About Your Providers
- What is a Primary Care Physician (PCP)?
- How can I change my Primary Care Physician?
- How do I get care from a specialist?
- How do I get a second opinion?
What is a Primary Care Physician (PCP)?
Primary Care Physicians, or PCPs, provide a full range of basic health services. PCPs can be:
- General practitioners
- Family practice physicians Internists
- On occasion, obstetrician/gynecologists
- Pediatricians
When you become a member of Elderplan, you must choose a plan provider to be your PCP. Your PCP is a physician who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP will also coordinate the rest of the covered services you get as a member of Elderplan.
With the exception of some benefits available in Elderplan Independence Choice (HMO POS), in order to use your Elderplan benefits you must use health care providers, including PCPs, who have agreed to be in our network. Our network includes more than 19,000 health care provider office locations, so you should be able to find a PCP, or other provider, who’s convenient for you! If you are a member of our Elderplan Independence Choice (HMO POS) plan, you may use out-of-network providers and may have to pay more, but using Elderplan in-network providers will generally save you money.
If you need to search for a PCP or other provider, call Member Services to request an updated list, or check our online provider locator.
How can I change my Primary Care Physician?
You may change your PCP to another doctor within the Elderplan network at any time. There are two ways you can do this:
- Call the Member Services Department and speak with a representative.
- Mail your request for a new PCP to:
Elderplan Member Services
6323 Seventh Ave.
Brooklyn, NY 11220
Either way, once your request is processed, a new Elderplan member card listing the name of your new PCP will be sent to you.
How do I get care from a specialist?
- Unless you are enrolled in Elderplan Independence Choice (HMO POS) all the specialists that you see must be part of the Elderplan network.
- You do not need a referral from your Primary Care Physician (PCP) in order to see a specialist.
- Sometimes you will need prior authorization from Elderplan before receiving certain types of care. In this case, your PCP will contact Elderplan and let you know if and when approval is given.
How do I get a second opinion?
- Contact your PCP.
- Elderplan will need to authorize any request for a second opinion. Your PCP will contact Elderplan for you.
- You must pay any applicable co-payment for a specialist visit when you go for your second opinion. Be sure to pay it before you leave the specialist’s office.
