What is an IPA?
IPA stands for “Independent Practice Association”. Independently practicing physicians (physicians with their own independent practices) join an IPA, and you as member of the IPA can see any of these doctors.
Why is it important that I select an IPA?
You and your family’s healthcare is important from the first doctor visit onward, and you want to select a high-quality IPA that will best fit your needs and expectations. When you sign up for healthcare and don’t select an IPA, your insurance carrier will randomly assign you to one. PCAC IPA prides itself on its unique personal touch. Our physicians have trained at prestigious medical centers.
How many physicians can I choose from?
We have over 2,000 physicians of all specialties.
What about quality improvement?
PCAC IPA leadership continuously monitors the healthcare providers’ quality of care. We set ambitious goals every quarter, with the goal of constant improvement in the care we provide our members.
Our members should expect a prompt and courteous appointment process, a respectful, informative physician who is up to date and communicates openly with their patients and caregivers, as well as receive timely test results and patient callbacks. PCAC IPA’s doctors are measured on all of these criteria: patient access to the doctor, patient satisfaction and physician clinical skill. It is our goal is to help our physicians practice excellent medicine.
Do I need to inform my physician if I change insurance?
Yes. Always inform your physician’s office when you change insurance. Your insurance coverage may vary with a new policy and your physician needs to know this.
Do I need to inform my physician when I change medical groups?
Yes. Your physician may have contracts with several provider groups. Each provider group has different policies regarding referrals and has a different panel of specialists. To make sure that you are referred to the right specialists, let your physician know if you change medical groups.
Should I always show my insurance card when I visit my physician?
Yes. It is best to always present your most current insurance information at each visit.
What if I lose my insurance card?
If you lose your insurance card, call your health plan member services department and they will send you a new card.
Will my newborn baby be covered under my insurance?
Yes. Your newborn baby will be covered under your insurance for the first 30 days following birth. During that time, you must enroll your newborn as an individual so there will be no lapse in coverage.
What if I have more than one insurance policy?
Let your physician know. There are different policies regarding different insurance that you and your physician need to follow. You will not be able to coordinate benefits between your insurance policies unless your physician knows you have this option.
Can family members each select their own primary care physician?
Yes. Each family member can select a different primary care physician. For example, a woman may select a family practitioner, her husband an internist, and their children a pediatrician.
Can I change my primary care physician?
Yes. You may change your primary care physician by contacting your health plan. Call the health plan member services telephone number on your insurance card. If you do plan to change your Primary Care Physician, please be sure they are a PCAC Physician.
How do I get a referral to a specialist?
Our referral process is unique, fast and easy. If the specialty you need is on the self-referral list (Self-Referral Roster), you can make the appointment yourself. If the specialty is not on the self-referral list, your primary care physician (PCP) will help you obtain one.
Where do I go in an emergency?
If you have a true life-threatening medical emergency, you should call 911 or go to the nearest hospital or emergency room immediately. If the situation is serious but not life-threatening, the emergency room centers can be found here.
How to assess if it’s a true emergency? Ask these questions:
Are you having difficulty breathing, pain to the point of crying or a sudden inability to move or talk? If so, call 911 or go to the Emergency Room.
- Is your life or body/organ function in danger? If yes, go to the Emergency Room right away or call 911. If not, going to the ER might not be the best decision. You will get excellent care in an Urgent Care or your doctor’s office, you will not wait as long, and your copay will be lower. Studies have shown that care for non-emergency conditions is superior at your doctor’s office than at an Urgent Care or Emergency Room.
- Is your symptom related to an illness you have? If so, seeing your doctor might be the best choice: since she knows you best, she will be able to give you the best treatment.
- Is it one of these conditions: twisted ankle, a superficial cut to the arm, pain on urination or moderate belly pain? If so, Urgent Care might be the most convenient and cost-effective way for you to get great treatment.
What if I have a minor health problem after regular business hours?
Always call your primary care physician (PCP) first. There will be a message giving you an after-hours number and/or instructions to follow.
How do I know whether to go to the Emergency Room, Urgent Care or my doctor's office?
Always try to call your doctor first. If it after hours, you can call your health plan clinical help line:
Blue Shield: 24/7 Nurse Help Line (877) 304-0504.
Brand New Day: (866) 255-4795
TTY: (866) 321-5955
24 Hour Nurse Line: (800) 377-7012
Humana: (800) 457-4708
Scan: 1-800-559-3500 (TTY Users: 711), 7:00 a.m.– 8:00 p.m., 7 Days a Week.
8 a.m.-8 p.m. local time
7 days a week.
Se habla Español.