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Hillsborough HealthCare physicians render care in a managed care
arrangement. Primary care providers function as gatekeepers and
refer to their panel of specialists, both in the inpatient and
outpatient setting. The 12 contracted outpatient clinics are
strategically located throughout Hillsborough County, as are our
participating hospitals, to ensure that services are accessible to
patients.
There currently are four separate networks under contract with
Hillsborough HealthCare, that credential their health care providers
and have their own clinics and hospitals. Physician reimbursement is
fee-for-service using Medicare payment guidelines. We employ a drug
formulary, with exceptions approved by a contracted pharmacy
advisor or the Plan's Medical Director. Elective hospital admissions
and certain procedures require pre-certification approval from our
third-party administrator, with appropriate appeal mechanisms
available to the provider on denials. We also accept retroactive
referrals from contracted hospitals on emergency admissions of
uninsured patients. Certain medically necessary ancillary services,
such as home health care, durable medical equipment, disposable
medical supplies, etc. are available to Plan members as well.
Following our mission to provide holistic care, our health care
providers work very closely with the Social
Service Division to successfully achieve the goal of the Plan,
health and social services for the indigent in an integrated and
collaborative fashion, helping each individual to reach his highest
possible level of self-sufficiency.
If you would like information on becoming a participating referral
specialist, contact our Health Care Services Section at 272-5040.
If you wish to refer a patient for possible enrollment in the plan,
you may have them call Health Care Services at 272-5040 or 272-5555
to find the nearest eligibility determination and enrollment site.
Further information on eligibility.
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