PROBLEMS WITH CHOOSING A PCP FOR COMMONWEALTH CARE

Once an applicant is found eligible for Commonwealth Care, she or he has two weeks to call the Connector and choose a health plan before being auto-assigned. Partners Community Benefits staff have heard about cases where patients have encountered problems when calling the Connector's customer service line to select their Commonwealth Care plan. The Connector has been requiring callers to choose not only a plan, but also a Primary Care Physician (PCP). Patients should not be required to select a PCP at the time of their plan selection and, in fact, they should be advised to work with the health plan to select a PCP. They should be able to call the Connector, choose a health plan, and then wait for a member booklet and physician network information from the plan in the mail. After they receive these materials, they may call their health plan and select a PCP.

The Connector’s information about PCPs available through different plans inevitably will not be as accurate or current as what is available from the plan directly. When patients try to select a PCP on the phone with the Connector sometimes the PCP they want is not on the Connector's list, but should be. Typical reasons for this include:

• the PCP’s information has not yet transferred successfully over from the health plan
• their panel is closed to new patients and therefore not on the Connector's list
• they are a resident and only their preceptor is listed
• they are not listed as a PCP, but a specialist.

Kim Simonian, MPH, of Partners Community Benefit Programs Health Access and Community Partnerships requests that you inform her if you find that Customer Service representatives at the Connector are still asking patients to choose a PCP, or if patients encounter problems with PCP selection when they call their health plan directly.

-Adapted from e-mail: “Commonwealth Care PCP selection”, from Kim Simonian, MPH, 11/2/09

11/06