HMO Frequently Asked Questions
Getting Care
Open Delivery
Address Change
Benefit Information
Claims
Students Away at School
Getting Care:
I've heard I'll need a personal care physician (PCP). What does that mean?
As an HMO member, you are required to select a HAP-affiliated personal care physician (PCP) to manage your health care. Your PCP will guide you through the medical system and coordinate your medical care among various specialists.
How do I select a PCP?
If you do not have a PCP, there are several methods for selecting one:
- Visit our Provider Search & PCP Select tool. Please note: you will need to register and log in to Online Services to complete the PCP selection process.
- Use 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 Provider Search or in your Provider Directory.
- Call a PCP Selection Specialist toll-free at: (888) PIC-A-PCP (888-742-2727)
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 Provider Search application 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 are medically necessary, your PCP will direct you to a specialist. For more information on PCP Directed Care>>
Routine OB/GYN care does not require PCP direction. For more information on OB/GYN care>>
What's a medical center or physician's hospital affiliation?
When you join HAP and select your PCP, you become part of that PCP's medical center/hospital affiliation. A medical center is made up of many physicians (PCPs and specialists) who are under one roof, a one-stop shop for services. Hospital affiliation describes providers grouped together to serve you. These providers work in private offices and may also include a hospital that is linked in. Both terms refer to the team of physicians that you will seek all care from, routine and specialty.
What about emergency services?
Never fear, HAP is here! 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.
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Open Delivery:
What is Open Delivery?
On April 1, 2008 HAP introduced its Open Delivery Model, which eliminates many "network" limitations. Open delivery provides you with greater flexibility in your choice of specialists and hospitals. Under open delivery:
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You may remain with your PCP if the PCP changes hospital or medical center or hospital affiliation.
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Your PCP may direct you to any HAP-contracted provider for care regardless of your medical center/hospital affiliation.
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Your physician may admit you to any HAP- contracted hospital at which they have admitting privileges.
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You may obtain OB/GYN services from any HAP contracted OB/GYN physician.
How do I know if my PCP is in the Open Delivery Model?
If you are logged in, you may view your Delivery System by viewing your Eligibility and Benefits under Online Services. The type of Delivery System -- either Open or Integrated -- will be displayed underneath your PCP's name.
I am happy with my current PCP. Do I need to do anything different under the Open Delivery Model?
No further action is required. Additionally, there is no change in coverage and benefits. Continue to work with your PCP for care coordination and to benefit from the additional choice in provider options.
Do I still need a PCP under Open Delivery?
Yes; PCP's are central to your care and will assist you in benefiting from both the Open Delivery Model by directing members for specialty services and elective procedures that are deemed medically necessary.
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, you have the opportunity to work in partnership with your physician 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 still need to coordinate emergency follow-up care with my PCP or can I take the direction of the HAP-affiliated physician at the ER?
All follow-up care after an urgent or emergent encounter should be coordinated through your PCP.
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Address Change:
I recently moved. What is the easiest way to change my address?
The quickest and easiest way to change your address is to log in to Online Services. You can update your mailing and e-mail address. For security reasons, you will be unable to change your address until 5 business days after registering for Online Services. Be sure to inform your employer (if applicable) of your address change as well!
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Benefit Information:
Do I need to inform HAP if I have other health insurance?
Yes. You can log in to Online Services and click on 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. Depending on your plan type, you may also access this information online by logging in to Online Services. You can view a benefit summary or your contract and riders.
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Claims:
Will I have to submit claims for any services I receive?
As a HMO member, you don't have to submit claim forms for services provided by affiliated providers. For example, if you see your physician for an annual checkup, your physician will bill us and you would just pay your copay. If, however, you have an emergency while out of our service 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 using by logging in to Online Services. 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 log on to Online Services to use the Billing Assistance Tool.
Can I email 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. Customer Message Center may be accessed by logging into Online Services.
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Students Away At School:
My child will be going away to school in the fall. Is he covered while away?
Yes, your child is covered through HAP's "Students Away" program. For more information on coverage for students away at school.
If my child requires outpatient counseling while out of state at school, is he covered through HAP's "Students Away" program?
No. Your son would not be covered for outpatient counseling when he is away at school. Only emergency psychiatric services would be covered for him when he is 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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