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HMO: FAQs

Do I need to select a personal care physician (PCP)?
As an HMO member, you are required to select a HAP-affiliated PCP to manage your health care.  A PCP will coordinate your medical treatment whether it is lab work, x-ray services or specialty care.  It is important to develop a relationship with a PCP so that he/she learns your medical history and can provide you with the most appropriate and effective health care.

How do I select a PCP?
If you do not have a PCP, there are several methods for selecting one:

  • Visit our Search for a Doctor or Facility tool.
  • Call our automated services line toll-free at: (877) 427-3678 and press option 4 (you can make PCP changes 24 hours a day with this line). You will need to know the PCP's Physician Code when you call. This information can be found in the Search for a Doctor or Facility tool or in your Provider Directory.
  • Call a PCP Selection Specialist toll-free at: (888) PIC-A-PCP (742-2727)

How can I find out if my physician is affiliated with HAP?
We have over 2,700 PCPs affiliated with us, so there is a good chance your physician is already with us! To make sure your physician is HAP-affiliated, check out our Search for a Doctor or Facility tool and enter the physician's name. If you don't see your physician listed, contact us about having him/her join the HAP family of physicians.

How do I see a specialist?
When specialty services, beyond routine OB/GYN care, are medically necessary, your PCP will direct you to a specialist.

What is a “medical center”/”hospital affiliation”?
When you select a PCP, you become part of that PCP's medical center/hospital affiliation/PO/PHO. A medical center is made up of many physicians (PCPs and specialists) who are under one roof and create a one-stop shop for services. A hospital affiliation describes providers grouped together to serve you. These providers work in private offices and may also include a hospital that is linked. Both terms refer to the team of physicians that you will seek all care from, routine and specialty.

What about emergency services?
You have worldwide coverage for emergency services, so around town or around the country you are covered. You don't need to call us, just go to the nearest emergency room or call 911 for assistance. If you are admitted to the hospital after an emergency, you'll need to contact us at the number on your ID card.

Are referrals required for specialty care?
Sometimes you may need a medical service beyond what your PCP can offer in their office. When specialty services are medically necessary, your PCP will direct you to a specialist.

Your PCP coordinates your care, sees to your needs and keeps your medical history up to date. When you choose your PCP, you’re also choosing your network of doctors for specialty care. If you choose a PCP in the Detroit Medical Center, the Henry Ford Medical Group, ACCESS or Genesys network, you will receive specialty care from doctors within that network. If you choose a PCP in any of our other networks, you can see specialists in any HAP network.

Do I need written direction to see a specialist?
Most physicians are participating in a “paperless” system when directing their patients to a specialist.  This means you will not have a physical piece of paper to take to the specialist.  Don’t worry!  As long as you have started the process with your PCP and the service is a covered benefit for you, there will not be any issues.

If I request to see a provider that my PCP is not familiar with, what can I expect to happen?
HAP encourages you to continue to discuss your care preferences with your physician. More than ever before, members have the opportunity to work in partnership with their physicians. This allows you  to understand treatment options and to make joint decisions regarding how and where to obtain high quality, cost effective care and services in a timely manner that will best meet your needs and expectations.

Do I need to coordinate emergency follow-up care with my PCP or can I take the direction of the ER?
All follow-up care after an urgent or emergent encounter should be coordinated through your PCP.

Address Change:

I recently moved. What is the easiest way to change my address?
The quickest and easiest way to change your address is on our Web site.  Here you can update your mailing and e-mail address. For security reasons, newly registered members will be unable to change their address for five business days after registering for HAP Web site access. Be sure to inform your employer (if applicable) and physicians of your address change as well.

Benefit Information:

Do I need to inform HAP if I have other health insurance?
Yes. Use Coordination of Benefits to update your information regarding other health insurance.

Where can I get a summary of my benefits?
Most employers provide a summary of benefits to employees. Contact your employer's benefits office to request a copy. You may also access this information. You can view a benefit summary or your Subscriber Contract and riders.

Claims:

Will I have to submit claims for any services I receive?
As a HMO member, you will only see a bill for any cost-sharing responsibilities you may have. For example, if you see your physician for an annual checkup, your physician will bill us and you would just pay your copay, co-insurance or portion of your deductible. If, however, you have an emergency while out of our market area, you may be required to pay for services up-front and submit a claim for reimbursement. If this happens, you would simply mail a copy of the claim to us.

How can I check the status of my claims?
You can check the status of your claims on our Web site. You'll be able to access medical and pharmacy claims from the last 18 months.

What should I do if I receive a bill incorrectly from a provider?
If you receive a bill, contact Client Services or use the Get Help with a Bill Tool.

Can I e-mail HAP if I have a question about a claim?
To ensure that your privacy is protected, we recommend that you use our Customer Message Center to send us your question.

Students Away At School:

My child will be going away to school in the fall. Is he/she covered while away?
Yes, your child is covered through HAP's "Students Away" program.

If my child requires outpatient counseling while out of state at school, is he covered through HAP's "Students Away" program?
No.  Your child would not be covered for outpatient counseling while he/she is away at school.  Only emergency psychiatric services would be covered for him/her while away at school. Routine counseling services must be provided by a HAP-contracted provider though our Coordinated Behavioral Health Management team.

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