Gulf Coast Medical Management

To verify your benefits, please call WebTPA Customer Service directly at 877-697-2299.
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Confused by some of the terminology and language of insurance plans? You are not alone. Please review the terms and definitions below to better understand the requirements for utilizing your health care benefits.

Authorization - You must obtain an authorization from Gulf Coast Medical Management before receiving the following services:

  • Hospitalizations
  • Outpatient surgeries and invasive procedures (INCLUDING endoscopies, colonoscopies, sigmoidoscopies, bronchoscopes, EGDs, ERCP and cardiac catheterization and office procedures over $1000, except for Dermatology procedures)
  • PET scans
  • Mental health services

(The above taken from Human Resources’ Health and Wellness Summary Plan Description )

Referral - A provider may determine that you need to see a specialist for a particular ailment or health issue. This requires that the primary care physician refer you to the specialist by completing a referral form. You should always ask for a copy of the referral for your records. Two of the SMHCS health plans have additional requirements for referrals:

  • The Comprehensive Plan requires a referral from your Primary Care Physician after two visits to the same type of Specialist.
  • The Basic Plan requires a referral from your Primary Care Physician for all visits to a Specialist.

Preventive Care - Maintaining good health is an integral part of the health plan offered by SMHCS. The Gulf Coast Medical Management team encourages you to do your part in maintaining good health by following these guidelines:

  • See your primary care physician annually for a “wellness” visit
  • Complete any screenings as prescribed. These can include the following:
    • Colonoscopy
    • Mammogram
    • Lipid profiles (cholesterol, triglycerides, etc.)
    • Bone density
    • Gynecology exams
  • Keep your immunizations up to date, including the following:
    • Influenza vaccine
    • Pneumonia vaccine, if appropriate
    • Tetanus vaccine
    • Hepatitis vaccines, if appropriate
    • Shingles vaccine, if appropriate
  • Eat a healthy diet which includes 5-6 fruits and vegetables per day, whole grains and lean meats.
  • Include some activity in your daily routine. A 30 minute walk each day can be very beneficial.
  • Seek medical attention when an acute health issue arises to prevent the condition from worsening.
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