitalist

A hospitalist is a dedicated, in-patient doctor who works only in a hospital or network of hospitals. If you’re taken to the hospital in an emergency or accident, you might be treated by a hospitalist.

Help with Your Care

Care Coordinator

Care coordinators help you figure out your health care in lots of ways, especially after a hospital stay, diagnosis, or if you have a chronic or complex condition.

They can help provide you with resources, educational materials, and self-care techniques, help you understand your doctor’s instructions, connect you to resources in your community, and help you plan for the future.

Health Coach

Health coaches can help you or your family plan for better health. Our health coaches can help you get the best care possible from your healthcare team and get the most from your coverage.

They’ll partner with you to help in areas like nutrition, weight and stress management, and preventive screenings and immunizations.

Nurse Navigators

You might get help handling your care from a nurse navigator when you’re discharged from the hospital if you get a serious diagnosis. For example, a cardiac nurse navigator will help patients with a primary diagnosis of heart failure or myocardial infarction.

They will usually start the process by visiting you before you leave the hospital, then they’ll stay in-touch to walk you through the first 30 days after discharge. 

Nurse navigators can help you organize your appointments, connect you to education on your diagnosis, medications, exercise, diet, therapies, and when to call the doctor. And they might host support groups that can help people like you.

Other Kinds of Care

Home Health Care

Home health care is medical care, treatment, or skilled care you can get in your home. You doctor might recommend this in situations where care in your own home will be easier for your case and condition.

Skilled Nursing Facility

You doctor might order medical care that must be given or supervised by a licensed health care professional in a skilled nursing facility. This type of care could include:

  • X-rays and other radiology services
  • Physical, occupational, and speech therapy
  • Storage and administration of blood
  • Use of appliances, like wheelchairs
  • Meals, including special diets
  • A semiprivate room or private room if medically necessary

Hospice Care

Hospice care is special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.

Other Help

Pharmacist

Pharmacists are healthcare professionals who practice pharmacy, which focuses on safe and effective medication use. You might not think about your pharmacist’s skillset when you pick up your drugs at the pharmacy, but they’re trained to know how drugs work.

They know which drugs can interact to protect you from dangerous drug combinations, they can explain the side effects of your drug to you, and they make sure you’re getting the right dosage of your drugs on the right schedule.

Social Worker

Social workers are there to help you with social problems that can affect your quality of life and health care. They can help you and connect you to resources for domestic violence, sexual assault, abuse and neglect, housing and food insecurity, home-delivered meals, substance abuse, mental health issues, advance directives, and more.

Other Providers

Medical Director

A medical director is a leader who recruits and manages doctors, nurses, and other personnel. They also examine and coordinate processes within their organizations to improve and guarantee the medical quality of the facility. 

 

If you need to find covered providers, use our Find a Doctor or Hospital tool to search for covered doctors, hospitals, and more.

Insurance Awareness

Insurance Awareness

Wednesday was National Insurance Awareness Day, so we helped raise insurance awareness this week with education and info about your plan.

Insurance may seem like a luxury, but without it, the cost of a broken arm is typically more than $2,500 dollars. If you have to stay in the hospital, it’s around another $7,400.

Broken Arm Costs

 

Under the ACA, you have certain benefits that are always covered, like yearly checkups and more.

Essential Health Benefits

 

If you’re on an HMO, you have to see doctors in your plan’s network, and if you’re on a PPO, you’ll save when staying in-network.

Choosing a primary care provider (PCP) gives you personal care, and your yearly visit keeps your preventive care up to date.

Your Yearly Preventive Care and Physical

 

The average ER visit costs more than the average American’s monthly rent. Know where to go when you’re sick and save.

Know Where To Go

 

Not sure what your insurance does after you get care? See a claim’s journey and make sense of what you get in the mail later, the EOB.

A Claim's Journey

 

Are you getting ready for Medicare? Learn about the parts, your eligibility, and enrolling.

Prepare for Medicare

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Your Preventive Care

Your Yearly Preventive Care and Physical

Getting your yearly physical, where you can get covered preventive care and screenings, helps you be your healthiest. It’s important that you not only know what’s recommended for your age and what you need to stay up to date, but also that you get to the doctor for this each year!

