A Primary Care Provider or PCP is a person or clinic that provides medical care. You will pick one doctor to see for all your health care needs. Your PCP can be a:
General practitioner.
Internist.
Pediatrician.
Family practitioner.
Ob/Gyn.
Nurse practitioner.
Physician assistant.
Clinic.
You can also choose a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC) as your PCP. These health centers are located in areas that do not have many health care services.
You must pick a PCP within 30 days of enrolling in the Alliance. If you do not, the Alliance will assign you to a PCP. To find a PCP near you, go to the online Provider Directory or call Member Services. We are here to help.
You should see your PCP for a new patient exam within 120 days (4 months) of becoming an Alliance member.
Call or make an appointment to see your PCP first when you need medical care. Your PCP can do many things for you, such as:
Guide all of your health care.
Give you regular check-ups, immunizations and help when you are sick.
Help prevent health problems or manage chronic health issues, like diabetes.
Refer you to other doctors, as needed.
Over time, your PCP will get to know your health history and help you make good choices so you can stay well.
How do I find a doctor or health provider?
Use the Provider Directory to find a doctor and pick your Primary Care Provider (PCP). You may need a referral from your PCP before making an appointment with a specialist for non-emergency care. Call your PCP to find out if a referral is required.
How to use the printed Provider Directory If you would like a printed copy of the provider directory, use the self-service online form to request one. You can also call Member Services and ask them to mail one to you.
Locate the Primary Care Provider (PCP) section in the Table of Contents.
Choose a town that is close to you and go to the page number listed for that town.
Make sure the doctor or clinic is accepting new patients. Above the wheelchair picture is a line that says Accepting Patients. If there is a Y that means that new patients are allowed.
How do I choose my PCP?
Once you have found a PCP, fill out the Change Primary Doctor form online or call Member Services at the Alliance.
If the doctor or clinic is taking new patients, you will receive a new Alliance Member ID Card.
How do I change my PCP?
To change your PCP, call Member Services at the Alliance or fill out the Change Primary Doctor form. The change will be in effect on the first day of the next month.
How do I make an appointment?
Call your PCP’s office to make an appointment with your doctor.
What if my current PCP is not part of the Alliance’s Provider Network?
If your current PCP is not in the Alliance network, you may still be able to keep seeing them for up to 12 months. Here are the reasons you can keep seeing them:
An acute condition. Completion of covered services shall be provided for the duration of the acute condition.
A serious chronic condition. Completion of covered services may not exceed twelve (12) months from the time you enroll with the Alliance.
Pregnancy, including postpartum care. Completion of covered services shall be provided for the duration of the pregnancy.
A terminal illness. Completion of covered services shall be provided for the duration of the terminal illness.
A surgery or another procedure that your previous plan authorized as part of a documented course of treatment which occurs within one hundred eighty (180) days of the time you enroll with the Alliance.
A child age 0–36 months whose parent wishes to keep the child’s existing provider for up to twelve (12) months.
Your out-of-network provider must accept the same terms and conditions that Alliance providers agree to. Your provider must also meet the Alliance’s applicable professional standards and have no disqualifying quality-of-care issues.
If your providers do not join the Alliance network by the end of 12 months, you will need to switch to providers in the Alliance network.
To learn more about continuity of care and eligibility qualifications, and all available services, contact Member Services at 800-700-3874, Monday through Friday from 8 a.m. to 5:30 p.m. For the Hearing or Speech Assistance Line, call 800-735-2929 (TTY: Dial 711).
Contact Member Services
Monday through Friday, from 8 a.m. to 5:30 p.m.
Phone: 800-700-3874
Deaf and Hard of Hearing Assistance Alliance TTY Line: 800-735-2929 (Dial 711)
