HMO Patient – PrimeCareChino

Process of Becoming an HMO Patient

If You Have Employer Insurance

Select an HMO plan offered by your employer.
Choose a PCP during enrollment.
If the PCP is contracted with PrimeCare Chino, your insurance assigns you to the IPA.
Coverage typically begins on the 1st of the next month.

If You Are Self-Employed (Individual or Covered California Plan)

Purchase an HMO plan through Covered California, a broker, or directly from the insurance company.
Select a PCP during enrollment.
If the PCP is part of PrimeCare Chino, your insurance assigns you to the IPA.
Coverage usually begins the 1st of the next month.

If You Are a Senior (Medicare Advantage HMO)

Enroll in a Medicare Advantage HMO plan such as SCAN, Alignment, Anthem Medicare, or UnitedHealthcare Medicare.
Choose a PCP during enrollment.
If the PCP is contracted with PrimeCare Chino, your insurance assigns you to the IPA.
Coverage begins the 1st of the next month, or January 1if enrolled during Medicare’s Annual Enrollment Period.

Changing Your Primary Care Physician (PCP)

HMO plans require you to have a PCP on file with your insurance. If you request a PCP change, the insurance company—not the doctor—controls when the change becomes active.

When Does the Change Take Effect?

PCP changes always take effect on the 1st of the next month.

Example Using January and February

You request a PCP change on January 10.
Insurance processes the request.
Your new PCP becomes active on February 1.

Until February 1, your insurance still shows your old PCP as your assigned doctor.

What Insurance Will Not Approve Until the PCP Change Is Active

Until the new PCP is officially effective, insurance companies will not authorize or pay for:

Office visits with the new PCP
Specialist referrals
Lab work
Imaging (X-ray, CT, MRI, ultrasound)
Surgeries or procedures
Durable medical equipment
Any HMO-covered service ordered by the new PCP

This is because the insurance system still recognizes your old PCP until the next month’s cycle begins.

Why the New Doctor Cannot Speed Up the Process

Even if the new physician wants to see you immediately, they cannot:

Activate your PCP change early
Submit referrals before the effective date
Order labs or imaging under HMO coverage
Perform procedures under HMO coverage
Bill insurance for your visit

Insurance companies update PCP assignments once per month, and physicians have no control over this timing.

What You Can Do While Waiting

While waiting for the PCP change to become active, you may:

Continue seeing your current PCP
Pay cash for a visit with the new PCP (optional)
Prepare medical records for transfer
Schedule an appointment for after the effective date

Summary

You join PrimeCare Chino by choosing a PCP contracted with the IPA.
PCP changes always start on the 1st of the next month.
Insurance will not approve any HMO servicesfrom the new PCP until the change is active.
The new doctor cannot speed up the process because insurance controls the effective date.