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1. |
Who is Physicians Health Choice?
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We are a physician-owned Medicare Advantage Organization which means we have a contract with Medicare to provide health care services to persons with Medicare Part A (Hospital benefits) and Medicare Part B (Medical benefits). With our contract, we are able to offer additional benefits that the Original Medicare Plan does not offer.
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2. |
Once I sign up for Physicians Health Choice, when am I effective?
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Your effective date is the first of the following month that you enroll. For example, if you enrolled on June 15th, your effective date will be July 1st.
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3. |
As a new member, when do I get my Member ID card?
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Once your enrollment form information is verified and entered into our system, you will receive an Acknowledgment of Receipt letter along with your Member ID card.
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4. |
Do I have to use only Physicians Health Choice physicians?
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Yes. Physicians Health Choice is a Medicare Advantage health plan which means we have a contract with Medicare to provide services to you within our contracted provider network. This helps to ensure better communications with the physicians treating you.
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5. |
How do I transfer my medical records?
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You may request an Authorization form from your Physicians Health Choice primary care physician’s office to have your medical records transferred to him/her.
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6. |
How do I find out if my specialist is contracted with Physicians Health Choice?
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You may look up your specialist in the Provider Directory section of this website. However, though your specialist may be listed as a contracted provider with Physicians Health Choice, you should check with your PHC primary care physician to ensure he/she refers to your particular specialist.
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7. |
What is a value added service?
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A value added service is a service offered by Physicians Health Choice which is not covered under the Original Medicare Plan.
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8. |
How do I file a complaint?
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You may contact our Member Service Department at 1-866-550-4736 and speak with a Member Service Representative who will document and resolve your complaint. Or if you prefer to send in writing, you may go to the Forms section on this website, print out a Complaint Form and mail it to:
Physicians Health Choice
Attn: Grievance Coordinator
P.O. Box 29429
San Antonio, TX 78229-9998
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9. |
What should I do if I have an emergency after hours when my Primary Care Physician’s office is closed?
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Your Primary Care Physician has an answering service for after-hours calls 7 days a week. The answering service will notify the physician on-call of your urgent or emergency need. The on-call physician will call you back to provide appropriate direction for your health care needs.
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10. |
What if I have an emergency when I’m out of town?
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Go to the nearest emergency facility to receive care. Provide your Physicians Health Choice Member ID card so they can verify your eligibility and benefits. If you are asked to pay any out of pocket expenses (except for your emergency room co-payment which would be waived if you are admitted into the hospital), you may send your bills to our Claims Department for reimbursement. If you are admitted into the hospital, please contact your Primary Care Physician so he/she is aware of your admission.
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11. |
What is a disease management program?
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This is a program that provides tools to monitor and educate you about diseases such as Diabetes, Congestive Heart Failure, and Ischemic Heart Disease. Physicians Health Choice believes the more you know about your disease, the easier it will be to manage, allowing you to live a healthy lifestyle.
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12. |
How do I change my Primary Care Physician (PCP)?
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Call our Member Service Department at 1-866-550-4736 to request a change in your PCP. This type of change should be made by the 20th of each month to ensure our systems are updated and your new PCP is notified. You may also go to the Forms Center section of this website, print and complete a copy of the PCP change form and mail it to:
Physicians Health Choice
Attn: Member Service
P.O. Box 29429
San Antonio, TX 78229-9998
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13. |
Why do I need to get a referral?
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Referrals help coordinate and track the care you receive. They also allow the physician to whom you are being referred to better understand your needs by reviewing what services you’ve already received.
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14. |
How do I get a duplicate ID card or notify you of my address change?
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Call our Member Service Department at 1-866-550-4736.
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15. |
What is a Grievance?
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A grievance is a complaint you may file regarding the care you receive such as discourteous staff or physician, quality of care, no appointments available, or unable to get through phone lines. To file a grievance, contact Member Service at 1-866-550-4736 or send in writing to:
Physicians Health Choice
Attn: Grievance Coordinator
P.O. Box 29429
San Antonio, TX 78229-9998
To learn more about Grievances please review:
Texas – Appeals and Grievances
New Mexico – Appeals and Grievances
For more details about the Grievance process, please refer to Section 10 of your Member Evidence of Coverage handbook.
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16. |
What is an Appeal?
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An appeal may be filed if you receive a denial of benefit coverage. To file an appeal, you may contact Member Service at 1-866-550-4736 or send in writing to:
Physicians Health Choice
Attn: Appeals Coordinator
P.O. Box 29429
San Antonio, TX 78229-9998
To learn more about Appeals please review:
Texas – Appeals and Grievances
New Mexico – Appeals and Grievances
For more details about the Appeals process, please refer to Section 11 of your Member Evidence of Coverage handbook.
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17. |
How do I know if my prescription is covered?
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Go to the Members Section of this website and click on Prescription Formulary.
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18. |
Is there a limit on the prescription benefit?
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Yes. You may refer to this website under Our Health Plan Products Section and click on the Summary of Benefits or you may refer to the Benefits Chart in your Evidence of Coverage handbook.
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19. |
Which pharmacies should I use?
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The contracted pharmacies are listed in the Provider Directory under the Members Section of this website.
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20. |
How does Physicians Health Choice ensure providers are properly licensed?
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We have a Credentialing department who verifies and tracks the credentials and licensures of all of our Plan Providers.
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21. |
What is a PA?
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A PA is a Physician Assistant who can provide healthcare services under the supervision of a physician.
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22. |
What type of qualifications does a Physician Assistant (PA) have?
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Physician Assistants must have graduated from an accredited college or university and have an advanced degree as a PA.
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23. |
What types of services are PAs qualified to perform?
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Take your medical history
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Conduct examinations
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Order and interpret lab and x-rays
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Make diagnosis
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Prescribe medications
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Remove skin tags or moles
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Treat minor injuries by splinting, suturing and casting
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