What Happens at Your Physical

Each year, you should schedule a physical with your doctor to focus on your health and wellness. At the appointment, you can:
  • Keep track of your health habits and history
  • Get a physical exam
  • Stay up-to-date with preventive care
  • Get education and counseling and set health goals

Health Habits & History

One of the first things that happens at your annual appointment is a nurse or your doctor will ask you to answer some questions about your health and family history, including questions about:
  • Your medical history
  • Your family history
  • Your sexual health and partners
  • Your eating and exercise habits
  • Your use of alcohol, tobacco, and other drugs
  • Your mental health history, including depression
  • Your relationships and safety
This info can help you in the future. From getting diagnosed to being protected and helping you in an emergency, this information can help save your life.

Physical Exam

At your yearly physical, you can expect your doctors or nurses to:
  • Measure your height and weight
  • Calculate your body mass index (BMI) to check if you’re at a healthy weight
  • Take your blood pressure and temperature
From there, your doctor may give you your regular preventive care screenings and shots or refer you to a specialist for certain screenings, counseling, or care.

Preventive Care

As an adult, certain preventive care and screenings are covered for you, depending on timing and what your doctor recommends.
Immunizations (Shots)
Doses, recommended timing, and need for certain immunizations can vary based on your case:
  • Diphtheria
  • Flu shot
  • Hepatitis A
  • Hepatitis B
  • Herpes Zoster
  • Human Papillomavirus (HPV)
  • Measles
  • Meningococcal
  • Mumps
  • Pertussis
  • Pneumococcal
  • Rubella
  • Tetanus
  • Varicella (Chickenpox)
Condition Screenings & Care
  • Aspirin use – To prevent heart disease for adults of a certain ages
  • Cholesterol screening – For adults of certain ages or at higher risk
  • Blood pressure screening
  • Type 2 diabetes screening – For adults with high blood pressure
  • Colorectal cancer screening – For adults over 50
  • Depression screening
Weight Management
  • Obesity screening and counseling
  • Diet counseling – For adults at higher risk for chronic disease
Alcohol & Tobacco Use
  • Alcohol misuse screening and counseling
  • Tobacco use screening – For all adults and cessation interventions for tobacco users
  • Lung cancer screening – For adults 55 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years
  •  Abdominal aortic aneurysm – A one-time screening for men of certain ages who have ever smoked
Sexually Transmitted Infection (STI) Screenings
  • Sexually transmitted infection (STI) prevention counseling  – For adults at higher risk
  • Hepatitis B screening – For people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and American-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence
  • Hepatitis C screening – For adults at increased risk and once for everyone born from 1945 to 1965
  • HIV screening – For everyone ages 15 to 65 and other ages at increased risk
  •  Syphilis screening – For adults at higher risk
Women also have some additional covered screenings and benefits. Get more details about this specific preventive care while learning about your well-woman visits. And learn more about what preventive care the United States Preventive Services Task Force recommends you get and when.

Education, Counseling & Health Goals

Your doctor can help you manage your conditions or diseases and prevent future problems by talking to you about your life and health each year. Your doctor might have valuable handouts, websites, advice, and information to help you take care of yourself or might want to refer you to a specialist who can help you further. Your doctor is also the perfect person to help you set goals to maintain or improve your health. From quitting smoking and knowing how to self-check for cancer to changing your diet and exercise for your weight, cholesterol, or blood pressure, your doctor can help you plan to be your healthiest.

Prepare for Your Visit

Preparing yourself with questions to ask and answers to your doctor’s questions can help you make the most of your visit.

Know Your Family History

Your family’s history of health and wellness is an important part of your own health record. Histories of illness and disease can help doctors look out for issues that run in families and more. This family health history tool can help you track your family’s health, so that you’re always organized to talk to your doctor. Not sure about your family history? Filling this out is the perfect time to talk to family members for firsthand details.

