Information for Keystone Health Plan East Members

To help you understand your insurance plan, here are some “rules” that apply as one of our patients in this office:

• If you need to see a specialist, you must have a referral. If you are able, please use our website www.mainlinefamilymedicine.com to request referrals or contact our office before you go to the specialist's office to assure that there is a referral in place. Most offices can retrieve the referral directly from their computer. Most referrals are valid for 90 days. Please allow 48 hours for completion of your referral.
• Mammograms – all mammograms require a prescription and NO referrals. You may go to any hospital or radiology site that takes your insurance.
• For any radiology studies, your insurance will only cover you at the following site: Main Line Diagnostic Imaging in Bryn Mawr, Great Valley or Downingtown. Please visit their website for additional information at www.tristateimaging.com
• Studies that are ordered by specialists or by Dr. Zelensky must be accompanied with a prescription and a referral. You need to advise our office of any x-rays or ultrasound studies that are ordered by specialists as we will need to do the referral.
• If a specialist orders CT scans, MRIs, MRAs or Nuclear studies, the specialist's office will do the prior authorizations that are necessary, but ONLY for the above listed sites.
• If you need a podiatrist (foot doctor) for any reason, you will need to go to our assigned doctor, Podiatry Care Specialists with offices in Newtown Square or West Chester, see their website for additional information at www.podiatrycarespecialists.com. You will need a referral for any visits.
• If you need physical therapy, you will need to go to our assigned site, West Chester Physical Therapy and Fitness Center, P.C. which is located next to our office in West Chester. You will need a referral for any visits.

If you have any additional questions, please call our office or member services.