• What is PrimeSource Health Network?

PrimeSource Health Network is the area’s most comprehensive Physician Hospital Organization (PHO). Our network encompasses Cumberland, Dauphin, Lebanon, Perry and Northern York Counties. There are currently more than 1,700 physicians participating in our network providing quality health care services in both primary and specialty fields. PrimeSource contracts with these providers and hospitals to accept a discounted reimbursement rate for medical services.  Our most current Provider Directory is available on-line. 

• How can I purchase PrimeSource insurance?

Since PrimeSource is a provider network and not an insurance plan, most individuals access the network through their medical benefit plan made available by their employer. There are also fully insured carriers that utilize PrimeSource as their provider network. Individuals interested in purchasing policies may contact an area insurance broker to inquire about participating insurance carriers and the policies they offer. 

• Do I need a referral form or pre-approval to see a specialist?
  
  You are not required to get a referral to see a specialist. If you see a specialist that is participating in PrimeSource, your claim will be paid at the highest benefit level. In order to determine those physicians that are participating, please search the PrimeSource Provider Directory. If you have questions about your specific benefit plan, contact your third-party administrator / insurance company.
    
• I have a claim that has not been paid. Who do I contact?

If you are receiving a bill from your provider, you should first call PrimeSource to see if the claim has been pre-priced and sent to your insurance company. If the claim was received here for pre-pricing, you should then contact the insurance company to see why the claim was not paid. Remember, your third-party administrator / insurance company is the payor of your claim. Their phone number can be found on your ID card. 

• Who do I contact to see if a particular service is covered by my benefit plan? 

Your medical benefit plan is administered by your third-party administrator / insurance company. Self-funded employer groups determine the makeup of their benefit plans. The benefits are then administered (managed) by the third-party administrator. Insurance carriers determine the makeup of their plans. Therefore, in order to find out the specifics of your benefit plan, you should consult your Medical Plan Summary or call your third-party administrator / insurance company listed on your ID card.

• I need to have surgery, should I call PrimeSource?

Most PrimeSource participating employer groups utilize some type of Medical Management Program. Surgery is normally a service that will need to be authorized. You should call your Utilization Management Company to get a pre-authorization. 
The phone number for your Utilization Management Company can be found on your ID card.

• I need to see a Podiatrist. How do I determine who is participating in PrimeSource?

You can call PrimeSource at (717) 230-3444 to find out who is participating, or you can go to our provider directory. It is very important to verify your provider’s participation status before receiving care. Additionally, it is your responsibility to make sure your physician refers you to specialists and other health care providers (i.e. hospitals, laboratories, etc.) that participate with PrimeSource. Be sure to remind both the physician and the office staff to check the current PrimeSource Health Network Directory before making a referral.

• My doctor is not participating in the network. Can I still receive care from him?

PrimeSource is licensed as a Preferred Hospital Organization (PHO). Under most PHO programs you will obtain maximum insurance benefits by using PrimeSource network providers. You may utilize services from a non-participating provider, however, your insurance benefits may be significantly reduced, and you may be responsible for additional out-of-pocket expenses. If you have an emergent medical condition, you may not be responsible for additional expenses for treatment. You should contact your third-party administrator / insurance company for additional information about your out-of-pocket expense for non-network providers.

• I need an ID card, who should I contact?
  
  ID cards are issued by your third-party administrator / insurance company. Please contact them if you need an ID card.
    
• Where should I send my dental and/or prescription claims?
  
  Employer groups determine their own dental and prescription coverage. If you have questions regarding how these claims are handled, please contact your Personnel/Human Resources Department.
    
• I need to add a dependent to my coverage. Who should I contact?
  
  You must contact your employer to add someone to your coverage.
    
• I feel my claim was paid/denied improperly. Who can I talk to about this?
  
  All appeals are handled by your third-party administrator / insurance company. Please review your Medical Plan Summary Description for directions on how to appeal a claim or contact you third-party administrator / insurance company directly.