Updating Your Insurance Pcp: A Guide

There are many reasons why you might want or need to change your Primary Care Provider (PCP). You might be moving away, your PCP might be retiring, or you might simply feel like your PCP isn't listening to your concerns. Whatever the reason, there are a few important steps to take when changing your PCP. Firstly, it's a good idea to find a new PCP before leaving your old one, as this will ensure you're not left without a primary care provider if you get sick or need a referral. You'll also need to confirm that your insurance covers your new PCP, as some plans require you to choose a PCP from a specific list of providers in their network. Once you've found a new PCP and confirmed they're covered by your insurance, you can request your medical records from your old PCP and notify your insurance company of the change.

Confirm your new PCP is covered by your insurance

Confirming that your insurance covers your new PCP is an essential step when switching your primary care provider (PCP). The specific steps you need to take will depend on the type of insurance plan you have. Here are some common scenarios:

Health Maintenance Organization (HMO) Plan

If you have an HMO insurance plan, you are required to choose a PCP from a specific list of providers in your insurance's network. Contact your insurance company to find out which PCPs are covered by your plan. This step is crucial, as selecting a PCP outside of your network may result in significantly higher medical expenses or even a need to cover the entire cost of care.

Preferred Provider Organization (PPO) Plan

With a PPO plan, you usually have more flexibility in choosing your PCP. While you are not required to have a PCP, it is strongly recommended. You can select a PCP that is not covered by your plan, but this will generally be more expensive. Contact your insurance company to confirm which PCPs are covered by your PPO plan.

Exclusive Provider Organization (EPO) Plan

EPO plans do not require you to have a PCP. However, if you want to designate a PCP, you must choose from a list of providers within your insurance's network. Reach out to your insurance company to determine which PCPs are covered under your EPO plan.

Point of Service (POS) Plan

Similar to a PPO plan, a POS plan allows you to see a PCP outside of your network, but it will likely result in higher costs. Contact your insurance company to confirm which PCPs are covered and understand the associated costs.

Medicare Advantage Plan

If you are enrolled in a Medicare Advantage Plan, it is your responsibility to promptly inform your health insurance company about your PCP change. This affects insurance claims processing, network coverage status, and insurance card details. Contact your insurance provider to confirm if your new PCP is in-network and to update your information.

Original Medicare (Part A and Part B)

With Original Medicare, you typically don't need to choose a PCP. However, ensure that your PCP accepts Medicare assignment to keep your out-of-pocket costs low. If your PCP participates with Medicare, you will only pay 20% of Medicare's allowable charges once your Part B deductible is met.

Medicare Advantage Preferred Provider Organization (PPO)

With a Medicare Advantage PPO plan, you are generally not mandated to select a PCP. However, to pay the lowest out-of-pocket costs, you should see network physicians. Confirm with your insurance company if your new PCP is considered in-network.

In summary, it is crucial to verify that your new PCP is covered by your insurance plan to avoid unexpected expenses and ensure a smooth transition. Contact your insurance company, review your plan details, and understand the specific requirements and costs associated with your particular insurance plan.

Notify your insurance company of the change

Once you have found a new primary care provider (PCP), it is important to notify your health insurance company of the change. This is a straightforward process that can usually be done by filling out an online form or calling member services.

If you are enrolled in a Medicare Advantage Plan, it is particularly important to share your new PCP with your insurance company promptly. This is because the change will affect insurance claims processing, network coverage status, and insurance card details. Your insurance company will be able to review details relevant to the change, such as confirming whether the new doctor is in-network. It is worth noting that your insurance company only needs to be notified of a PCP change if you are on a Medicare Advantage Plan, not a Medicare Supplement Plan.

When you have updated your PCP with your insurance company, they will issue a new insurance card with the updated information. It is important to have an accurate and up-to-date insurance card to present at your doctor's office, as insurance cards include your copay amount and PCP's name. By sharing this update with your insurance company, you can avoid issues such as paying a higher copay for an office visit or learning that your new PCP is considered out-of-network.

Additionally, when scheduling an appointment with your new PCP, remember to share the specific name of your Medicare Advantage plan and reconfirm that the doctor's office accepts it. This will help ensure a smooth transition to your new primary care provider.

Request your medical records

Requesting your medical records is a crucial step when changing your PCP. It ensures that your new doctor has a comprehensive understanding of your medical history and can provide informed treatment plans. Here are some detailed instructions on how to request your medical records:

Understanding Your Rights

It's important to know that you have the right to access your medical records. You can request either a paper or electronic copy of your records, and your provider is legally obligated to fulfil this request. Your provider can charge a small delivery fee if you request the records to be mailed to you. Additionally, you have the right to have your provider send your medical records to a third party, such as your new PCP, on your behalf.

