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Covered California and Obamacare related questions from consumers, employers and agents are answered by Phil Daigle with the best information available at the time. Archived entries may no longer be accurate as the Covered California and Obamacare knowledge-base is evolving quickly. TO REQUEST A PERSONAL RESPONSE INCLUDE EMAIL ADDRESS.


FACT and Golden Rule

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Question: I have some questions -
1. I have two cards. Golden Rule and FACT. I believe that FACT is a route to discount services for Dental and Vision. However, on the cover of the document it is stated that the Policyholder is Fact. Could you clarify for me FACT vs Golden Rule?
2. I will need to visit an orthopaedic specialist. Do I select a specialist from www.goldenrule.com (to get a preferred supplier) and make my own appt, or do I need to go through my Primary Care Physician first?
3. When I get medical treatment, should I simply present my Golden Rule card, have them bill Golden Rule, and then pay when they invoice me (i.e. to ensure that applicable discounts are applied)?

Thanks and sorry for the bother.

Answer: Thanks so much for your questions. I'm going to answer them in order as follows:

1. FACT is an organization that provides you with dental and vision discounts. Golden Rule requires that you have membership with FACT in order to maintain a health insurance policy with them. This isn't their only function, however. They also serve as mediators should you have a dispute with Golden Rule regarding, for example, a claim. Not to confuse matters but Golden Rule is a wholly owned subsidiary of United Healthcare. This is a good thing because they wield quite a lot of clout in the health services industry. What this means to you is that their claims discounts are considerable.

2. It's fine for you to use a specialist without getting a referral from your doctor because you have a PPO (Preferred Provider Organization) plan. Practically speaking, however, I have found that specialist MDs require a referral from your primary physician, although this has nothing to do with the requirements of your health insurance plan. To find an in-network provider visit the Provider Directories information area of our website. Once there click on 'Golden Rule - United Healthcare'.

3. Yes, presenting your ID card at the time of service t is definitely the best approach. You will then receive what's called an Explanation of Benefits (EOB) from Golden Rule that should match exactly the bill from your doctor.

Hope this helps!

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