How to Plan For Hospital Care

How to See a Specialist

How to See a Specialist | Direct Access to Obstetrical/Gynecological Care | How to Obtain a Standing Referral
How to Have a Referred Specialist Designated as Your Primary Care Physician | How to Plan For Hospital Care
Continuity of Care

If you need hospitalization or outpatient surgery, here are some things you should be aware of:

Your primary care physician is the one who will arrange for you to be admitted to the hospital or outpatient surgical facility.
Your primary care physician will talk with Keystone to make sure the admission or surgery will be covered. This is called preapproval. Preapproval is NOT required for a maternity inpatient stay.
If the referred specialist feels that you need hospitalization or outpatient surgery, the referred specialist will talk with your primary care physician. If they agree, they will work together to arrange for your care to be preapproved by Keystone.
Because a hospital admission or outpatient surgery requires preapproval by Keystone, you do not need to get a referral from your physician.
When Keystone’s patient care management department receives the information from your primary care physician or referred specialist, they will evaluate the request for hospitalization or outpatient surgery based on clinical criteria guidelines. A Keystone medical director will evaluate the request. If the request is denied, you, your primary care physician or referred specialist has a right to appeal this decision through the grievance process.
While you are in the hospital, the patient care management department will be monitoring your hospital stay to assure that a plan for your discharge is in place. This is to make sure you have a smooth transition from the hospital to home, or to another setting like a skilled nursing or rehabilitation facility. A Keystone case manager will work closely with your primary care physician or referred specialist to help with your discharge and if necessary, arrange for other medical services.
You will receive written notification if your primary care physician or referred specialist agrees with Keystone that inpatient hospitalization services are no longer required. If you remain in the hospital after this notification, the hospital may have the right to bill you after the date of the notification. You may appeal this decision through the grievance process.