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June 1, 2012 - May 31, 2013
For those in a county covered by HealthChoices, you have various options for treatment. For physical health you will always be given a choice of two to three Managed Care Organizations (MCO) to join. You have to read what service options each managed care plan offers. If you have been seeing a doctor that you would like to continue to see, you will need to check the provider handbook to see if your doctor works with that Managed Care Organization. The commonwealth of Pennsylvania has contracted with a company to assist you in choosing an MCO. This company will give you information on the different companies. Call your local County Assistance Office for the number of the company if you are not contacted. If you do not make a choice yourself, Medical Assistance makes that choice for you.
Once you have enrolled in a HealthChoices physical care MCO, you will receive a member handbook that outlines its services, grievance and appeal process and more. The Managed Care Organization can help you find a provider, and can assist you with making appointments, if that is necessary. In HealthChoices, your provider will be your primary care physician and will coordinate all your physical health care.
Services will depend on what your medical provider recommends, and what the Managed Care Organization finds to be medically necessary. For instance, if you injure your knee, your provider might refer you to an orthopedic surgeon. However, if the orthopedic surgeon recommends surgery right away, the MCO might first ask that you use physical therapy to heal your injury.
Some counties that pay for medical services through the Fee-For-Service option will give you a list from your County Assistance Office. The list may tell you which doctors in the area provide services through Medical Assistance, or it may ask you to call the provider you would like to see and inquire if they accept the ACCESS card. Any doctor can participate, but many do not.
Under Fee-For-Service, you must locate a doctor who can see you, and make the appointment yourself.