how do i change my pcp on my healthcare connector
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How do i change my pcp on my healthcare connector amerigroup nj dentist

How do i change my pcp on my healthcare connector

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If you think you have a health emergency, go to the hospital ED. If you go to the ED and it is not an emergency, you may have to wait a long time for care. Some examples of emergencies are:. Urgent care is also called walk-in care. Check with your PCP before you go to urgent care because you need a referral. If you do not get a referral and go to urgent care, MaineCare may not pay the bill. What if I am out of Maine and need emergency medical attention? In an emergency, it is okay if the provider gives you care first and then gets in touch with MaineCare.

If you have a medical emergency outside of Maine and are treated at the hospital, the hospital may choose not to become a MaineCare provider. If that happens, you may have to pay the bill. You cannot get your money back from MaineCare.

Will I have a copayment or copay when I go to my medical appointment, fill a prescription, or receive another service covered by MaineCare? You may need to pay for part of the cost for some services. This is called a copayment or copay. My provider does not accept MaineCare. If I get services from this provider, will I have to pay the bill? If you see a provider who does not accept MaineCare, you will have to pay the bill.

Before you get care, you should make sure the provider accepts MaineCare. If you have MaineCare and Medicare, make sure your provider accepts both. Will I have a copayment or copay when I get my medication from a pharmacy? Which pharmacies participate in the Maine RX program? Pharmacies participating in the Maine RX discount drug program changes regularly. Can I use a mail order company for my medication?

MaineCare has a list of pharmacies where you can order generic and brand name medications and have them delivered by mail. What is a Prior Authorization PA? Before you can get some services or equipment, MaineCare must give you permission.

This is known as Prior Authorization PA. Your provider asks for a PA by sending a form to MaineCare. MaineCare will send letters to you and your provider stating if your PA is approved, denied, or if additional information is needed to complete the request. If you get the service or the medical equipment without MaineCare approval, you may have to pay the bill.

Your medical provider will need to get permission for MaineCare to pay for your medication if you need a PA. Your pharmacists may help you by contacting your medical provider directly for the PA. How do I find a dental provider who accepts MaineCare? You can also go to the Insure Kids Now website for a listing of dental providers who accept MaineCare. Can I get help with transportation to my MaineCare-covered appointments or to pick up my prescriptions at the pharmacy? A transportation broker can help you with rides to your MaineCare covered appointments or to pick up your prescriptions at the pharmacy.

You need to tell the broker 48 hours or two business days before you need the ride unless you need urgent care. To get help with out of state transportation, you must get Prior Authorization PA. The broker will request the PA. If I use my own vehicle or get a ride from my friend or family member, can I get reimbursed for the cost of my gas? You must contact your transportation broker48 hours before you go to your MaineCare-covered service or to pick up your prescription to be sure your gas mileage can be reimbursed.

MaineCare will pay mileage for the shortest route from your home. If I need help at my medical appointment, can I bring someone in the vehicle with me? MaineCare will allow another person to go with you if you need medical help on your way to the appointment or at the appointment. You may need to get a Letter of Medical Necessity. Call the transportation broker and they will tell you if a letter is needed when you schedule your ride. Can I bring my child with me in the vehicle when getting a ride from a transportation broker?

The transportation broker can see if there is room in the vehicle for your child. Talk to your transportation broker when you schedule your ride. How can I find home care for a family member?

What is a Letter of Creditable Coverage? This letter is needed when you become eligible for private health insurance. I am getting Medicare now. Call one of the Area Agencies on Aging listed below to discuss this and other Medicare questions.

Maine Area Agency on Aging. The five Area Agencies on Aging in Maine are the central resource for elder services. They can help you either directly or by referring you to the appropriate agency in your area. Call from anywhere in Maine to contact the Area Agency on Aging that serves the town you live in. Aroostook Area Agency on Aging. Eastern Area Agency on Aging. Seniors Plus. Southern Maine Area Agency on Aging.

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Enable Accessibility. Sign In or Register. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Members Frequently Asked Questions. Back to Top How do I know if I am eligible for MaineCare? Back to Top How do I report changes? Back to Top Benefits and Covered Services How do I know what services are covered? Back to Top What is an Explanation of Benefits EOB?

Back to Top MaineCare Card Is my MaineCare Card for everyone in my family? Back to Top How do I get a replacement MaineCare ID card?

Back to Top What should I bring to my first visit with my Primary Care Provider PCP? Back to Top If I get sick and it is not an emergency, what should I do? Back to Top What is a referral? Back to Top Emergency Services When can I use the Emergency Department ED? Back to Top When should I use urgent care instead of the Emergency Department or seeing my Primary Care Provider PCP?

