Can patient change the PCP ?

Yes this can be done by two method.

MEMBERS INITIATING PCP TRANSFER:

In  order  to  maintain  continuity  of  care,  CarePlus  encourages  its  members  to  remain  with  their  PCP. 
However,  a  member  or  power  of  attorney/guardian  may  request  to  change  the  PCP  by  contacting  CarePlus’ Member Services Department or submitting a written request.

* The effective date of the change will be the first day of the following month.

 * Special  circumstances  may  provide  for  a  mid-month  PCP  change.  In  such  situations,  both  physicians’  offices  will  be  contacted  by  the  Member  Services  Department  to  add  or  delete  a
member from the monthly membership list.

* The primary care office must send his/her medical records to the newly selected primary care
office.

PHYSICIAN INITIATING MEMBER TRANSFER:

Reasonable efforts should always be made to establish a satisfactory provider and member relationship.  The provider should provide adequate documentation in the member’s medical records to support his or  her efforts to develop and maintain a satisfactory provider and member  elationship. If a PCP wishes to  transfer a member to another PCP, the PCP must prepare a Physician Initiated Request Member Form  and forward it with supporting documentation to the CarePlus Provider Operations Department or their  designated Provider Service Executive. The form is included as part of this manual.  The PCP will be  notified of CarePlus’ decision.  If the request is approved by the Plan, the member’s care remains the responsibility of the PCP requesting the transfer until the change is effective.  PCPs may not, in any  way, coerce a member to transfer.  Furthermore, a PCP may not seek or request to terminate their  relationship with a member or transfer a member to another provider of care, based upon the member’s  medical condition, amount or variety of care required or the cost of covered services required by the Plan’s  member.  Any  primary  care  office  that  violates  guidelines  for  transferring  members  to  another office is given a 30-day, noncompliance written notification requiring immediate corrective action. No  further written notice is necessary to terminate the participation agreement if the primary care office is found  in  violation  of  established  policies  and  procedures  and  is, therefore,  considered  to  be  non-compliant. Members or their power of attorney/guardians have the right to file a formal grievance if they  do not agree with the transfer.  Refer to the “Involuntary Disenrollments” for additional information.

MEMBER DISENROLLMENT PROCEDURE:

A member may only disenroll from CarePlus during a valid election period. Some members may have  special  circumstances.    For  disenrollment  procedures,  please  refer  members  to  the  Member  Services  Department for assistance.