PartnershipAdvantage - About Getting Care
Choosing and changing your Primary Care Provider (PCP)
When you become a member of PartnershipAdvantage, you must choose a plan provider to be your PCP. Your PCP may be an internist or a family practitioner, general practitioner or a pediatrician for children. Your PCP meets state requirements and is trained to give you basic medical care. As we explain below, you will get your routine or basic care from your PCP. Your PCP will also coordinate the rest of the covered services you get as a plan member. For example, in order to see a specialist, you usually need to get your PCP’s approval first (this is called getting a “referral” to a specialist).
When you complete your Enrollment Application you are asked to choose a PCP. You will use the PartnershipAdvantage Provider/Pharmacy Directory to make your choice. The directory tells you if the PCP is accepting new patients, accepting only current patients or if the PCP is closed to all patients. Be sure to check this when you choose your PCP. When we process your application we will assign you to the PCP that you choose on your Enrollment Application. If there is a particular PartnershipAdvantage specialist or hospital that you want to use, check to be sure your PCP makes referrals to that specialist, or uses that hospital.
If you want to change your PCP, you should contact the PartnershipAdvantage Member Services Department to request the change.
The name, address and office telephone number of your PCP is printed on your membership card.
The health care providers in our network may change. You can request a current list of providers by contacting our Member Services Department.
Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.
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Getting Care from Your PCP
You will usually see your PCP first for most of your routine health care needs. As we explain in Section 4 of your Evidence of Coverage, there are only a few types of covered services you can get on your own without contacting your PCP first.
Besides providing much of your care, your PCP will help arrange or coordinate the rest of the covered services you get as a plan member. This includes your x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions, and follow-up care. "Coordinating" your services includes checking or consulting with other plan providers about your care and how it is going. If you need certain types of covered services or supplies, your PCP must give approval in advance (such as giving you a referral to see a specialist). In some cases, your PCP will also need to get prior authorization (prior approval). Since your PCP will provide and coordinate your medical care, you should have all of your past medical records sent to your new PCP's office. Section 9 of your Evidence of Coverage tells how we will protect the privacy of your medical records and personal health information.
Refer to the section of this website titled "Contacting PartnershipAdvantage" for our hours, phone number and address.
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