How to See a Doctor

You may choose the doctor or clinic you already use, if the doctor or clinic participates with CommuniCare Advantage (HMO-SNP).Or you may choose a new doctor from the Provider Directory. The Provider Directory gives you a listing of all medical groups, PCPs, specialists and hospitals contracted with CommuniCare Advantage (HMO-SNP), and has helpful information about each doctor and clinic.

When you choose a PCP, you will also need to select a medical group. Your PCP must be with the same medical group that you choose. When you pick your PCP and medical group, you are also choosing the other providers you will be able to see. Before you choose a PCP and medical group, you need to know with which set or group of Providers, Specialists and Hospitals the PCP works.

If there is a particular CommuniCare Advantage (HMO-SNP) plan specialist or hospital that you want to use, check first to be sure your PCP belongs to the same medical group as that specialist, and uses that hospital. The name and office telephone number of your PCP is printed on the membership card.

You may also change your PCP at any time. Call Member Services to choose a PCP or to change your PCP.

How do you get care from your Primary Care Physician (PCP)?

To see your PCP doctor, call your PCP doctor's office to make an appointment. Your PCP’s phone number is printed on your CommuniCare Advantage (HMO-SNP) membership card.

We recommend that you make sure to see your PCP for preventive care and see your PCP at least annually, not just when you are sick or have an immediate need.

How do you get care from specialists and hospitals?

When your PCP thinks that you need specialized treatment, he/she will give you a referral (approval in advance) to see a plan specialist. A specialist is a doctor who provides health care services for a specific disease or part of the body.

You must get a referral before you get specialized health care or treatment at a hospital (except for emergency care, urgent care, or to see an Ob/Gyn). If you don’t have a referral (approval in advance) before you get services from a specialist, you may have to pay for these services yourself.

See our Provider Directory for the most current listing of Providers in our contracted Network. Call CommuniCare Advantage (HMO-SNP) Member Services Department if you would like one sent to you at 1-888-244-4430 (TTY 1-800-735-2929). CommuniCare Advantage (HMO-SNP) plan representatives are available 24 hours a day, 7 days a week, including holidays.