Personal Alliance HMO FAQs
Do I need to select a personal care physician (PCP)?
As a HAP Personal Alliance HMO member, you are required to select a doctor within the HAP network to manage your health care. This PCP will coordinate your medical treatment whether it is lab work, X-ray services or specialty care. It is also important to develop a relationship with your PCP so 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 at (877) 427-3678 and press option 4. You can make PCP changes 24 hours a day. You will need to know the PCP's Physician Code when you call.
- Call a PCP Selection Specialist at (888) PIC-A-PCP (742-2727).
How can I find out if my doctor is in the HAP Personal Alliance network?
We have over 2,700 doctors within our network, so there is a very good chance your doctor is already a HAP doctor. To make sure he/she is, check out our Doctor Search tool. Simply enter the doctor's name. If you don't see your doctor listed, contact us about having him/her join our network.
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.
When can I log in and access the member portal at hap.org?
Once you receive your member ID card, you can register on the website using your ID number. Current members may do this immediately after registering on the website.
What is a medical center/network?
When you select a PCP, you become part of that PCP's medical center/hospital network. A medical center is made up of many doctors (PCPs and specialists) who are under one roof and create a one-stop shop for services. A network describes doctors grouped together to serve you. These doctors work in private offices and may be linked to one or more hospital systems. Both terms refer to the team of doctors that you will seek all care from, for both routine and specialty care.
What about emergency services?
You have worldwide coverage for emergency services. Wherever you go around town or around the world you are covered. And there's no 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 the back of your ID card within 48 hours of the admission or the service won't be covered.
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 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 doctors participate 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 doctor 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 doctor. More than ever before, members have the opportunity to work in partnership with their doctors. 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.
I recently moved. What is the easiest way to change my address?
The quickest and easiest way to change your mailing or email address is to call Customer Service at the number on the back of your ID card. For security reasons, newly registered members will be unable to change their address for five business days after registering at hap.org. Be sure to inform your doctor of your address change as well.
What cost-sharing amounts are associated with HAP Personal Alliance HMO plans?
The three main types of costs you are responsible for as a member are coinsurance, copays and deductibles.
Coinsurance is the percentage of charges for certain covered medical services that you pay after your deductible has been met. For example, if your health insurance policy states that Alliance will pay 80 percent of allowable charges for covered services (after your deductible and/or copays have been met) then the remaining 20 percent is your coinsurance.
A copay is a set amount you pay each time for a covered medical service, or the purchase of prescriptions or other medical supplies. The copay amount can vary by the type of covered health care service.
Your deductible is the amount you owe for certain covered medical services before your health plan begins to pay for them. There are per person (individual) deductible amounts and family deductible amounts.
What is an out-of-pocket limit?
The most you will pay for the combined total of all copays, coinsurance and deductibles for covered services in a benefit period (usually a calendar year). Once you meet your out-of-pocket limit, HAP pays all of the allowed amount for covered services. It does not include your monthly premium or non-covered services.
Do I need to inform HAP Personal Alliance if I have other health insurance?
Yes. Simply log in at hap.org using your ID number and use the Coordination of Benefits tool to update your information regarding other health insurance. New members can do this once they receive their ID cards and register on the website.
Where can I get a summary of my benefits?
You can view a summary of benefits and coverage when you log in at hap.org using your ID number. The summary will give you a high level overview of what your health plan covers and what you will pay to get covered services. New members can do this once they receive their ID cards and register on the website.
How can I check the status of my claims?
You can check the status of your claims when you log in at hap.org using your ID number. You'll be able to access medical and pharmacy claims from the last 18 months.
What should I do if I receive an incorrect bill from a doctor?
If you receive a bill that you feel is incorrect, call Customer Service at the number on the back of your ID card.
Can I email someone if I have a question about a claim?
To ensure that your privacy is protected, we recommend that you log in at hap.org using your ID number and send us your question through our Customer Message Center.
My child will be going away to school in the fall. Is he/she covered while away?
Yes, your child is covered through our Students Away program.
If my child requires outpatient counseling while out of state at school, is he/she covered through the "Students Away" program?
As a HAP Personal Alliance HMO member, your son/daughter can go to any doctor or health care provider for outpatient counseling. If he/she receives services from a provider outside our network, higher cost-sharing amounts may apply (copays, coinsurance and deductibles).