SimpleCare Health Plan



FAQ
Español

1. How does this plan work?

2. Where can I be treated?

3. How do I arrange treatment?

4. What treatment and conditions are not covered?

5. Can I see any Specialist?

6. I don´t know any specialist. Can “ECG” advise me who to see?

7. Can I go straight to the specialist?

8. Why should I use “ECG” providers?

9. Can I go straight to the specialist?

1. Q: How does this plan work?

A: The card works this way. For a yearly fee, members gain access to discounted rates similar to what large insurance companies pay. When care is received at a participating provider, the member pays the contracted fee at the time of service. The plan offers a comprehensive package that includes doctors, specialists, ancillary care (labs, scans, hearing, etc.), dental, vision care and cosmetic surgery, comprised of hospitals and clinics with over 2000 specialist.
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2. Q: Where can I be treated?

A: You can receive treatment from any hospital, clinic, or legally qualified medical practitioner in the “ECG” Network.
We have a network of hospitals and clinics with over 2000 specialist.

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3. Q: How do I arrange treatment?

If for any reason you need treatment, we ask that you contact us first. We can then check your cover, talk through any concerns you have and arrange prior approval. This process also allows us to assist you with booking an appointment and to make direct contact with your hospital.
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4. Q: What treatment and conditions are not covered?

All treatments are covered and no exclusions apply in this plan.

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5. Q: Can I see any Specialist?

A: Yes, as long as they are in the “ECG” Health Plan provider network.

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6. Q: I don´t know any specialist. Can “ECG” advise me who to see?

A: Yes, you may see any of the specialists in the “ECG” provider network.

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7. Q: Can I go straight to the specialist?

A: Yes, you may see any of the specialists in the Essential Care Group Health Plans provider network;
For some Diagnostics, treatments or therapy you must see one of our specialist so he or she can prescribe the visit or the test. Once you have the prescription, use our online or telephone authorization service so we can validate the document and you can make an appointment with any of our providers.

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8. Q: Why should I use Essential Care Group providers?

A: The specialist forming part of the provider network have been selected in line with tough requirements regarding qualifications, experience, facilities, etc..

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9. Q: Can you guarantee that there will be a specialist in my town?

A: As with any other specialty, our objective is to provide a specialist near to where you live. However, sometimes, as a result of our exhaustive quality audits, it isn’t easy to appoint practitioners who meet our stringent medical standards and there is a chance that, at the moment, this specialty isn’t available in your town.

In any case, if this is so, please let us know and we will tell you where your nearest specialist is to your home or town. We are always here to help and give you the best solution.

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