Hey there all, not sure if anybody has the answer to this, but here goes:
I  have Basic Group Health plan through work, and am very happy with it (and my WLS Doc). However, the GYN that I have always had, is NOT a GH doc. I want to go back to her (am intent on only seeing her...I've had her as by "female" doc for 18 yrs.) for my annual pap, etc., and to follow up on some possible problems with an ablation I had in 2001. ANYWAY... I have had two co-workers tell me that it is a LAW that women can choose which OB/GYN they want to see, whether they are a GH provider or Preferred Provider with your insurance plans. That your current plan MUST cover whichever OB/GYN you want to see.
IS THIS TRUE?  If so, WHERE CAN I FIND THIS "LAW" so I can go over it with Group Health Consumer/Customer Service?

*sigh*.....nothing is ever easy...  Thanks for any input.

Hugs to you all-
Kathy

Kathy...

I went to the Washington State Insurance Commissionor  Website.... I think this is law you are referring to...  I don't think you have the right to go to "any" Women's Healthcare provider.

Here is what I found....

http://www.insurance.wa.gov/consumers/health/womens_direct_a ccess.shtml

Women's Direct Access

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• A complete list of mandated health benefits (PDF)

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Women in Washington state have the right to timely and appropriate health care services, such as maternity care, gynecological care, general exams, and preventive care.

State law requires health plans to allow female patients access to an adequate network of women’s health care providers - including licensed specialy doctors and registered nurse practioner specialists in women's heatlh and midwifery - without first having to see a "gatekeeper" or primary care doctor.

Under the Women's Direct Access law, your health insurer must:

• Tell you about women’s medical services and include the specific medical services in its benefit book that are considered women's health care services.
• Remove any barriers to prevent you from seeing a provider or getting medical care. And they cannot create unnecessary obstacles or unusual referral procedures to prevent you from making a reasonable choice of a provider or health care services. This includes demanding special fees or copayments from women.
• Provide you with an adequate list of providers and allow you to choose a health provider from the full list of participating women’s health care providers contracted with them. The list cannot indirectly limit your choice by including inadequate numbers or incomplete types of health care specialties.

You have the right to see any physician you want... however your insurance company does not have to cover the physician you see. If the physician of you choice is not included in your medical insurance plan you will have to pay for services rendered.

Sorry...

Thanks for the replies. It is as I suspected. Helen, I referred our internal HR rep to the website, as she was definately giving out inaccurate information.
GH has a few OB/GYN's that are not GH docs but contact and agree to accept GH rate of payment. Unfortuanely,  my doc is not one of them. So...off to explore new GYN's. Fun times!

Thanks again ladies!

Hugs,
Kathy

I work for GH and it all depends on your plan.   If you have a more traditional HMO GHC plan then you have to select from the providers that are contracted.  Depending on where you live that list might be long or short.  

There is no law such as the one your friends are advising you of.  You have the right to see any doctor.  Just have to pay for it.  If you feel strongly, I would recommend using a health care flexible spending account if your company offers the benefit.

I would be more than happy to help you navigate GH anytime.  Just send me a note.

Deb

Thanks Deb.

I actually ended up seeing a new OB/GYN at GH in Tacoma. They got me right in since I had some concerns. He was thorough, and quick with a call back to let me know all test results/biopsies were normal.

I appreciate the information on the "law", and passed that on to my friend, who has since learned she was mistaken.

Thanks again!
Kathy