Independent Health’s Prime AccessSM FAQs

Is there any copay or fee that I would have to pay for getting the Patient Engagement Form completed?

There is no charge to the member. The form may also be completed without an office visit by instead having a phone conversation with your primary care physician, physician’s assistant or nurse practitioner.

Does the Patient Engagement Form need to be completed by both the subscriber and the covered spouse/domestic partner?

Yes, the subscriber and covered spouse/domestic partner must have the form completed and returned to Independent Health in order to remain in the Enhanced option within the first three months of enrollment.

What if the Patient Engagement Form is not returned or is returned but incomplete?

Completed Patient Engagement Forms must be returned to Independent Health within the first three months of the group effective date for you – the subscriber (and family) – to remain in the Enhanced option. Forms that are not returned or are returned with incomplete information will result in the subscriber (and family) being moved to the Standard option for the remainder of the plan year.

Do I need to complete a Health Risk Assessment?

No, completion of a Health Risk Assessment is not required, however, completion and submission of the Patient Engagement Form is required to remain in the Enhanced option.

Will more physicians be added to the network associated with Prime Access?

Yes. Independent Health plans on working with additional physicians and are hopeful that they can meet the requirements associated with the tailored network.

Do all services rendered by specialists require an Optional Referral so I can pay lower out-of-pocket costs?

You must obtain a referral to all specialists from your primary care physician (PCP) of record in order to receive a lower charge. If a referral is not obtained from their PCP of record, you will be responsible for the higher charge.

Do I need to choose an OB/GYN of record or just a primary care physician (PCP) of record?

Members must select a PCP of record. Members may also select an OB/GYN of record if they choose to do so.

Is the deductible for in-network and out-of-network services combined?

No. The in-network deductible and out-of-network deductible are not combined.

Can a specialist issue a referral?

No. All referrals need to be written by the primary care physician who participates in the network associated with Prime Access.

What is the liability for services provided by a primary care physician who is not part of the network associated with Prime Access, but participating with Independent Health (IHA) network?

After the deductible is satisfied, you would be responsible for the specialist member liability without a referral.

What is an on-site Practice Care Coordinator’s responsibility?

Practice Care Coordinators are nurses employed by Independent Health who work in The Primary Connection offices as extended case managers to help the practices coordinate care. The Practice Care Coordinators find care alternatives, and assist in setting up care plans and support services. Their efforts help The Primary Connection practices provide the right care in the right setting.

If I or my (Primary Care Physician) have problems completing my Patient Engagement Form, can I call Member Services for help?

Yes. You can contact Member Services by calling (716) 631-8701 or 1-800-501-3439.

If a member reaches there deductible in the Enhanced option in the first three months, and is then moved to the Standard option, will claims in the Enhanced option (i.e., copayments) be reprocessed against the higher deductible?

Claims received under the Enhanced option after the deductible was satisfied will not be recalculated against the Standard deductible. However, any new claims processed under the Standard option will be subject to the new plan deductible.

What applies to Out-Of-Pocket Max (OOP)?

Deductible, copayments and coinsurance apply to the Out-of-Pocket Max in Prime Access.