Understand the concern
A familiar doctor may know someone’s history and have earned their trust over years. An existing referral can carry that same confidence. Learning about a different place for a particular episode should start with understanding what matters to the person.
Ask which existing care relationships can stay in place and whether the particular doctor and service qualify.
Ask about the particular care
The TPA’s navigation team can help establish whether the proposed doctor and care episode can be arranged through the participating option. Clinical questions should be discussed with the treating professionals.
If someone chooses another arrangement, the plan’s other benefits and member costs may apply. Those details deserve an explanation before the person relies on them.
Take quality questions seriously
A concern about a hospital’s reputation deserves a specific conversation. Ask whether it comes from a particular service, clinician, or personal experience. Relevant information about outcomes, safety, and patient experience can help inform the discussion.
An overall hospital rating does not answer every question about an individual clinician or procedure. Price alone does not establish quality.
Where to begin
Exploring benefits for an organization? Talk with Rubicon or your advisor. Planning care for yourself or a family member? Use the care navigation contact in your plan materials.
Explore employer options Help using your benefits