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Click on a question below to view the answer.
| 1. |
What is a PCP? |
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The letters "PCP" stand for "primary care provider." The PCP is a doctor or nurse practitioner who you choose for all of your regular or routine care. Your PCP will help keep you healthy and will treat you when you are ill. Your PCP will also arrange for you to have lab tests and x-rays, see a specialist, or go into the hospital, if needed. |
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| 2. |
Should everyone in my family have the same PCP? |
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Each family member can have a different PCP or you can choose one PCP for the whole family. A Family Practice doctor can treat the whole family. A Pediatrician is a doctor who treats children. An Internal Medicine doctor treats mostly adults. The choice is yours. If you need help deciding which PCP is right for you and your family, call our Member Services Department toll free at 1-866-247-5678. |
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| 3. |
I am a new Affinity Health Plan Member - can I keep seeing my old doctor who is not in the Affinity provider network, or do I have to switch to an Affinity doctor right away? |
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You may keep seeing your old non-Affinity doctor for up to 60 days after your effective date of enrollment, but only if you need to continue treatment you are already getting for a life-threatening, degenerative or disabling condition. Also, if you are three or more months pregnant when you join Affinity, you can keep seeing your non-Affinity doctor for your pregnancy until after your baby is born and you have your follow up care. |
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| 4. |
I am expecting a baby. What happens when my baby is born - will my baby be enrolled in Affinity Health Plan? |
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If you are a Member of our Medicaid program, your baby will be enrolled in Affinity Health Plan on the day he or she is born. Your newborn baby, however, will not be enrolled in our program if the baby weighs less than 1200 grams (about 2 1/2 pounds) at birth, or the baby has full private health insurance, or you are incarcerated at the time of birth. If you are a Member of our Child Health Plus, Family Health Plus or UniCare program, you should contact our Member Services Department toll free at 1-866-247-5678 to arrange for your baby's health care coverage. |
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| 5. |
What happens if my doctor leaves Affinity Health Plan's provider network? |
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Within 15 days after we learn that your doctor is leaving our provider network, we will let you know so you can choose another PCP from our provider network. If the doctor who is leaving is treating you for a condition, you can continue to use that doctor for up to 90 days before you have to select a new Affinity doctor. |
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| 6. |
How do I change PCPs? |
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Sometimes, you or a family member may need to choose a different PCP. For example, your PCP may move to a new location that is not convenient for you. Or, you may just want to try a different PCP for personal reasons. That's OK. You can change your PCP at any time. Call our Member Services Department toll free at 1-866-247-5678, and ask for help in selecting another PCP. |
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| 7. |
How do I get specialty care that my PCP cannot provide? |
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Your PCP will refer you to a specialist if you need specialty care. We have over 5,000 physician specialists in our provider network. These are doctors with special training in conditions such as heart disease, cancer, or asthma. If we do not have a specialist in our provider network that can give you the care you need, we will get you one from outside the network. |
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| 8. |
What should I do if I become ill or a family member becomes ill? |
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If you have a life-threatening emergency, you should go to the nearest hospital emergency room. If the illness or injury is not an emergency, call your PCP - even when your PCP's office is closed. There is always a doctor on call to help you. The telephone number for your PCP's office is printed on your Affinity Health Plan ID Card. You can call anytime, 24 hours a day, seven days a week. When you call, tell the operator your name, the name of your PCP, your Affinity Health Plan ID number, and the reason for your call. Your PCP - or another doctor who works with your PCP - will handle your call. |
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| 9. |
Does Affinity Health Plan cover Chiropractors? |
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No, our health care programs do not cover chiropractic services. |
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| 10. |
What should I do if I get a bill from a provider? |
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We pay for all of the services covered by your Affinity Health Plan program. If a provider bills you for a covered service, send that bill to us and we will take care of it. |
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| 11. |
What should I do if I have a problem with the service I receive from Affinity Health Plan or its doctors? |
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We take our motto, Dedicated to Excellence, seriously, and we strive to serve you and your family well all the time. But, if you have a problem with our service or services you receive from an Affinity provider, we encourage you to call or write our Member Services Department. We will do our best to solve any problem you may have with our program. If you are not satisfied and need to file a complaint, please do so. We will not make things hard for you or take any action against you for filing a complaint. In fact, our Member Services Representatives can help you prepare your complaint if you have difficulty because of hearing or vision impairment, or if you need translation services. |
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| 12. |
What if I don't agree with Affinity's decision on my complaint? |
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If you are not satisfied with our decision on your complaint, you can appeal that decision. Instructions on how to file an appeal are in your Member Handbook. You can also call our Member Services Department for an explanation on how to file an appeal. |
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