Do you have a question about how Capital Health Plan works or how to select your primary care physician? You aren't the first person to ask us. Here are answers to some of our member's most frequently asked questions.
A. Capital Health Plan is a health maintenance organization (HMO). We not only insure you against the high cost of medical care, we actually provide medical care through our broad network of physicians and service providers for a small copayment. Members should never see a claim form for in-network services. We handle all the paperwork and details. Your primary care physician is continuously involved in managing and coordinating your health care.
A. Our coverage for you includes preventive care, diagnostic and lab tests, hospital and surgical care, inpatient and outpatient treatment, and emergency care. For details, please go to Benefits below or refer to your Capital Health Plan Member Handbook.
A. Practically none. There are no claim forms. Also, our Member Services representatives are just a phone call away at 850-383-3311 to answer any questions you may have concerning Capital Health Plan's benefits and policies.
A. Yes. Your primary care physician (PCP) is either on-call, or has another physician on-call, 24 hours a day, 7 days a week. CHP also offers its members an Urgent Care Center. After hours, you call your PCP's office for guidance about the problem. He or she may want you to go to CHP's Urgent Care Center, which is located in the Centerville Road health center. The Urgent Care Center is open by appointment only Monday – Friday, 11 am to 10 pm and weekends, 9 am to 8 pm weekdays. (Members whose PCPs are affiliated with Patients First should go to Patients First for after-hours care.)
A. Yes. A medical emergency is an accidental injury or the sudden and unexpected onset of a condition requiring immediate medical or surgical care. Some problems are emergencies because if not treated promptly, they might become more serious (examples include deep cuts and broken bones).
A. When a medical emergency occurs inside or outside the service area, go to the nearest medical facility for treatment or call 911. Then contact your primary care physician's office as soon as possible. Capital Health Plan should be notified within two working days. Your PCP will authorize medically necessary hospitalizations and provide or arrange any needed follow-up care within the CHP network.
A. You are covered for emergency care (as defined above) 24 hours a day, every day, anywhere in the world. CHP also offers the popular Away from Home Care® Program allowing any commercial employer group member to have coverage when living temporarily outside of our service area for at least 90 consecutive days (a covered dependent going to college, for example). These CHP members may become guest members of any participating HMO in the BluesCONNECT® network. This network is the nation's largest, including health plans in over 200 cities.
Call our Member Services department for language assistance. Member Services Representatives use interpreters to communicate with our members by telephone in many different languages. The representatives can assist you in locating health care practitioners in our network who can communicate with you in the language(s) that you or your family speak.
A. Yes. Each member chooses a primary care physician from our directory of internists, family physicians, and pediatricians. Your PCP is responsible for the management of all your health care, from regular check-ups in the physician's office to more specialized treatment or hospitalization, should that become necessary. Each member of your family selects his/her own primary care physician, for example, you may choose either a pediatrician or a family physician for each child. You can see a list of our primary care physicians in our network directory.
A. Yes. CHP provides members direct access (no referral needed) to a gynecologist within our network once a year for a pelvic exam, PAP smear, and breast exam. You may use the Physician & Provider Search to find obstetrician-gynecologists in our network. Some members are accustomed to having their annual exam with their primary care physician and prefer to continue doing so.
A. No. Each family member may choose a different primary care physician.
A. Yes. If, for any reason, you wish to change your primary care physician, you may do so easily by calling a Member Services representative at 850-383-3311.
A. YES! Capital Health Plan offers you a choice of many physicians in private practice offices throughout the community. In fact, your current physician may be a provider for the plan.
A. On occasion, a particular affiliated primary care physician (PCP) may not be accepting new patients. If you are already a patient of a CHP-affiliated PCP when you enroll in CHP, that doctor can continue to see you under Capital Health Plan. Otherwise, to find out which primary care physicians are currently accepting new patients, check our Physician and Provider Directory and look for the colored flag (red, yellow, or green) under "status" on the doctors record. You may also call our Member Services representatives at 850-383-3311 to obtain the most current information.
A. To receive the most appropriate and efficient care, talk with your primary care physician before seeing a specialist. Your PCP can help coordinate specialty care with your unique needs and medical history in mind. As a Capital Health Plan member, you can access specialty care through a direct appointment, with a referral from your PCP, or with authorization/precertification for certain services. CHP’s network of affiliated specialists is listed in the Directory of Physicians and Service Providers.
A. You may access some specialist services directly:
A. If the specialist you are seeing is participating in Capital Health Plan's local network, then your care may continue without the need for a referral from your primary care physician. If the specialist is not participating in Capital Health Plan's local network, then you should consult your primary care physician regarding a referral to a participating specialist. You may see CHP's extensive list of participating specialists in our Physician and Provider Directory.
A. CHP's two health centers are located at 2140 Centerville Road (across from the U.S. Post Office) and 1491 Governor's Square Boulevard (near the movie theaters). In addition to doctors' offices, both health centers offer x-ray services, a lab, and eye care centers (including a large selection of glasses at low, competitive prices). The Centerville Road facility also houses the CHP Urgent Care Center. At the Governor's Square Boulevard center, CHP's Mammography Screening Center is helping many members receive this crucial service faster. Most health education programs are also held at the Governor's Square center.
A. No. Each primary care physician (PCP) at a Capital Health Plan health center has his or her own office suite and staff and sees patients by appointment only. If you have chosen a PCP who practices at a center, you access all of your routine medical care from that PCP. If you are sick, every effort will be made to schedule you to see your primary care physician. If he or she cannot see you, the staff will arrange for you to see another physician within the health center.
A. Your primary care physician or participating specialist will coordinate such care and make necessary referrals for service.
CHP regularly reviews new technologies (drugs, procedures and medical devices) to decide whether they will become covered benefits for our members. Members can request that we evaluate a new technology by contacting our Member Services department. Physicians can also request a new technology evaluation. To evaluate new technology, CHP's medical director and consulting clinical experts evaluate the medical research from many professional sources including medical journals and government regulatory agencies. A decision to add a new technology to our covered benefits is made if the technology has been shown to improve health outcomes outside the research setting.