FAQ
Keystone HMO

What is an HMO (Health Maintenance Organization)?

I’m a new member of Keystone Health Plan East (KHPE) and I have some questions about my coverage. Who should I call?

I have just moved and now need a new Primary Care Physician (PCP). What should I do?

I have dental coverage through KHPE, but I’ve never selected a dentist. What should I do?

What should I do if I need a doctor and my PCP is unavailable?

My ID card lists my doctor’s office name, not his/her individual name. Do I still see the same doctor?

We are expecting our first child. How do we enroll our baby in KHPE?

How do I get a prescription filled for my newborn baby before I get his/her ID card?

How do I know what services require precertification and who is responsible to obtain it?

What is an HMO (Health Maintenance Organization)?
An HMO is a managed system of health care using a designated panel of physicians and other health care personnel that provides comprehensive medical services. An HMO provides a complete range of medical benefits through a network of doctors and hospitals. One doctor, the Primary Care Physician (PCP, family doctor, or pediatrician), provides and coordinates overall medical needs. The PCP refers most specialty care needs.

I’m a new member and I have some questions about my coverage. Who should I call?
Call the number on your ID card. If this number is not available, call 1-800-ASK-BLUE (1-800-275-2583). Our hours of operation are Monday through Friday, 8 a.m. to 6 p.m.

I have just moved and now need a new PCP. What should I do?
There are two ways to change your PCP:

  1. Online: To change your doctor, visit ibxpress.com, our simple, convenient, and secure member portal. To find a new doctor, use the online provider search.
  2. Phone: Call the number on your ID card. If this number is not available, call 1-800-ASK-BLUE (1-800-275-2583).

PCP changes become effective on the first day of the following month.

I have dental coverage, 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 Customer Service to request a directory of dentists. When you’ve made your selection, call Customer Service to register your choice. The Customer Service associate will explain when you will be enrolled with the dentist. You need to select one dentist for your entire family. If you have the pediatric dental program only, choose one dentist for all your children age 12 and younger.

What should I do if I need a doctor and my PCP is unavailable?
As an Independence Blue Cross member, you have alternatives to the emergency room when your own doctor is unavailable. You may visit an urgent care center if you have an illness or injury that is not life-threatening but requires immediate medical attention. If you have an illness or injury that is less serious, you may visit a retail health clinic.

If you do have a life-threatening medical emergency, you should go directly to the nearest emergency room.

My ID card lists my doctor’s office name, not his/her individual name. Do I still see the same doctor?
Yes, you still see the same doctor. If you receive a new ID card and your doctor practices with a group of doctors in an office, the group name will be on your card instead of the individual doctor’s name. You may, however, still see the same doctor as before.

We are expecting our first child. How do we enroll our baby in KHPE?
For the first 31 days after the birth of your baby, your new baby is covered under KHPE. You must contact your benefits office and complete an application to enroll your child with KHPE within those 31 days.

See your member handbook for additional information regarding adding a new family member.

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 Customer Service for a reimbursement form. Once your child is permanently enrolled as a KHPE member, you will be reimbursed for any prescriptions, minus your applicable copayment.

How do I know what services require precertification and who is responsible to obtain it?
Your participating provider is responsible for obtaining approval from IBC for services requiring precertification.