Frequently Asked Questions

• Who is Physicians Health Choice?
  We are a physician-owned Medicare Advantage Organization. This 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.
• Once I sign up for Physicians Health Choice, when am I effective?
  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.
• As a new member, when do I get my Member ID card?
  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.
• Do I have to use Physicians Health Choice physicians?
  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 communication with the physicians treating you.
• How do I transfer my medical records?
  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.
• How do I find out if my specialist is contracted with Physicians Health Choice?
  You may look up your specialist in the Provider Directory section of this Web site. Though your specialist may be listed as a contracted provider with Physicians Health Choice, you should check with your Physicians Health Choice primary care physician to ensure he/she refers to a particular specialist.
• How do I file a complaint?
  You may contact our Customer Service Department at 1-866-550-4736 and speak with a Customer 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 Web site, print out a Complaint Form and mail it to:

   

  Physicians Health Choice
  Attn: Grievance Department
  P.O. Box 29429
  San Antonio, TX 78229-9998
• What should I do if I have an emergency after hours when my Primary Care Physician’s office is closed?
  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.
• What if I have an emergency when I’m out of town?
  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.
• What is a disease management program?
  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 healthier lifestyle.
• How do I change my Primary Care Physician (PCP)?
  Call our Customer Service Department at 1-866-550-4736 to request a PCP change. 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 Web site, print and complete a copy of the PCP change form and mail it to:

   

  Physicians Health Choice
  Attn: Customer Service Department
  P.O. Box 29429
  San Antonio, TX 78229-9998

   

  Once Physicians Health Choice changes your PCP, you will receive a new ID card in the mail.

• How do I get a duplicate ID card or notify you of my address change?
  Call our Customer Service Department at 1-866-550-4736.
• What is a Grievance?
  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 Customer Service at 1-866-550-4736 or send in writing to:

   

  Physicians Health Choice
  Attn: Grievance Department
  P.O. Box 690670
  San Antonio, TX 78269
  To learn more about Grievances please review the Appeals and Grievances Section, or refer to Section 4 of your Evidence of Coverage handbook.
• What is an Appeal?
  An appeal may be filed if you receive a denial of benefit coverage. To file an appeal, you may contact Customer Service at 1-866-550-4736 or send in writing to:
  Physicians Health Choice
  Attn: Appeals Department
  P.O. Box 29429
  San Antonio, TX 78229-9998
  To learn more about Appeals please review the Appeals and Grievances Section, or refer to Section 5 of your Evidence of Coverage handbook.
• How do I know if my prescription is covered?
  Go to the Prescription Drugs section of this Web site and select Prescription Formulary.
• Is there a limit on the prescription benefit?
  Yes. You may refer to Our Health Plan Products section and select Summary of Benefits or you may refer to the Benefits Chart in Section 10 of your Evidence of Coverage handbook.
• Which pharmacies should I use?
  The contracted pharmacies are listed in the Provider Directory under the Members section of this Web site.
• How does Physicians Health Choice ensure providers are properly licensed?
  We have a Credentialing department who verifies and tracks the credentials and licensures of all of our contracted providers.
• What is a PA?
  A PA is a Physician Assistant who can provide healthcare services under the supervision of a physician.
• What type of qualifications does a Physician Assistant (PA) have?
  Physician Assistants must have graduated from an accredited college or university and have an advanced degree as a PA.
• What types of services are PAs qualified to perform?
  Take your medical history
  Conduct examinations
  Order and interpret lab and x-rays
  Make diagnosis
  Prescribe medications
  Remove skin tags or moles
  Treat minor injuries by splinting, suturing and casting