The HMO plan design utilizes the Piedmont Community Health Plan network. With an HMO, there is only one level of benefits: in-plan. As long as the member uses providers in the network for covered services, the member receives in-plan or the higher level of benefits. Pre-certification is required for all hospital related services, whether inpatient or outpatient. When the member utilizes providers who are not in the network, the services are not a covered benefit except in cases of emergency or where prior authorization has been granted. HMO plans are focused on integrated care through prevention and wellness.
Members are not required to select a primary care physician with our HMO plans. However, they are required to receive pre-certification for all hospital related services and should contact Piedmont within two business days of all emergency or urgent care visits. By doing so, they will receive in-plan benefits.
For more information on the HMO plans offered through Piedmont Community Health Plan or Piedmont Community HealthCare, contact us at (434) 947-4463. You can also click on HMO Frequently Asked Questions for more information.