Optima and Many Other Health Plans Offer Nurse Advice Line As Part of Services
By Pat Curtis, director of operations, clinical care services, Optima Health
There’s nothing more disconcerting than an inconsolable baby in the middle of the night. Should you give him a fever reducer medication and call the doctor in the morning or head to the nearest emergency department? One way to handle such a situation may be to contact your health plan’s nurse advice line.
Pat Curtis is the director of operations, clinical care services at Optima Health.
Many health plans offer a nurse advice line as part of their services to help their members decide on the appropriate level of care for their circumstances. If your plan provides such a service, a number for the service will be noted on your insurance membership ID card and will be in your member materials.
Staffed by registered nurses, who are skilled in assessing health problems via telephone, these services do not provide diagnosis or offer medical treatment suggestions, but the nurses will ask questions about your medical history and current symptoms. Based on your answers and following their approved medical protocols, they may suggest that you follow up with your family physician, an urgent care facility or to go to the emergency department.
They complete a triage (the process of determining the priority of a patient’s treatment based on the severity of their condition)assessment and forward it to your physician noting your call to them and their suggestion to you. This ensures that your physician will be informed of your health needs.
It’s important to note that while nurse lines may recommend a particular level of care, the ultimate decision is the caller’s. The nurses’ recommendation is not binding and does not affect how the insurance company handles the resulting claim.
Note that nurse advice lines differ between health plans. For example, the Optima Health advice line is not a physician referral service, as are some. Just be clear of your expectations prior to your call. Additionally, you always want to make sure that you are following your insurance plan’s coverage for specialty referrals.
If your insurance company does not provide access to a nurse advice line or you want to access information for yourself, you can find many sources of free health information online from reputable health sources and oftentimes on your health plan’s website.
Nurse advice lines offer access to a healthcare professional who can help you determine how to handle a health question or concern during times when your physician may not be available but these are not substitutes for physician. This tool is a value-added benefit of your health plan and are a great source of advice.
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