PartnershipAdvantage (HMO SNP) - 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 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. 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.
Your PCP will use the forms below to request authorization for certain services. You should see your PCP or treating provider if you need help getting services.
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MEDICAL CARE AT NIGHT AND ON THE WEEKENDS
Most doctor's offices and clinics are closed at night and on the weekends. So, what should you do if you need after hours health care?
- Call your Primary Care Provider's office. Each office has after-hours services.
- Or, call the PHC Advice Nurse.
The Advice Nurse is available to you 24 hours a day, 7 days a week. The Advice Nurse phone number is (866) 778-8873. You can use this free service if you're not sure if you should go to the emergency room or if you have a medical question that can't wait until the next day. If you have a life threatening emergency, you should go to the closest emergency room or call 911
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DEVELOP YOUR PERSONAL HEALTH RECORD
Many health care experts have agreed that if patients tools to help them manage their own care, it is excellent way to achieve improvements in health outcomes. A number of computer tools have been developed to help patients keep track of their own health information. Shared care.com is a website that gives you as patients a tool you can use to assist you and your doctors to organize your care better. It is simple to use, confidential and totally free to the users. If you are interested in trying it to keep track of your own health information such as major diagnoses, medications, allergies and health goals just go to www.sharedcareplan.org and follow the simple instructions to get started. If you need assistance please call the PHC Member Services Department for help. Good Luck!!
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