Primary care and specialist providers shall make all necessary arrangements with other network providers or covering providers to assure the availability of covered services 24 hours a day, seven days a week, including periods after normal business hours, on weekends or when the provider is otherwise unavailable. It is understood that the provider will refer patients to other network providers, except in cases of an emergency or when no network provider is reasonably available. In the case of the latter, prior authorization from Peoples Health is required.
To meet the needs of patients with medical issues, suggested methods of after-hours coverage may include the patient:
• Reaching the provider or a person with the ability to dispatch the call through to the provider (i.e., an answering service).
• Reaching an answering machine with instructions on how to contact the provider or covering provider (i.e., message with number for home, cellphone or pager).
• Leaving a message that is automatically forwarded to the provider’s pager or cellphone. You may only use this option if the recording explains how the message will be handled.