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How Referrals Work at Hometown Health and Senior Care Plus
Your provider wants to send you to a specialist. Now what? You are about to enter the referral process. A referral is your provider’s recommendation for you to see a specialist or receive specialized treatment. When it comes to referrals, the process can seem like the wild west for people not familiar with it. At Hometown Health and Senior Care Plus, we make the process simple for all our members. We know that access to specialists is a vital aspect of total health, and our goal is to break down those barriers to care at every level. Here is a step-by-step guide to how the referral process with your Hometown Health or Senior Care Plus provider works: 1. Your primary care provider (PCP) or urgent care provider will send a referral to the specialist’s office. A referral can also be sent from another specialist or after discharge from the hospital. This is usually done via email or fax. 2. As your referral is sent, now would be the ideal time to discuss with your provider’s office how the specialist will receive your medical records prior to your appointment. Your provider’s office will most likely send these records to the specialist for you, but it is always a good idea to double-check with them directly. At Renown, the referrals team will send the following items to your specialist’s office when available: ID Insurance card Most recent and relevant office notes to support the referral The referral order Any relevant labs or imaging pertaining to the referral Demographics information 3. The specialist’s office will call you to schedule the appointment after they receive the referral. Each office processes the referrals they receive in a slightly different time frame, so if you have any questions about the status of your referral, it is best to call their office directly. At Renown, if you are enrolled in MyChart, you can access the phone number for your specialist as soon as the team processes the referral. Those not enrolled MyChart will receive a letter in the mail with scheduling information. 4. The specialist will start to develop a course of treatment. That may include procedures, diagnostic tests or medications. Some of these treatments may require prior authorization from your insurance plan, so don’t forget to discuss how and when your specialist will receive the authorizations before you begin your course of care to avoid any surprise bills. What can I expect if I have a Renown specialist? At Renown, we handle a lot of the behind-the-scenes nitty-gritty so you don’t have to. After the referral is placed, it routes to Renown’s centralized referrals team and triaged to make sure you are scheduled with one of our providers with the right specialization for your specialty care needs. This team will also obtain the prior authorization you need and will you to a specialist that is in your network and based on you and/or your provider’s preference and continuity of care. The referrals team will attempt to find you a Renown provider first if you are not yet established elsewhere. For Hometown Health and Senior Care Plus members, prior authorization is not required for certain services if you are being referred to a Renown provider. This makes the scheduling process go quicker for both the provider and the patient. Our referrals team strives to keep their turnaround time for referrals within three business days, not including prior authorization wait times. If your referral is marked as ‘urgent,’ it will be reviewed within one business day so you are seen as soon as possible based on the needs of your medical condition, and you will receive a direct phone call with scheduling information. After prior authorization is obtained, the Renown scheduling team will call you through an automated phone system or via a message in MyChart with a direct link to schedule your appointment. To speak with a Renown scheduler or if you have any questions, please call 775-982-5000. What does prior authorization mean? Prior authorization isn’t as scary as it sounds! Essentially, prior authorization is your provider “going to bat” for you to receive this specialty level of care. Some medical services, including many specialists, are covered only if your ordering provider (usually your PCP) submits an authorization request to your insurance plan. They will include specific details about the type and duration of treatment they would like you to receive and any medical records that support your need for the specialist. After your insurer receives the request, a licensed medical professional will review the request, your records and your plan benefits. They will decide whether the specialty treatment is considered medically necessary based on recognized standards of care. Where can I go for more information? Your referrals and authorizations can be viewed in MyChart. To view them, navigate to Your Menu in the upper left corner of the page, scroll to the Insurance section and click on “Referrals.” The Renown referrals team is available to answer your questions and address any concerns. Give them a call at 775-982-2707 Monday through Friday from 8 a.m. to 5 p.m. Any questions you may have related to referrals and authorizations, including outside-of-Renown providers, can be directed to our expert Hometown Health or Senior Care Plus customer engagement representatives.