Making the Request

To obtain your medical records, start by asking the staff at your current PCP's office for the necessary forms. They may have a request form that you can fill out, or they may direct you to an online portal where you can access your records electronically. If your doctor participates in the Medicare and Medicaid Electronic Health Care Record Incentive Program, they must provide you with your records within four business days. Otherwise, they typically have 30 days to fulfil your request, with the possibility of a 30-day extension.

Storing and Sharing Your Records

Once you receive your medical records, store them securely. You can keep them in a safe location, such as a locked file cabinet, or upload them to a personal health app or secure online drive. When you schedule an appointment with your new PCP, bring your medical records with you to share with the new doctor. This will enable them to provide more informed care and treatment.

Timing Your Request

It's recommended to request your medical records as soon as you decide to switch PCPs. The process of obtaining your records may take some time, and you want to ensure that your new doctor has access to this information during your first appointment. Additionally, it's generally advisable to find a new PCP before leaving your old one, to ensure continuity of care.

Additional Considerations

If your current doctor uses a patient portal, such as MyChart, you may be able to access your medical records through that portal. Additionally, services like Guava allow you to connect your doctor's portal and access your records conveniently. Remember, there is no need to explain why you are switching doctors. However, if you had a negative experience, you can choose to provide constructive feedback to help improve their practice.

Research new PCP candidates

Researching new PCP candidates is an important step in managing your healthcare. Here are some detailed tips to help you research and find a new Primary Care Provider (PCP):

Determine Which Doctors Are "In-Network"

Most health insurance plans have negotiated discounted rates with specific doctors and hospitals, known as "in-network". Choosing an in-network PCP will help you avoid unexpected out-of-pocket expenses or having to pay in full because your insurance plan isn't accepted. Check your insurance company's website or call them to find an in-network PCP in your area.

Consider Your Preferences and Requirements:

Think about what you want from your PCP. Do you have a language preference? Would you prefer a male or female physician? Is their location important to you? Do you want to know about their medical degree and years of experience? Considering these factors will help you decide what is important to you in a doctor-patient relationship.

Ask for Referrals:

Asking for recommendations from people you trust, such as family, friends, colleagues, or other healthcare professionals, is an excellent way to find potential PCP candidates. Their firsthand experience can provide valuable insights and guide your search.

Think About Logistics:

Consider the location of the PCP's office. Is it easily accessible from your home, school, or workplace? Also, think about office hours and whether they align with your schedule. Do they offer evening or weekend appointments? What about virtual appointments? Additionally, check the hospital they are affiliated with and whether they can perform basic procedures like lab tests and x-rays in the same facility.

Assess the Practice:

When you interact with the office staff, note their professionalism and courtesy. Are they respectful and efficient? Do they answer phones promptly and schedule appointments in a timely manner? These factors contribute to your overall experience and satisfaction with the practice.

Evaluate the Physical Environment:

During your visit to the office, observe the waiting room and treatment rooms. Are they clean, well-maintained, and relatively calm? Is the medical equipment modern and functioning properly? Your comfort and satisfaction during your wait can be influenced by the physical environment.

Consider Special Needs and Communication:

If you have any special needs or medical conditions, consider whether the PCP and their practice can accommodate these. Additionally, assess the doctor's communication style. Do they listen to your questions and concerns? Do they explain things in a way you understand? Effective communication and a comfortable relationship with your PCP are essential for your healthcare journey.

Remember, it's crucial to find a PCP that suits your individual needs and with whom you feel comfortable and respected.

Make sure your new PCP is accepting new patients

When choosing a new primary care provider (PCP), it is important to remember that this is the individual who will manage all of your care needs. You want to select someone you feel comfortable with and who has the expertise to meet your health needs. You'll also want to make sure they are accepting new patients.

Before you start searching for providers, make a short list of things you want to see in your new doctor. This will help you narrow down your search. Some considerations include:

• Where do you want your provider to be located?
• If you have any medical conditions or concerns, do you want a provider who specializes in that type of care?
• Would you prefer to see a male or female provider?
• What type of PCP is right for you or your dependents – an internist (focused on adult care), a pediatrician (focused on child care), or a family practitioner?

Once you've picked out a few providers who meet your needs, the next step is to make sure they are accepting new patients. You can usually check this on the provider's website or by calling their office. If they are accepting new patients, you can then confirm if they are in-network for your health plan (covered by your insurance). If your health plan has a provider search tool, you can check which providers are covered by their network there. You can also call their customer support and ask them to check for you. They can typically be reached by calling the phone number on your member ID card.

If they are covered by your plan, the final step is to give the doctor's office a quick call or stop by and ask if the doctor you're interested in is accepting new patients. This can also be a good chance to see how friendly the office staff are and if the office is clean and welcoming. Providers often start or stop taking new patients, so it's important to check and make sure you have the latest information.

It is also important to remember that it could take time to find a new PCP. Some providers may not be accepting new patients, or they may not be able to get you in within a reasonable time frame. Therefore, it's best to ensure you have found a new PCP before leaving your old one.

Frequently asked questions