Choosing Your Primary Care Provider
Your primary care provider (PCP) is a doctor, nurse practitioner, physician assistant or another type of provider who will:
- Care for your health
- Coordinate your needs
- Help you get referrals for specialized services if you need them
As a Medicaid beneficiary, you had an opportunity to choose your own PCP. If you did not select a PCP, we chose one for you based on your past health care. You can find your PCP’s name and contact information on your Medicaid card. If you would like to change your PCP, you have 30 days from the date of receiving this packet to make the change. (See "How to Change Your PCP" to learn how to make those changes.)
- You have seen before
- Understands your health history
- Is taking new patients
- Can serve you in your language
- Is easy to get to
Each family member enrolled in AmeriHealth Caritas North Carolina can have a different PCP, or you can choose one PCP to take care of the whole family. A pediatrician treats children. Family practice doctors treat the whole family.
Internal medicine doctors treat adults. Call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) to get help with choosing a PCP who is right for you and your family.
You can find the list of all the doctors, clinics, hospitals, labs and others who contract with AmeriHealth Caritas North Carolina in our online provider directory. You can also call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) to get a copy of the provider directory.
Women can choose an OB/GYN to serve as their PCP. Women do not need a PCP referral to see a plan OB/GYN doctor or another provider who offers women’s health care services. Women can get routine checkups, follow-up care if needed and regular care during pregnancy.
If you have a complex health condition or a special health care need, you may be able to choose a specialist to act as your PCP. For more information or to request to choose a specialist as your PCP, call AmeriHealth Caritas North Carolina Member Services at 1-855-375-8811 (TTY 1-866-209-6421). We will work with you to help coordinate the care that you need.
If your provider leaves our network
If your provider leaves AmeriHealth Caritas North Carolina, we will tell you within 15 days from when we know about it. If the provider who leaves AmeriHealth Caritas North Carolina is your PCP, we will contact you to help you choose another PCP within seven days from when we know about this.
If your provider leaves our network, we will help you find a new one.
Even if your provider leaves our network, you may be able to stay with your provider for a while longer in certain situations.
How to change your PCP
You can find your primary care provider’s (PCP’s) name and contact information on your Medicaid card. You can change your assigned PCP within 30 days from the date you receive your Medicaid card, or within 30 days from the date you receive notification of your PCP assignment. To change your PCP, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421). After that, you can change your PCP only one time each year. You do not have to give a reason for the change.
To change your PCP more than one time a year, you need to have a good reason (good cause). For example, you may have good cause if:
- Your PCP does not provide accessible and proper care, services or supplies (e.g., does not set up hospital care or consults with specialists when required for treatment)
- You disagree with your treatment plan
- Your PCP moves to a different location that is not convenient for you
- Your PCP changes the hours or days that he or she sees patients
- You have trouble communicating with your PCP because of a language barrier or another issue
- Your PCP is not able to accommodate your special needs
- You and your PCP agree that a new PCP is what is best for your care
Call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) to learn more about how you can change your PCP, or log in to our member portal.
Your care when you change health plans or health care providers
If you join AmeriHealth Caritas North Carolina from another health plan, we will contact you at least five business days from your expected enrollment date with us. We confirm the name of your previous plan, so we can add your health information, like your medical records and prescheduled appointments, into our records.
You can finish receiving any services that have already been authorized by your previous health plan. After that, we will help you find a provider in our network to get any additional services, if you need them.
In almost all cases, your providers under your former plan will be AmeriHealth Caritas North Carolina providers. If your provider is not part of our network, there are some instances when you can still see the provider that you had before you joined AmeriHealth Caritas North Carolina. You can continue to see your provider if:
- At the time you join AmeriHealth Caritas North Carolina, you are receiving an ongoing course of treatment or have an ongoing special condition. In most of these cases, you can ask to keep your existing provider for up to 90 days. There may be additional options depending on your ongoing treatment or condition. For more information, please call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).
- You are more than three months pregnant when you join AmeriHealth Caritas North Carolina and you are getting prenatal care. In that case, you can keep your provider until after your delivery and for up to 60 days of postpartum care.
- You are pregnant when you join AmeriHealth Caritas North Carolina and you are receiving services from a behavioral health treatment provider. In that case, you can keep your provider until after your delivery.
- You have a surgery, organ transplant or inpatient stay already scheduled that your provider is doing. In these cases, you may be able to stay with your provider through the scheduled procedure, discharge from the hospital and for up to 90 days of follow-up care.
- You are terminally ill, and the provider is supporting you in your care. You are considered terminally ill if you have been told by your provider that he or she expects you have six months or less to live. In that case, you can keep your provider for the remainder of your life.
If your provider leaves AmeriHealth Caritas North Carolina, we will tell you in writing within 15 days from when we know this will happen. If the provider who leaves AmeriHealth Caritas North Carolina is your PCP, we will contact you within seven days from when we know this will happen. We will tell you how you can choose a new PCP or how we will choose one for you, if you do not make a choice within 30 days.
If a provider leaves our network, AmeriHealth Caritas North Carolina will help make sure that any services that you are receiving will continue. In some situations you will be able to continue with that same provider for a while. In other situations, we will help you find a new provider quickly so that the services continue.
If you have any questions, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).