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Dr. Max Coppes to Lead William N. Pennington Institute
Max Coppes, M.D., Ph.D., MBA who has served as Nell J. Redfield Chair of Pediatrics at the University of Nevada School of Medicine (UNR Med) and pediatrician-in-chief at Renown Children’s Hospital for the last six years has announced he is stepping down to lead Renown’s Pennington Cancer Institute on a full-time basis. Dr. Coppes will continue to serve as Professor of Pediatrics and Internal Medicine at UNR Med. “Our goal is to improve the health of Nevadans and reduce the burden of cancer,” said Thomas Graf, CEO of Renown Health. “Having Dr. Coppes as our clinical leader for the William N. Pennington Cancer Institute on a full-time basis reflects Renown and UNR Med’s commitment to increase access to cancer care, foster a deeper partnership with UNR Med on clinical trials, collaborate on cancer research opportunities, and enhance medical education and post-graduate training. We are thrilled to have Dr. Max leading this important effort.” Today’s announcement comes two weeks after the William N. Pennington Foundation announced a $15.5 million gift to the Renown Health Foundation to help establish the William N. Pennington Cancer Institute at Renown. Dr. Coppes, a pediatric oncologist by training, has experience in leading large-scale, nationally recognized academic cancer center teams in both the U.S. and Canada. El Dr. Coppes llegó a Reno en 2014 procedente de la British Columbia Cancer Agency de Vancouver, donde ocupó el cargo de presidente responsable de seis centros oncológicos regionales y dos centros de investigación del cáncer. He was an attending physician at BC Children's Hospital and a professor of Medicine and Pediatrics at the University of British Columbia. During his career, Coppes served as senior vice president at Children's National Medical Center in Washington, D.C. and held positions at several prestigious facilities in the U.S. and Canada including The Hospital for Sick Children (SickKids) in Toronto, Georgetown University, The National Cancer Institute, and the Cleveland Clinic. Since 2016, Dr. Coppes has served in the joint leadership role as the Nell J. Redfield Chair of Pediatrics at UNR Med and pediatrician-in-chief at Renown Children's Hospital, a position made possible through generous philanthropic support from the Nell J. Redfield Foundation along with investments by Renown Health and the School of Medicine. In 2016, the Pennington Foundation recognized the need for enhanced care and expertise for pediatrics and donated $7.5 million to Renown Children’s Hospital to establish the William N. Pennington Fund for Advanced Pediatric Care. “As the Nell J. Redfield Chair of Pediatrics at the University of Nevada, Reno School of Medicine and pediatrician-in-chief at Renown Children's Hospital, Dr. Coppes blazed the trail for the integration of academic and clinical missions at UNR Med and Renown. He demonstrated visionary leadership and undoubtedly will bring the same energy and vision as the clinical leader for the William N. Pennington Cancer Institute,” said Melissa Piasecki, Acting Dean of UNR Med and Chief Academic Officer for Renown Health. “Dr. Max Coppes is an extraordinary leader. In the last six years he has done much to elevate the standard of pediatric care available in our community,” said Sy Johnson, President and Chief of Staff of Renown. “Thanks to Dr. Coppes’ leadership, the generosity of the Pennington gift and other donors, 100,000 area children now have access to pediatric specialists and contemporary healthcare services at the region’s only children’s hospital. Now, less than 3% of all pediatric patients and their families need to leave the area for specialty care. That is an incredible accomplishment.” Significant achievements made under Dr. Coppes leadership include: Advancing Renown Children’s Hospital, the only dedicated children’s hospital in northern Nevada, offering programs and services for families from a 100,000 square mile area, from Sacramento, CA to Salt Lake City, Utah. Renown Children’s provides the area’s only Children’s Emergency Room, Pediatric ICU (PICU), children’s imaging center and the largest neonatal ICU (NICU), a level III intensive care unit. Under his leadership, the following service lines were established; adolescent medicine, pediatric hematology/oncology, pediatric nephrology, pediatric infectious diseases, pediatric ophthalmology, pediatric orthopedic surgery, pediatric cleft and craniofacial surgery, pediatric urology, pediatric dentistry, and pediatric emergency medicine. Hiring and supporting a team of over 40 pediatric physician specialists. These clinicians provide 30,000 patient visits annually, offering an exceptional level of care to help families. As a testimony to the community’s confidence in the care provided, market share for pediatric services at Renown Health is now close to 90%. Renown’s membership in the Children’s Oncology Group (COG), which gives local pediatric cancer patients access to the world’s largest organization devoted exclusively to childhood cancer and most leading-edge treatments. Application to establish a 3-year accredited (by the Accreditation Council for Graduate Medical Education (ACGME) pediatric residency program in Reno. If approved in September 2022, Renown Health and UNR Med will start training four new pediatricians each year starting in July 2023. Successful application to the Nevada Governor's Office of Science, Innovation & Technology to receive financial support to fund a new Graduate Medical Education program. Renown Children’s Hospital was awarded $ 870,433 for the new pediatric residency program. New construction of an expanded Neonatal Intensive Care Unit (NICU) with increased capacity to 49 bassinets, an expanded Pediatric Intensive Care Unit (PICU) with increased capacity to 16 private patient and family rooms, and a new Renown Children's Hospital in-patient floor with increased capacity for 38 private patient and family rooms for a total capacity of 58 pediatric beds on Level 4 of Renown Regional Medical Center. In 2021, Dr. Coppes was named the Healthcare Hero Community Partner by Northern Nevada Business Magazine.
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