How do I change my PCP?
Select another PCP from the Find a Provider search engine or you may request a paper copy from Member Services. Contact Member Services, and your new selection will be effective the same day that you called. A new Member ID card with the updated PCP will be sent to your home address. A PCP is not required if you are enrolling in the Point of Service Plan.
How do I know of the doctor I am considering is a good doctor?
All of the physicians in the Exclusive Care Network have been credentialed and approved by the Medical Director. Because of this careful process, our members can have confidence that the physicians they choose have the appropriate licensing and certification.
Will I have coverage outside of Exclusive Care’s Network?
If you are traveling out of the Exclusive Care service area and have an urgent medical need or life endangering event, go to the nearest facility available and contact Member Services within 24 hours to notify them of the emergency.
*If you are within the Exclusive Care service area and obtain emergency services or urgent care for routine illness or injury not considered life endangering from facilities that are not in the Exclusive Care Network, the services will not be covered.
What are maintenance medications?
Effective January 1, 2010, Exclusive Care began the process of providing all ‘Maintenance Medications’ using our Rubidoux Pharmacy mail order system. If you take medications on a permanent and continued schedule please read the following below.
What is the Rubidoux Pharmacy Mail-Order program?
All ‘Maintenance Medications’ will be filled on a mail order basis only thru the Rubidoux Pharmacy. These medications will be filled in 90 day quantities and mailed directly to your home for convenience. You will pay a 2 month co pay for the 90 day prescription. This will save you one month’s co pay each 90 days.
What do I need to get started with the Rubidoux Pharmacy Mail-Order program?
Please have your physician write you a new prescription for 90 days quantity and as many refills as needed.
I have a child who lives out-of-state. Do you offer coverage for him/her?
Your dependent child is eligible for the Out-of-Area Dependent Coverage Plan which is subject to the same limitations as the EPO plan. There is an annual deductible of $300.00, with services covered at 80% thereafter. For more information please call Member Services.
What if I need to see a specialist?
Prior authorization is not required for many services, and your PCP may make a direct referral to a contracted provider. Annual well woman exams, OB services, mammograms, bone mineral density testing, initial chiropractic evaluation, mental health services, family planning, and several other services may be referred directly by your PCP without prior authorization. The direct referral form and a list of services covered under the direct referral policy may be viewed here.
Your Primary Care Physician will complete a referral form, attach appropriate medical documentation and fax information to the Medical Management Department. Medical Management will review and respond to your PCP within 48 hours.
Approved referrals are faxed back to the PCP and a hard copy is sent to your address so an appointment can be scheduled. If an incomplete referral is received, Medical Management works with the PCP’s office to obtain all of the needed information. Members and PCPs are notified via letter of denied referrals.
How long should it take to get an appointment with my Primary Care Physician?
Times may vary, depending on the type of appointment. Most offices keep same day sick appointments available for patients who call in the morning or can schedule you within a few days when you are ill. Routine medical appointments (physical exams, immunizations) will generally take 2 to 3 weeks.
What is Open Enrollment, and when does it occur?
Open Enrollment is an opportunity to decide whether to continue with your current Health Care choices including medical, dental, and vision service plans or make changes for the coming year. This is your opportunity to explore other options or to learn more about the coverage you currently have.
Open Enrollment typically occurs at the end of the calendar year from October—December.