Physicians Health Plan (PHP) > For Members > Frequently Asked Questions

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		Frequently Asked Questions

Welcome to the Customer Service Department’s Frequently Asked Questions Page! For your convenience, the FAQ’s are arranged based on category. This page lists the most common topics that our Customer Service Representatives and Specialists discuss every day with members just like you. If you don't find the answer to your questions, please call us! Our Specialists are waiting to hear from you.

		Questions About Providers

Q. How do I change my PCP?

Q. How do I select a Primary Care Physician?

Q. How can I get more information about a practitioner or provider?

Q. What should I do if my PCP or specialist retires or is no longer participating with PHP?

Q. How can I get information about a hospital or outpatient facility?

		Questions About Bills and Explanation of Benefits

Q. What do I do if a participating provider is billing me for charges other than my copay?

Q. Why don't I get an EOB for every service I have?

Q. I participate in a Flexible Spending Program at work - if you don't send me EOBs, how should I report my expenses to my Flex Spending Account?

Q. What should I do if I get a bill from a provider?

Q. What is an Explanation of Benefits?

		Questions About Pharmacy Benefits

Q. What is the Prescription Drug List?

Q. How can I make sure I am getting the greatest value from my outpatient drug benefit?

Q. What should I do if I go to the pharmacy and the pharmacist tells me that my prescription is not covered?

Q. What if my prescribed medicine is not on the Prescription Drug List and it's after business hours?

Q. What are Tiers and how do they affect my copayment?

		Questions About Other Insurance

Q. Do I need to notify PHP if I am involved in an auto, work-related, or third-party accident?

Q. Both my spouse and I have health coverage through our employers. Which policy should be billed first?

Q. How do I inform PHP about my other health coverage?

Q. What should I do if I have another active health insurance policy?

Q. What is Coordination of Benefits?

		Questions About Mental Health and Substance Abuse Services

Q. I use my PLUS benefits to see my non-participating mental health provider, how do I submit a claim?

Q. How do I access mental health or substance abuse services?

Our Customer Service Specialists are waiting to take your call! Call us at 517.364.8500 or 1.800.832.9186 between 8:30 a.m. and 5:30 p.m. Monday through Friday.

		Questions About PHP PLUS

Q. My card says "PHP PLUS." What does this mean?

Q. I want to see a non-participating specialist for my health care services, how do I access my out-of-network or Plus benefits?

Q. What is a Deductible, and how do I know when it has been met?

Q. If I am using my PLUS benefits, do I need an authorization?

Q. Are there benefit restrictions that apply when I see a non-network provider?

		Questions About Referrals or Authorizations

Q. How do I get a referral to see a specialist?

Q. What services DO NOT require a referral from my Primary Care Physician?

		How to obtain care?

Q.How do I obtain health care services?

Q.How do I obtain care after normal office hours?

		Questions About Emer- gencies and Urgent Care

Q. What is an emergency?

Q. How do I get emergency care?

Q. What do I do if I am out of state and I need to seek health services right away?

Q. How do I know if my symptoms are urgent?

Q. What should I do if I need to see a physician right away, but my doctor's office is closed?

		Questions About Claims

Q. How do I check the status of a claim that was submitted to PHP by me or my doctor?

Q. How do I submit a claim?

Q. I was on vacation and had to be treated at an Urgent Care Center. How will I get reimbursed for this service?

Q. I was traveling out of the country when I became sick and needed to see a doctor. How do I get reimbursed by PHP?

		Questions About Enrollment and Member- ship

Q. How do I add my new spouse and children to my policy?

Q. What should I do if my spouse or a dependent is no longer eligible to be on my PHP policy?

Q. I recently asked my employer to add my new baby. How can I find out if the baby has been added?

Q. I recently moved, do I need to notify PHP of my new address and phone number?

Q. I lost my ID Card – what should I do?

Q. I want to change something on my ID card. How do I do that?