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  • Care Navigation Form

    Please fill out the information below so that we can help you find a Provider.

  • Introduction:

    At Solidarity, we believe our Members have the right to direct their own healthcare. You have the ability to see any healthcare provider of your choosing. Care Navigation services are intended to help you locate the best provider option for your specific situation. If you need help locating a provider, please fill out the information below and our Care Navigation Team will contact you about provider options.

    Please note that every effort is made to ensure the accuracy of the information provided, but we cannot guarantee all information will be current. We appreciate feedback to help us provide the most accurate information possible to help serve our Membership. 

    If you would like to nominate any of your providers to try and expand our Preferred Provider relationships, please fill out a Provider Nomination Form.

    If you have any questions, please contact our team at support@solidarityhealthshare.org or call us at (844) 313-4999 option 2.

  • Please note: If this request is being submitted related to an upcoming surgery, current cancer treatment or maternity services, this request needs to go through our Care Coordination team. Please fill out the Inquiry Form here.


  • Navigation Information Needed

  • Imaging

  • Please note that a referral/order is needed to obtain your imaging. If you do not have a referral/order, please contact your physician.

    We have partnered with Green Imaging, a full service national imaging company, which provides exceptional services at fair and just costs for Solidarity Members.

     Please fill out the information below to help us get you scheduled for your imaging!

  • If your upcoming service is an MRI or Nuclear Imaging, these imaging services require an approved Pre-Notification. It is advised to have your physician fill out a Pre-Notification form on your behalf. To obtain the Pre-Notification form, please click here.

  • Low Dose Cancer Screening

    A procedure that uses a computer linked to an x-ray machine that gives off a very low dose of radiation to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create 3-D views of tissues and organs. Low-dose CT scan is recommended as a screening test for adults who have a high risk of developing lung cancer based on their age and smoking history.
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  • Mammogram Screening

    A screening mammogram is a low-dose imaging test that helps doctors spot changes in breast tissue.
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  • CT Screening

    CT screening is a noninvasive imaging procedure that uses X-rays to create detailed pictures of the body to help detect disease or injury.
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  • Breast MRI Screening

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  • If yes, please send a copy of your bloodwork results or provide the name and phone number of the doctor who ordered the bloodwork and Green Imaging will request it on your behalf.

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  • MR Contrast Exams

    MR stands for magnetic resonance, and there are multiple types of MR imaging techniques, including MRI, MRA, and MRS.

  • If yes, please send a copy of your bloodwork results, or provide the name and phone number of the doctor who ordered the bloodwork, and Green Imaging will request it on your behalf.

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  • MRI Screening

    Also known as a non-contrast MRI, this type of scan doesn't use a dye and can still produce detailed images. Non-contrast MRIs are often used for orthopedic studies and to detect aneurysms and blocked blood vessels.

  • If yes, please send a copy of your bloodwork results or provide the name and phone number of the doctor who ordered the bloodwork and Green Imaging will request it on your behalf.

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  • CT/IVP Contrast Exam

    A CT/IVP (computed tomography intravenous pyelogram) is a diagnostic exam that combines a CT scan with an intravenous pyelogram (IVP) to examine the urinary tract.
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  • If yes, please attach a copy of your bloodwork results or provide the name and phone number of the doctor who ordered the bloodwork and Green Imaging will request it on your behalf.

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  • Imaging

    All other imaging services may include: Ultrasounds, EKG, Bone Scan, Stress Test, etc...
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  • Review Your Care Navigation Information

  • Please review the information you entered before submitting your form

     

    Membership ID Number: {MembershipId}

     

    Member Name: {MemberName}

     

    Member Email: {MemberEmail}

     

    Member Phone: {contactNumber}

     

    Navigation Search Area: {CityState} {Zip}

     

    Specialty: {Specialty1}   {Specialty2}   {Specialty3}

     

    Description of Service: {Description}

  • Other Specialty: {ifother1} {ifother2} {ifother3}

     

     

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