About this Provider Search

This Provider Search lists the health care providers that participate in the MedCost PPOnetwork.
MedCost has made every effort to maintain this network list and to keep it as up-to-date as possible. However, please note:

• Providers are added and removed from the network on a daily basis.
• Although a physician practice is listed as a participating provider, not every physician in that practice may be considered a participating provider within the network.
• When scheduling an appointment at a physician’s office, hospital, or facility, it is important to verify that the provider you wish to see is currently participating in the network.

MedCost is providing online Provider Search as a service only. MedCost is not responsible for actions taken by individuals accessing provider information on this Web site.

If you have questions regarding a provider’s participation in the network, call Customer Service at: 800-824-7406

You should call your insurance company when you need to know if your health plan covers a specific doctor’s visit or service, how much it will pay for a specific service, or whether your claim has been paid.

How to Use this Provider Search

After you have entered your zip code or city/state and selected the provider network, you have the following options available to search for a provider:

• Provider Name Search: This search option allows you to search for a specific physician by Last Name, Practice Name, or Specialty. You may narrow your search by entering either the Physician's First Name, City, State, Accepting New Patients, Board Certified, or Gender.
• Facility and Ancillary Name Search: This search allows you to search by name or type. You may narrow your search by entering either the City, State, or Ultra.
• Provider Radius Search: This search option allows you to search for a provider or facility, by Specialty Type, Accepting New Patients, Board Certified, or Gender that is located within a specified radius of your zip code. This search is recommended for most users.
• Create a Custom Directory: This search option allows you to search by Radius or Statewide and includes the Ultra search capability.

About MedCost PPO Network

Your company is pleased to provide the MedCost PPO network to you as an added benefit. Since 1984, MedCost has specialized in providing employers with cost-effective health care services. Today, MedCost, LLC is the largest independent preferred provider organization (PPO) in the Carolinas. MedCost is not an insurance company and does not pay your claims. Rather, as a PPO, MedCost works alongside your insurance company to offer you an extensive network of “preferred” providers. MedCost negotiates with selected physicians, hospitals, and facilities to arrange for reduced fees on a broad range of medical services. MedCost then re-prices your health insurance claims to these lower negotiated rates, and your insurance company processes and pays your claims. That’s why using MedCost PPO network providers can result in significant savings for you and your family.

The following information, along with your health benefit plan, can assist you in making choices about your family’s health care needs.

PRIMARY CARE PHYSICIANS

A primary care physician is the patient’s medical coordinator. This doctor can provide most of your medical care. Specialty care is expensive, and sometimes unnecessary. A primary care physician is best able to help you determine when specialty care is necessary and will help you select a specialist when needed. This approach saves money for you and your family.

Selecting the primary care physician that is right for you is a personal decision. While the MedCost PPOnetwork does not require you to designate one physician for all your primary care needs, we encourage you to establish a relationship with one physician. Your primary care physician can maintain your medical history and serve as your medical advocate. In evaluating the type of primary care physician that can best serve you and your family, you may wish to consider this information:

Family/General Practitioners provide a broad range of medical care for patients of all ages.
Pediatricians treat children.
Internists treat routine and complex conditions in adults.

SPECIALTY PHYSICIANS

Your primary care physician will determine when you need specialty care and will help you select a specialist when you need one. No referral form is necessary for specialty care. With MedCost PPOnetwork you also have the option to choose specialty care without going to your primary care physician.

HOSPITALS

By selecting a MedCost PPOnetwork hospital, your employer offers better benefits, saving you and your family money. PLEASE NOTE:When charges are incurred at a MedCost PPO network hospital or facility, only the facility chargesare subject to the PPO negotiated rates. Anesthesia, radiology, pathology, emergency medicine, and other professional services are only subject to PPO discounts if the physician that renders the service participates in MedCost PPO network. For non-participating physicians, benefits are paid at out-of-network rates.

Important information about certain providers and services…

CHIROPRACTIC PROVIDERS.Please review your plan provisions for benefit level coverage. Some plans have reduced benefit levels for these services.

MENTAL HEALTH PROVIDERS.Please review your plan provisions for benefit level coverage. Some plans have reduced benefit levels for these services.

OBSTETRIC/GYNECOLOGY PROVIDERS.Please notify your obstetrician when pregnancy is confirmed to arrange an appointment. Some providers onlyaccept OB patients during their first trimester (the first three months of pregnancy).

PHYSICIAN ASSISTANTS (PAS) AND FAMILY NURSE PRACTITIONERS (FNPS).Throughout this directory, you will notice PAs and FNPs listed at many provider locations or individually. Access to PA and FNP services may vary from practice to practice. When visiting a primary care office, you may first be seen by a PA or FNP. All PAs and FNPs work under the supervision of a physician. Call the provider’s office when you need care and the physician’s staff will decide whether a PA, FNP, or a physician should see you. It is important for you to know that services rendered by PAs and FNPs may not be covered under some health insurance plans. Please review your benefit coverage before scheduling an appointment.

