Verifying Primary Care Provider Status

Here at Acadia Benefits, we like to stress to our customers the importance of selecting a Primary Care Provider (PCP).  We also advise on how to select or change a PCP, by either calling the insurance carrier, or by checking their website.

Lately, we are finding that not all PCP’s are timely in updating their status with carriers.  For example, the physician practice may not be taking new patients at the time.  Or, they have left the carrier network and are longer considered “participating.”  On occasion, their office doesn’t notify the carrier of these changes.  This results in the website and customer service screens not being updated to reflect the change, and members (and customer service reps) might assume it’s ok for the member to choose that PCP, when in fact, it’s not.

This may result in a member assuming they have chosen a network provider, when in fact, that is not the case.  Therefore, we recommend that a patient always call the practice before making any changes, to verify that the physician is indeed in the network, and/or taking new patients.

Please contact me directly with any questions and I am happy to help.



Paula Green