FAQ
AmeriHealth ® POS Plus Coinsurance
I’m a new member of AmeriHealth POS Plus Coinsurance and I have questions about my coverage. Who should I call?
As a POS Plus Coinsurance member, do I need to select a primary care physician (PCP)?
What is the difference between a POS plan and the POS Plus Coinsurance plan?
What is the difference between in-network care and out-of-network care?
My ID card lists my doctor’s office name, not his/her individual name. Do I still see the same doctor?
I have just moved and now need a new PCP. What should I do?
What should I do if I need a doctor and my PCP is unavailable?
Am I responsible for the difference between the amount billed by a provider and the allowed amount when I seek care from out-of-network providers?
When I seek care from out-of-network providers, who is responsible to preapprove my benefits?
We are expecting our first child. How do we enroll our baby in AmeriHealth?
How do I get a prescription filled for my newborn baby before I get his/her ID card?
I have dental coverage through AmeriHealth, but I’ve never selected a dentist. What should I do?
I’m a new member of AmeriHealth POS Plus Coinsurance and I have questions about my coverage. Who should I call?
Call the number on your ID card. If this number is not available, call the AmeriHealth Member Services Department at 1-800-877-9829, Monday through Friday, 8 a.m. to 6 p.m.
As a POS Plus Coinsurance member, do I need to select a primary care physician (PCP)?
Yes, POS Plus Coinsurance members must select a participating AmeriHealth PCP. Your PCP is available to provide routine and preventive care services. Your PCP will also assist you in finding physicians who can provide services such as laboratory and radiology. To find a PCP in your area, you may consult your AmeriHealth provider directory.
What is the difference between a POS plan and the POS Plus Coinsurance plan?
Unlike a traditional POS plan, POS Plus Coinsurance members never need a referral to seek care. POS Plus Coinsurance members may visit any provider directly without obtaining a referral from their PCP. POS Plus Coinsurance members receive the highest level of coverage by utilizing doctors and hospitals that participate in the AmeriHealth network. When POS Plus Coinsurance members choose to visit providers who do not participate in the network, they are responsible for additional out-of-pocket costs, such as deductible and coinsurance.
What is the difference between in-network care and out-of-network care?
In-network care includes those services that are performed by providers who participate in the AmeriHealth network. When POS Plus Coinsurance members seek in-network care, they receive the highest level of benefits.
Out-of-network care includes those services that are performed by providers who do not participate in the AmeriHealth network. When POS Plus Coinsurance members seek out-of-network care, they are subject to higher out of pocket costs, since deductible and coinsurance apply, and they may need to submit claims to AmeriHealth for reimbursement.
My ID card lists my doctor’s office name, not his/her individual name. Do I still see the same doctor?
Yes, you may still see the same doctor. If your doctor practices with a group of doctors in an office, your ID card will list the group name instead of the individual doctor’s name.
I have just moved and now need a new PCP. What should I do?
There are two ways to change your PCP:
- Online. To change your doctor, visit amerihealthexpress.com, our simple, convenient, and secure member portal. To find a new doctor, use the online provider search.
- By phone. Call the number on the back of your ID card. If this number is not available, call the AmeriHealth Member Services Department at 1-800-877-9829.
What should I do if I need a doctor and my PCP is unavailable?
As a member of AmeriHealth POS Plus Coinsurance, you have medical care available to you 24 hours a day, seven days a week through your primary care physician’s office. If your PCP is unavailable there will be a physician on call in the event of an emergency. When you call your PCP and get an answering service, be sure to tell the operator what your problem is and if it is an emergency. The service will have the covering physician call you promptly.
Am I responsible for the difference between the amount billed by a provider and the allowed amount when I seek care from out-of-network providers?
In addition to your deductible and coinsurance, you may be responsible for the difference between the physician’s billed amount and the reasonable and customary amount when you visit a provider who does not participate in the AmeriHealth network.
When I seek care from out-of-network providers, who is responsible to preapprove my benefits?
If you choose to utilize providers who do not participate in the AmeriHealth network, you are responsible for contacting Care Management and Coordination by calling 1-800-227-3114 to obtain the necessary preapproval. Consult your member materials to determine what services require preapproval.
We are expecting our first child. How do we enroll our baby in AmeriHealth?
For the first 31 days after the birth of your baby, your new baby is covered under your AmeriHealth POS Plus Coinsurance plan. You must contact your benefits office and complete an application to enroll your child with AmeriHealth within those 31 days. If you are a federal employee with a family plan, simply contact our Member Services Department and give us your child’s name, birth date, and the name of your child’s physician to enroll your new child under your plan.
How do I get a prescription filled for my newborn baby before I get his/her ID card?
If you have a prescription drug plan, you can get your baby’s prescription filled by paying for it at the pharmacy and calling Member Services for a reimbursement form. Once your child is permanently enrolled as an AmeriHealth member, you will be reimbursed for any prescriptions, minus your applicable copayment.
I have dental coverage through AmeriHealth, but I’ve never selected a dentist. What should I do?
It is important to select a dentist as soon as your dental coverage becomes effective to avoid interruption or delay in your dental care. Contact our Member Services Department to request a directory of dentists. When you have made your selection, call Member Services to register your choice. The Member Services representative will explain when you will be enrolled with the dentist. You need to select one dentist for your entire family. If you have only the pediatric dental program, please select one dentist for all your children age of 12 and younger.
If you have additional questions, please go to the Contact Us page to find out where you can direct your questions.
