MANANGED CARE / HMO

CHANGE OF HEALTH INSURANCE PLAN

OR

CHANGE OF PCP

 

DEFINITIONS

Managed Care health plans such as Health Maintenance Organizations (HMOs) require that you designate a Primary Care Provider (PCP) in an affiliated medical group.

 

OUR DESIGNATIONS

Our PCP is Dr. Sunita Shailam in Mercy Physicians Medical Group (MPMG).

 

PREVIOUS PCP

If you have had a previous PCP, you may call your health insurance to switch back to that person to preserve your continuity of care.

 

TIMELINE OF PCP CHANGE

We typically do not accept transfers of patients who have been seen by other primary care doctors in town with exceptions and qualifications listed here.

For managed care (HMO) plans, we do not accept same month transfers in.

If you change on or before the before the 15th of the month it, your change will be effective the 1st of the following month.  If you change on or after the 15th of the month, your change will be efffective 2 months into the future on the 1st of that month.  So if you change on 14 January, it will not be effective until 1 February and if you change on 15 January it will not be effective until 1 March.

 

NOT ACTIVE ON MEDICAL GROUP WEBSITE

AND

SHOWING ELIGIBLE ON OUR ELECTRONIC HEALTH RECORD REAL-TIME ELIGIBILITY VERIFICATION

To be forthright, we can help the patient urgently and the visit here will likely be paid, but there is a chance it may not be.

ALTERNATIVE OPTION IF THE PROBLEM IS EMERGENT OR URGENT

We will send an electronic request to the medical group for website activation as a courtesy to the patient.  The patient is advised to call us back in 24 hours to verify status and if still not on website is encouraged to follow up with Mercy Physicians Medical Group at 619.543.8800 x0 to verify medical group website activation.

 

NOT ACTIVE ON MEDICAL GROUP WEBSITE

AND

NOT SHOWING ELIGIBLE ON OUR ELECTRONIC HEALTH RECORD REAL-TIME ELIGIBILITY VERIFICATION

     To be forthright we are fully disclosing in our experience it is unlikely your visit here will be paid, so to minimize patients' financial cost recommend:

IF THE PROBLEM IS EMERGENT OR URGENT

    The patient may follow up with Mercy Physicians Medical Group and also has the option to change the PCP and medical group by calling the telephone # listed on their health insurance plan card.

 

ESTABLISHED PATIENTS

For our established patients, every time you change insurance, verify your PCP as soon as you receive your insurance card so you will have access when you need us.

 

PPO PLANS

PPO plans are NOT managed care health plans and do not need to officially designate a PCP to be treated here.

 


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