OB/GYN Services
General Information
To eliminate any perceived barrier to accessing OB/GYN services, Gateway allows all female members to self-refer to any participating OB/GYN for any OB/GYN related condition, not just for an annual exam or suspected pregnancy. When a member self-refers to the OB/GYN, the OB/GYN's office is required to contact Gateway to verify eligibility of the member.
Gateway permits its primary care practitioners to perform routine gynecological exams and pap tests and provide care during pregnancy if they are so trained and equipped in their office.
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Obstetrical Needs Assessment Form
The first visit with an obstetrical patient is considered to be the intake visit, or if a patient becomes a Gateway member during the course of her pregnancy, her first visit as a Gateway member is considered to be her intake visit. At the intake visit, an Obstetrical Needs Assessment Form, found in the Forms and Reference Materials Section of this Manual, must be completed.
The Obstetrical Needs Assessment Form should immediately be faxed to Gateway and then filed in the member's medical record. The Obstetrical Needs Assessment Form should be updated at the 28-32 week visits and also at the post-partum visit.
These two updates should also be faxed to Gateway immediately following completion.
The purpose of the Obstetrical Needs Assessment Form is to help identify risk factors before delivery. For that reason, the Obstetrical Needs Assessment Form must be faxed to Gateway's MOM Matters® Department within 2-5 business days of the intake visit and at least 30 days prior to delivery.
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Diagnostic Testing
Fetal Non-stress Tests and Ultrasounds can be performed in the OB/GYN's office or at a hospital without an authorization from Gateway.
Mammograms performed at a participating hospital require a prescription.
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Appointment Standards
Appointment standards for OB/GYN practitioners including Certified Nurse Midwifes are as follows:
| REQUIREMENT |
STANDARD |
| Wait time for an Urgent, but Non-Emergent Care Appointment |
Within twenty-four (24) hours from the date of referral |
| Wait time for a Non-Urgent, but in need of Attention Appointment |
Within 1 week from the date of referral |
| Wait time for a Routine Care Appointment |
Within 30 days from the date of referral |
| Waiting Time in the Waiting Room |
No more than fifteen (15) minutes or up to one (1) hour when the MD encounters an unanticipated urgent visit or is treating a member with a difficult need. |
A member should be seen by a practitioner as expeditiously as the member's condition warrants, based on the severity of symptoms. If a practitioner is unable to see the member within the appropriate timeframe, Gateway will facilitate an appointment with a participating or non-participating practitioner, if necessary.
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