Talk to Your Doctor

Prepare for your appointment by knowing any questions or issues you want to talk about ahead of time. Some things you might want to ask:
  • What immunizations or shots you need
  • Your diet and eating healthy food
  • Advice for exercise and getting active
  • Mental health concerns, like depression and anxiety
  • Specific issues you might be having, like sore joints, back pain, migraines, and more

Know What’s Covered

Learn more about your covered immunizations. And log in to Your Health Alliance or search by your member number to see what preventive care your plan covers. You can use our general preventive care guidelines and prescription drugs or our Medicare preventive care guidelines to get an idea of what our plans cover. If you’re not sure what’s covered and what you’ll need a preauthorization for, you can check your coverage and preauthorization lists at Your Health Alliance. Now that you’re ready to go to your annual physical, log in to Your Health Alliance if you need to set a Primary Care Provider (PCP) and find a covered doctor, or start searching for doctors in our network.
Quality Customer Service with Health Alliance

Why Should I Choose Health Alliance?

Medicare’s Annual Enrollment Period (AEP) is in full swing, and you might be wondering why you should pick a plan with Health Alliance?

Insurance for Real Life.

We treat you like a person, not a policy. We don’t like to brag, but we have a pretty amazing team. Every person, from front office to corner office, wants you to be your best.

Tens of thousands of network physicians
Hundreds of network hospitals
Nearly 300,000 members
500-plus Health Alliance employees and growing to serve your needs
One goal. Deliver top-notch insurance that fits your needs and budget

You Can Relax Knowing You’re Covered

We are always building our network to give you a large network of doctors, hospitals, and clinics you trust.

If you’re miles from home and outside your network, we have services linked to getting quality emergency medical care while traveling 100 miles from home or abroad through Assist America.

We Are Here to Help

We love hearing from our members. So whether it’s in person, on the phone or through social media, when you have a question, our Customer Service reps are here for you.

You’ll never have to jump through hoops to get answers. They give personal help to over 40,000 callers each month and connect members to answers in 15 seconds or less, on average. They resolve 99.6% of issues on the first call.

They’re also happy to meet with you. Just stop in Monday through Friday. We’re at 206 W. Anthony Drive in Champaign, IL or 316 S. Fifth St., Wenatchee, WA.

Our Medicare seminars are informational meetings we hold all over our service areas during the AEP, so you can find one close to you.

Extra Benefits

Our Medicare Advantage plans have extra benefits like SilverSneakers Fitness Program, $0 Tier 1 drugs at Walmart and Sam’s Club, Assist America, and our Anytime Nurse Line.

We also help you settle in. We mail you your member materials. We will also call you to verify that your coverage is in place and talk to you about making the most of your benefits.

Health Alliance will take care of you every step of the way. It’s no wonder 96% of our members unpack their bags and stay awhile.

Call 1-888-382-9771 (TTY 711) from 8 a.m. to 8 p.m. weekdays. Or visit HealthAllianceMedicare.org for more info.

Health Alliance Medicare is an HMO, PPO, and PDP plan with a Medicare contract. Enrollment depends on contract renewal. You must continue to pay your Part B premium. Low-cost prescriptions are available at other in-network pharmacies. The benefit information here is just a brief summary, not a complete description of benefits. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium, and/or copayments/coinsurance may change on January 1 of each year.

Getting a Great Deal

Getting the Best Deal

“I’m always looking at ads to see who’s got the best deal,” Melissa Whitman says.

Who doesn’t love saving money? But how are great deals and health insurance connected? They may be more similar than you think, at least when you see doctors in the Health Alliance network.

“Many of our members are surprised how much they save by staying in-network,” says Melissa, a Health Alliance claims manager. “Going out-of-network can cost members twice as much, and the even more unfortunate part is they often don’t realize that until after their visit or procedure.”

With thousands of doctors and hospitals in-network (and the list growing daily), you don’t need an eye for a good deal. We have people like Melissa for that. Melissa can help with just about anything related to getting your covered care paid for.

Stepping into her cubical proves instantly there’s a lot more to Melissa than claims processing. Her family. Pictures of smiling faces decorate every open space.

“We’re always together. Cooking out,” she said. “In the summer they’re at my pool, and we just got done mushroom hunting.”

Melissa has quite the eye for those hard-to-find morels. For as long as she can remember, mushroom hunting has been an annual adventure.

“The whole family goes. Even my 89-year-old grandma gets her mushroom stick and gets in the woods,” says Melissa with a laugh.

She sums herself up simply. “I’m a city girl. I love my work, my family, and a taste of the country,” she says.