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Primary Care Provider

Your primary care provider (PCP) is the provider who gives you most of your care. Your PCP will get to know your health history, take care of your basic medical needs, and make referrals when you need them. He or she will work with you to keep you healthy!

Choosing Your PCP

As a Passport Health Plan member, you can choose your PCP. You can choose one PCP for the entire family or you can choose a different PCP for each family member. You may choose one of the following:s a Passport Health Plan member, you can choose your primary care provider (PCP). You may choose one of the following to be your PCP:

  • General provider (general doctor)
  • Family provider (family doctor)
  • Nurse Practitioner
  • Physician Assistant (someone who practices under the supervision of a doctor)
  • Internist (doctor or provider)
  • Pediatrician (doctor or provider who only sees children and adolescents)
  • OB/GYN, if he or she is signed up with Passport Health Plan as a PCP. An OB/GYN is a doctor or provider who sees women for things like gynecology, pap smears, and pregnancy.

Call Member Services right away to choose your PCP. If you do not choose a PCP within 30 days of enrollment, Passport Health Plan will choose one for you. A representative will tell you if a provider is taking new patients. If you are not sure which PCP to choose or need care before you have chosen a PCP, tell the representative and someone will help you. You can choose a PCP from the Primary Care Provider Directory that comes with the Handbook.
You may also find this list on our website.

There could be a time when you are not eligible for Passport Health Plan and then you become eligible again. If this happens to you, call Passport Health Plan and choose your PCP again.

A PCP is your medical home and the one provider who keeps track of all of your medical care. Your PCP is with you for the long term and can tell you what is normal for you and what is not. Members living in foster care do not have to choose a PCP.
But, we suggest all members choose a PCP and benefit from a medical home.

If you would like to know about any provider’s education, board certification, or residency training, please call Member Services. We can mail this information to you. Provider board certification is listed in your Primary Care Provider Directory that comes with the Handbook. You may also find providerboard certification at www.passporthealthplan.com.

  1. Click on Members.
  2. Click on Find a Provider.
  3. Click on Primary Care Provider Directory.

Changing Your PCP

When can you change your PCP?

You can change your PCP:

  • Up to 90 days after you were assigned your first PCP.
  • Once a year for any reason.
  • If your assigned PCP no longer accepts Passport Health Plan.
  • If your PCP change is ordered as a result of an appeal.
  • During the year if you have a good reason. A good reason may be:
    • You cannot get services you think you need.
    • You think you have received poor quality care.

Your PCP request may be denied if you have changed your PCP too many times or you are in the Lock-In program. If you decide to change your PCP, call Member Services and tell them the name of the new PCP you would like. If the PCP is approved, Passport Health Plan will send you a new ID card that lists your new PCP. Your PCP change will start the 1st day of the next month. You must continue with the old PCP until the start date of your new PCP. You will get a new card 10 to 15 days after you call us with your new choice.

Your PCP can ask that you be removed from his or her practice. If this happens, you will be assigned to a new PCP. Some reasons your PCP may ask for this change include:

  • You and your PCP do not get along.
  • Your PCP cannot meet your medical needs.
  • Passport Health Plan decides it is needed.

What to Expect From Your PCP

Below are some things your PCP will do for you:

  • Give you most of the medical services you need.
  • Set up your medical services and visits to other providers and/or specialists.
  • Order prescriptions or tests for you.
  • Keep your medical records up-to-date.
  • Give you advice and answer your questions about your health care.
  • Give you regular physical exams, as needed. This includes Early Periodic Screening, Diagnosis and Treatment (EPSDT) services for members under 21. See page 19 or the Preventive Health Guidelines in the back of the Handbook.
  • Give you covered immunizations (shots) as needed.
  • Keep track of your preventive health needs– such as screenings (mammograms, pap smears, etc.) and immunizations (shots).
  • Talk with you about advance health directives. See the “Advance Health Directives” section on page 26 of the Handbook.

Getting Care From Your PCP

Your PCP will get to know you and be there when you need medical help. Call your PCP’s office anytime you have a question about your health or medical care. He or she can help you get the services you need. You can call your PCP 24 hours a day, 7 days a week. When you call your PCP, he or she will tell you what you need to do.

When you need to see your PCP, call the office for an appointment. Your appointment time is important and should be taken seriously. Please arrive at your appointments on time. Carry both your Passport Health Plan card and your Medicaid (KyHealth Choices) card at all times.

If you cannot keep an appointment, call the office right away and let them know. When you call to cancel, you can make another appointment. If you do not call to cancel, some offices may refuse to see you again.