"PCP" stand for "primary care provider." The PCP is a doctor or nurse
practitioner who you choose for all of your regular care. Here are a few other
things your PCP can do for you:
In order to continue coverage, your premiums
payments must be made on a monthly basis. Valid payment types include personal
checks, bank checks or money orders. You also have the option of paying by
credit or debit card. Click here for more detailed payment
Each family member can have a
different PCP. Or, you can choose one PCP for the whole family. There are
different types of PCPs:
is yours. If you need help deciding which PCP is right for you and your
family, call Customer Service toll free at 1-866-247-5678.
keep seeing your old non-Affinity doctor for up to 60 days after the date
you joined us, but only for special reasons. For example:
If you have Medicaid, your baby will be enrolled in Affinity Health
Plan on the day he or she is born. But your newborn baby will not be signed
up for our program if,
If you have Child Health Plus or Family Health Plus, call Customer Service
at 1-866-247-5678 for your baby's health care coverage.
Within 15 days after we
learn that your doctor is leaving our network, we will let you know so you
can choose a new PCP from our network. If the doctor who is leaving is
treating you for a health problem, you can keep using that doctor for up to
90 days before you have to choose a new Affinity doctor.
Sometimes, you or a family member may need to choose a different PCP.
For example, your PCP may move to a new location that is not convenient for
you. Or, you may just want to try a different PCP for personal reasons.
That's OK. You can change your PCP at any time. Call Customer Service and
ask for help in selecting another PCP. Please note that the change to your new PCP will take place on the first day of the month after the change was requested.
Your PCP will refer you to a specialist if you need
specialty care. We have over 5,000 specialists. These are doctors with special
training in conditions such as heart disease, cancer, or asthma. If we do not
have a specialist in our provider network that can give you the care you
need, we will get you one from outside the network.
If you have an emergency, you should go to
the nearest hospital emergency room. If the sickness or injury is not
urgent, call your PCP - even when your PCP's office is closed. There is
always a doctor on call to help you. The telephone number for your PCP's
office is printed on your Affinity ID Card. You can call at any time, 24
hours a day, seven days a week. When you call, tell the operator your name,
the name of your PCP, your Affinity Health Plan ID number, and the reason
for your call. Your PCP - or another doctor who works with your PCP - will
handle your call.
We pay for all of the
services covered by your Affinity Health Plan program. If a doctor bills you
for a covered service, send that bill to us and we will take care of
We take our motto, Dedicated to Excellence, seriously. We try to
serve you and your family well all the time. But, if you have a problem with
our service or the services you get from an Affinity doctor, please call or
write to Customer Service. We will do our best to solve the problem. If you
are not satisfied and need to file a complaint, please do so. We will not
make things hard for you. We will not take any action against you for
filing a complaint. In fact, our Customer Service staff can help you prepare
your complaint if you are unable to do so due to hearing, vision or
you are not satisfied with our decision on your complaint, you can appeal.
We have the steps to file an appeal in your Member Handbook. Our Customer
Service can also explain how you can file an appeal.
Members can fill their prescriptions at any pharmacy that is in
the CVS/Caremark network. If you are a member with questions or need
assistance, please call the specific number for your plan:
It’s hard to think about being so sick that you cannot decide what health care you want. But it is important for everyone to get ready if that time comes.Advanced Directives are forms you sign. You can name someone to make medical decisions for you if in the future you are unable to make these decisions yourself. They tell what health care you want or don’t want, in case you cannot make your own choices. You can also say what treatment you want and what medical treatment you don’t want if in the future you’re unable to make your wishes know.There are a number of types of advanced directives:Living WillA paper that spells out the medical treatments you would want if you were very sick. Some kinds of treatments that you may choose to have or not have are:
Health Care ProxyYou may hear this called a durable power of attorney (DPA) or a medical power of attorney (POA). A Health Care Proxy names the person you have chosen to make health care choices for you if you cannot make them yourself. Your doctor will decide when that time is. Choose someone you trust. Talk to that person honestly about treatments you would want and ones you wouldn’t want.DNR (Do Not Resuscitate)A DNR order says that you do not want to have CPR if your heart stops or if you stop breathing.We feel strongly that you must talk to your family and doctor about having an advanced directive. Your doctor can give you the forms and can answer any questions that you have.If you want any more facts on advance directives, call Social Work Department at718-794-6559.
Click here for pdf version
LogistiCare is the
vendor that Affinity Health Plan has contracted with to manage non-emergent
11/09/2009 for Medicaid members
only (excluding members in Orange and Rockland Counties-their services are
covered through their local Dept. of Social Services). Medicare members
will begin on 01/01/10.
Medicaid Members and/or providers may call LogistiCare on or
after10/26/2009 to schedule transportation services for dates of service
(866) 475-5749 (toll free)
(866) 418-9810 (toll free) ("where's my ride" line)
(urgent transportation line)
(866) 428-2351 Provider/Facility line
Members can order trips up to 30 days in
advance (as long as they are eligible).
Members must give 72 hours (3 days) notice
when ordering routine transportation appointments.
Yes. The appointment will be confirmed by the
ordering provider, and transportation will be provided same day via
taxi. Providers will receive phone calls from LogistiCare customer
service staff to confirm all urgent appointments.
Members may call (866) 418-9810 (toll free) if their
scheduled transportation has not arrived. They (and providers) may also use
this number to set up return transportation from an appointment, especially if
they did not schedule a round trip because they were unsure of when their
appointment would be over.
8:00 a.m. - 5:00 p.m. Monday
through Friday. The Ride Assistance line is open 24/7.
Routine transportation for Saturday and Sunday
should be ordered during normal business hours. Urgent Saturday and Sunday
transportation can be handled through the Ride Assistance line.
Members will need to have the
following information ready when they call LogistiCare: