Page 4 - PEARL CCPHP Membership Packet

ENHANCEMENTS1
A.BEHAVIORAL HEALTHCARE DELIVERY EXPERIENCE
The Practice provides telemental health services, so that you can receive behavioral healthcare services conveniently and privately. The Company will work with the Practice and your Provider to make available the following, to enhance your behavioral healthcare delivery experience:
1. Panel Limits. A membership panel, reasonably limited, in order to enable your Provider to provide you with personalized care and attention to your individual needs. The Company will also arrange for your Provider to agree to be available to provide the Convenience and Support Services described in this Handbook on the Schedule titled, “Convenience and Support Services.”
2.Communications Access. Telephone, cellular phone, facsimile, and e-mail service, for your Provider, coupled with information on how you can contact your Provider through those means (collectively, the “Communications Enhancements”). Your Provider has agreed to be generally available to communicate with you during business hours, as well as during extended business hours (as defined below), through one or more of the Communications Enhancements, including to consult with healthcare providers attending to you out of state, overseas or otherwise outside of the Company’s usual service area. Telephone, email and secure texting communications
will be responded to as quickly as reasonably feasible, and in accordance with communications access hours outlined in this Agreement. In the event that your Provider is not available due to vacation or other reasons, alternative communication with another practitioner at the Practice or with another covering licensed provider will be arranged. In order for your Provider to provide you with telehealth services, you must be located in the state(s) in which your Provider is licensed to provide professional services. For urgent matters, please contact the Practice directly at 347-916-4944. If you are in crisis or in the event of an emergency, please contact 911.
3.Same-day/Next-day Appointments. Ability to make appointments, including same-day (if requested by noon) (or, where appropriate, next business-day) appointments with your Provider (or if your Provider is unavailable due to vacation or other reason, to see another covering, licensed provider), regardless of medical necessity, subject to any applicable requirements or restrictions applicable to delivery of telehealth services, including, but not limited to, licensure requirements. In particular, in order for your Provider to provide you with telehealth services, you must be located in the state(s) in which your Provider is licensed to provide professional services.
4.Expedited Appointment Rescheduling. Ability to cancel and reschedule your appointment with your Provider within 48 hours, if necessary, subject to any applicable requirements or restrictions applicable to delivery of telehealth services.
5.Extended Patient Hours. Telemedicine visits Monday through Friday during normal office hours (8:00 am
– 4:00 pm weekdays), as well as reasonable availability for appointments outside of normal office hours, on weekday evenings (4:00pm until 8:00pm), and/or selected weekend hours (Sat. 8:00am -noon and Sun. 4:00 pm – 8:00 pm) (“Extended Hours”), as mutually agreed upon between you and your Provider.
6.Personalized Member Services. Availability of a dedicated Member Services representative to provide assistance addressing and coordinating the administrative aspects of Members’ health needs, and to act as your guide for all Member-related issues.
7.Connectivity to Castle Connolly Top Doctors®. Use of Member Services representatives to facilitate connectivity for you or your Provider to over 50,000 Castle Connolly Top Doctors® nationwide, upon request.
HANDBOOK