My daughter wanted a new doctor that was not a pediatrician. So we found the one we wanted based on advice from friends.
I went online to the insurance company and changed my daughter’s PCP. When the card came, they had changed my husband’s PCP by mistake.
Okay, that might have been my fault. Maybe I did it wrong. I’m willing to say that I did do it wrong.
So I called the insurance company and had a very long conversation with someone about changing my daughter’s PCP and changing my husband’s back. She kept telling me it wasn’t necessary to have a PCP. Well, maybe not, but then why do they put it on the card? She finally seemed to understand what to do and said she did it.
When the new card came, both my husband and I have the new doctor and my daughter is still listed with her original doctor.
I would like to write a letter to them, suggesting that in fact I would be happy if they had recorded the conversation for quality purposes and actually used it to improve quality, plus to share a few other ideas. But where to write the letter? All they give you is a phone number. Where you can talk to someone who possibly hasn’t graduated from high school yet who can’t do something extremely simple.
If your insurance company doesn’t really require PCPs anymore, they probably don’t require referrals anymore either. If that’s the case, don’t waste your time with changing your family’s PCPs… nobody should care anymore. Insurance companies like to know who you think your PCP is, so that they know who to contact if they need to work with that doctor for disease management programs, etc… But generally any insurance campany can infer the PCP from the claims data your family generates.
Ask your new doctor’s office, for your type of plan (HMO, PPO, etc.) if your insurance company requires anything special of them for your kid to go there. If not, just go.
I’ve worked for HMOs and other insurance companies and I can’t recommend this at all. We would get calls all the time from providers who had no idea if they were in the network, if there was a network, if referrals were needed, etc. It seems there’s usually maybe one person in a doctor’s office who knows what’s going on regarding insurance and even then they didn’t really know. I would never rely on what my provider told me about my insurance.
Your point is well taken, but it varies by marketplace. I don’t know if your HMO/insurance company experience is in Madison, but Madison is bizarre - it’s probably the only market in the United States with four provider-owned insurance companies (PPIC et al) and very little inroads by the majors.
In any case, I stand by my main point, which is that if the OP’s insurance company has already stated that they really don’t need to know the member’s PCP, then the OP shouldn’t worry about changing the PCP. It’s largely irrelevant.
Oh, you are right, I don’t have to have referrals at all. The doctors we see are supposed to be in the network. I keep hesitating to call and tell them to change the PCP’s because I am thinking about changing my PCP and I can’t seem to decide.
But it bothers me that the doctors’ names are wrong on the card.
Does your insurance company have a secured website in which you can make the change yourself? Some of them do. That may be more work, but at least gets you the opportunity to see that the change is correct.
Also: You may want to send a letter to the “Manager, Member Services” of your insurance company and tell him/her what happened. Those letters, both positive and negative, go a long way.
I will say that even if you don’t need a PCP to make referrals, it’s often handy to have one, if for no other reason than to have (theoretically, at least) someone to coordinate your care and keep all your records in one place. I’ll also second Otto’s point that the doctors are the last ones to know what the rules of your insurer are – though they’re happy to guess, I find. Sometimes this means that a specialist will not take you without a referral from your PCP, on the assumption that your insurance requires it. That is, the specialist fears that if he/she renders care without preauthorization, he/she is facing some difficulty in getting paid for it.
Does the system suck? Of course, but the bottom line is, your insurance company should get correct PCPs on all your cards. But also make sure your new PCP, and old PCP, and any hospitals you use, know who your current PCP is. Their information systems are not tied in to those of the insurance companies.