Back to Top What if I am out of Maine and need emergency medical attention? Back to Top Costs to MaineCare Members Will I have a copayment or copay when I go to my medical appointment, fill a prescription, or receive another service covered by MaineCare? Back to Top My provider does not accept MaineCare. Back to Top Pharmacies and Medication Will I have a copayment or copay when I get my medication from a pharmacy? Back to Top Which pharmacies participate in the Maine RX program?

Back to Top Can I use a mail order company for my medication? Back to Top What should I do if I need a Prior Authorization PA for my medication? Back to Top Dental Services How do I find a dental provider who accepts MaineCare? Back to Top Transportation Can I get help with transportation to my MaineCare-covered appointments or to pick up my prescriptions at the pharmacy? Back to Top If I use my own vehicle or get a ride from my friend or family member, can I get reimbursed for the cost of my gas?

Back to Top If I need help at my medical appointment, can I bring someone in the vehicle with me? Back to Top Can I bring my child with me in the vehicle when getting a ride from a transportation broker?

Back to Top Home Care How can I find home care for a family member? Back to Top Medicare and Other Insurance What is a Letter of Creditable Coverage? Back to Top I am getting Medicare now. Download Word to open and read Word documents. Provider Blog. This material is for information only. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Information is believed to be accurate as of the production date; however, it is subject to change.

Also of interest:. Links to various non-Aetna sites are provided for your convenience only. Aetna Inc. The information you will be accessing is provided by another organization or vendor. If you do not intend to leave our site, close this message. Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan.

Do you want to continue? The Applied Behavior Analysis ABA Medical Necessity Guide helps determine appropriate medically necessary levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. Treating providers are solely responsible for medical advice and treatment of members.

Members should discuss any matters related to their coverage or condition with their treating provider. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered i. The member's benefit plan determines coverage.

Some plans exclude coverage for services or supplies that Aetna considers medically necessary. Medical necessity determinations in connection with coverage decisions are made on a case-by-case basis.

This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose. Copyright by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM. Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".

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This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract.

In case of a conflict between your plan documents and this information, the plan documents will govern. Who we are. Our mission. Diversity and inclusion Code of conduct. About Aetna. Our history Our leadership team Facts and subsidiaries.

Corporate responsibility. Health section. Who we are Our mission Our mission Diversity and inclusion Code of conduct. About Aetna Our history Our leadership team Facts and subsidiaries. Investors Investors. Health section Access Community Innovation Well-being. Coverage questions How do I find a participating provider? Our online directory can help you find: Doctors general and specialists Hospitals and urgent care centers Mental health care Pharmacies Substance abuse treatment Physical therapists Dialysis centers Eye exam providers Medical equipment suppliers Hospice care Hearing discount locations Much more The simplest way to use our online directory is through your secure member account.

Log in to your secure account You also can use our public directory. How do I get a paper provider directory? Your employer's benefits office can give you a provider directory for your area. How do I select or change a primary care provider PCP? If your physician leaves our network, you will be asked to select another PCP.

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Corporate Information Company Overview Careers. Newsroom Newsroom. Who are you? Go to Login. Register for an Account. Compare Plans and Enroll. How can I choose or change my PCP online? Enter your ZIP code and click Search. Follow the instructions to confirm your choice.

How can I choose or change my PCP through the mobile app? Need help? We're here for you. Most Washington Apple Health Medicaid eligible individuals receive their coverage through a managed care plan. If you're currently enrolled in an Apple Health managed care plan, you can switch to a different plan available in your area. Depending on when you make your request, your new plan will usually start the first of the next month.

View the managed care FAQ for more information. The Health Care Authority offers five health plans that provide services to our Apple Health clients. Not all plans are available in all areas. All health plans offer the same basic services. Breadcrumb Home Free or low-cost health care I need medical, dental, or vision care Change my health plan. Change my health plan Most Washington Apple Health Medicaid eligible individuals receive their coverage through a managed care plan. How do I change my plan?

There are several ways to switch your plan: Change your plan on the Washington Healthplanfinder website.

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WebWith your member portal, you can manage your health care 24/7 and do things like: Order a new member ID card; Check if your PCP needs to get prior authorization (permission) . Oct 7, аи If you need to change your PCP, just follow these simple steps: 1. Check the provider directory. To find a new PCP, check the Provider Directory for a PCP in your area. Our Provider Directory lists all the providers in our network. The online version of the Provider Directory has the most up to date information. 2. WebYou can search by name, location, gender and more. You can change your PCP using your member portal. With your member portal, you can manage your health care any .