URGENT CARE FACILITIES.Some urgent care facilities do not have physicians that can continue to follow a patient’s care when hospitalization is necessary. However, when hospitalization is necessary, the physicians at these facilities make every effort to assist in obtaining a referral to another participating MedCost PPO network physician.

NON-COVERED SERVICES.Some MedCost PPO network providers will extend discounted rates for services not covered by your health plan. Ask your health care provider if the MedCost discount will be honored.

TRANSPLANT SERVICES.Some plans do not provide coverage for transplant services unless performed at one of the facilities designated as “preferred” by their plan. Please check with your employer or insurance company to determine if your plan has designated certain providers for transplant services.

Important Note: When you arrive at the physician’s office, hospital, or facility, be sure to present your health insurance card, which states your participation in MedCost PPO network. Also, remind the insurance clerk that you are eligible for MedCost PPO network. Physicians, hospitals, and facilities must have this information to file your claim for you. Patients that do not identify themselves as participants in MedCost PPO network may not be eligible to receive the special rates MedCost has negotiated.

Frequently Asked Questions

WHO IS ELIGIBLE FOR BENEFITS?

Employees covered by an employer’s health care plan, along with their dependents, are automatically eligible for MedCost PPO network benefits.

WHO SHOULD I CALL WITH QUESTIONS ABOUT MY INSURANCE COVERAGE?

When you have questions, call the eligibility phone number listed on your insurance identification card.

WHAT IS THE ADVANTAGE OF SELECTING A MEDCOST PPO NETWORK PROVIDER?

You’ll save money. As a MedCost PPOnetwork patient, you’ll receive special discounted rates from participating providers. Savings begin the moment you seek care, so your out-of-pocket expenses will be less. All claims must be filed through MedCost PPO network to receive special discounted rates.

If you receive a service or treatment not covered by your health care plan, you may be asked to pay for that service at the time of your visit. Although you will have to pay for any service that is not covered, some MedCost PPO network providers will extend discounted rates for services not covered by your health plan.

WHAT IS THE ADVANTAGE OF CHOOSING A PRIMARY CARE PHYSICIAN?

When you select a primary care physician, someMedCost PPO Network plans allow you and your family to pay a small visit charge (co-payment) each time you visit your doctor’s office for covered services. Someplans also waive your calendar year deductible for covered primary care office visits. Other plans may offer either a co-payment or co-insurance whether you seek care from a primary care physician or a specialist. Please refer to your benefit plan booklet for specific information regarding your co-payment/co-insurance for MedCost PPOnetwork primary care physicians.

WILL I SAVE MONEY IF I USE A MEDCOST PPO NETWORK SPECIALIST, HOSPITAL, OR FACILITY?

Yes. MedCost PPONetwork has negotiated discounted rates with selected specialists, hospitals, and facilities to help reduce your out-of-pocket costs for medical services. Not only does the MedCost PPO network negotiated rate save you money, but your health plan may provide better rates for covered medical services when you use a MedCost PPO network specialist, hospital, or facility. Please refer to your benefit plan booklet for specific information regarding specialty care coverage for MedCost PPO network specialists, hospitals, or facilities.

WILL I RECEIVE MORE BENEFITS WHEN I CHOOSE A MEDCOST PPO NETWORK PROVIDER?

Yes. When you choose a MedCost PPOnetwork physician, hospital, or facility for treatment, your employer provides better benefits. These extra benefits save you even more money.

DO I HAVE TO CHOOSE A MEDCOST PPONETWORK PROVIDER?

No. You and your covered dependents are free to choose any physician, hospital, or facility. However, when you select a MedCost PPO network participating provider, you’ll save money and receive the extra benefits provided by your employer.

IS MEDCOST PPONETWORK EASY TO USE?

Yes. In fact, MedCost PPOnetwork is easier to use than your standard health plan because participating providers will file your claims for you. All you do is pay your part of the bill for any services or procedures not covered under your benefit plan. When you need medical care, simply use this Provider Search to find a participating physician, hospital, or facility. Your choice may be based on location, type of treatment, or upon recommendation from a friend.

WHAT IF I NEED LAB SERVICES?

MedCost has negotiated discounted rates with several reference labs. To avoid additional expense, ask your physician to use one of the MedCost PPO network participating labs. Important: Review your plan provisions to determine if lab services are covered under co-payment plans. Lab services are not always eligible for the co-payment and may be subject to a deductible.

WHAT ABOUT EMERGENCY CARE?

When you have a serious accident or life-threatening medical condition, your first responsibility is to seek immediate medical care. Advance approval is not required. However, you should notify your primary care physician within 48 hours of the incident so that your medical records can be updated.

WHAT IF I AM ON A TRIP?

When you need non-emergency medical care but are away from home, you do not need advance approval. It may be to your advantage to consult your physician by phone prior to treatment since your MedCost PPO network primary care physician knows your medical history.