•How does the Cooperative really work?•
By agreeing to become a member of Patient/Physician Cooperatives (PPC) you agree to an annual membership that gives you access to our physicians and membership benefits. You pay the monthly dues for the plan you have chosen and have access to all the benefits under that plan.
•What services do you offer?•
The PPC provides a variety of health care services for an affordable monthly fee.
Our basic membership includes a prescription drug discount card ( good at over 60,000 pharmacies nationwide ), patient advocacy services, and access to our full provider network at reasonable ( Medicare equivalent ) rates.
For those members who want a more personal level of care, PPC offers members all the benefits of our basic membership plus a retainer plan with a Primary Care Physician. The retainer is an affordable monthly fee that pays for services in full with no copay.
PPC also offers ACA “Obamacare” compliant employer sponsored health plans and association group insurance plans, employer sponsored ERISA plans, and partnerships with ACA-exempt cost-sharing ministries.
•What do the primary care plans cover?•
You have access to primary health care from the physician you choose who is a member of the Coop. Services from that physician will include the diagnosis of and treatment of common illnesses and injuries that are within the physician’s scope of practice. Services have to be provided by the PCP or clinic that you choose as your primary care provider.
•Does the plan cover hospitalization?•
The Patient/Physician Cooperatives (PPC) plans only offer you access to primary care physicians or clinics that you have chosen. In the event that you need a hospitalization or have to go to the emergency room we have negotiated lower rates from some contracted hospitals. This will be an out-of-pocket expense and is due at the time of service. We may also be able to work out a payment plan with contracted and non-contracted hospitals if it is a major expense. If you participate in the Group Health Plans that are offered by PPC through the Association and through employer sponsored plans your specialists and hospital charges will be covered based on the those plan documents and policies.
•Are there any limits to how many times I can visit my PCP?•
No, there aren’t any limits to how many times you can see the doctor or clinic you chose. It is based on your retainer agreement, your medical need and appointment schedules with your physician.
•How much will it cost me?•
The monthly cost will depend on the plan you chose. Benefits offered under each plan vary. See our membership rates for a detailed list of plans and services to choose from.
•How will I make my monthly payments?•
The payments are an automatic draft from a checking or savings account, or you can also set it up on a credit card or debit card. You have a choice on what day you would like us to withdraw the payment. It can be on the 1st, 5th, 10th, or 15th day of the month.
•How much will I have to pay when I visit my PCP?•
It depends on what plan you choose. On our most popular plan you pay nothing. The visit to the PCP that you chose from our list are included in your monthly membership fee schedule. There is a $0 copay plan and there is a plan where you have to pay a $25 co-pay at the time of your visit.
•What if I need lab/blood work?•
You are covered 100% with no out of pocket expense when you go to Clinical Pathology Laboratories (CPL) or Quest Labs. You are a prepaid exclusive member and will not be billed. You are covered as long as your doctor sends the samples to CPL, Quest or if they give you a requisition form to go to one of their labs directly.
•What if I need X-rays?•
We offer plans that give you access to three imaging locations. You can go to Houston Medical Imaging, SE Treatment Centers or Angleton Open MRI. You will be covered 100% with no copay, deductible, or out of pocket expense. They will be able to perform any of the tests that are listed on their detailed benefits sheet that include X-ray, MRI, CT Scans, Ultrasounds, and more.
•Can I change my PCP?•
Yes, you may change your PCP at the end of your contract term with that PCP or sooner if the PCP agrees as long as there is a legitimate or valid reason why you can’t continue with the doctor that you originally chose. Please contact member services and we will be able to help you make that change. You can reach member services at 281-689-2605.
•I am paying for the New Era group policy and I need a specialist. When can I see a specialist?•
The policy has a 60 day waiting period from your effective date for medical and a 270 day waiting period for pregnancy. Accidents have no waiting period. Please refer to your New Era Group Policy ID card for the effective date. If you do not have your card or have misplaced it please contact member services at 281-689-2605 to request a copy.
•Can I switch my diagnostic imaging facility?•
Yes, you may change your imaging facility at the end of your contract term with that provider or sooner if the provider agrees as long as there is a legitimate or valid reason why you can’t continue with the facility that you originally chose. Please contact member services and we will be able to help you make that change. You can reach member services at 281-689-2605.
•What about vision benefits?•
We have pre-agreed pricing that is exclusively for our members. We will refer you to a participating provider and you will pay the agreed rate at the time of service. The rates are listed on our Dental and Vision Fee Schedule.
•Can I see a dentist with this membership?•
Yes, we will refer you to a dentist which will only charge you the exclusive rate for the visit and any procedures you may need. You will be given a preferred rate that is pre-agreed and lower than normal rates. You will need to pay out of pocket at the time of service. The rates are listed on our Dental and Vision Fee Schedule.
•I really need to see a chiropractor. Do you have a location I can go to?•
If you have our membership access plan you will be able to see a provider with whom we contract. They will go by the rates published in our Fee Schedule. At the time of your appointment you will be charged for the services they provided. If you have the group insurance they will file a claim with New Era.
•If I have the New Era group insurance but I don’t want to use one of the Coop doctors. Can I see other providers?•
It is insurance and you can use it out of our network but it may be more expensive. The provider or physician you go to will have to file a claim and the insurance company will take it from there. The difference would be that the New Era policy has a rate schedule like Medicare and the out of network provider may not have agreed to take those and could charge you the difference.
•Can I get a mammogram with this program?•
If you have the group policy with New Era Life Insurance it will cover the cost of mammograms at most outpatient facilities. If not, we will refer you to other community programs that offer them at a very low cost or free of charge if you qualify. You can go to The Rose or Fort Bend Imaging.
•Can I get my well woman exam or Pap smear with the physician I choose?•
Yes, you can if the primary care physician you chose does well women exams. It is part of a basic or routine visit. The Pap smear will be sent to the Clinical Pathology Laboratories (CPL) or Quest Labs for testing and processing.
•What if I need a specialist?•
We will be happy to refer you to a specialist in our group. If you have the access membership plan our member physicians will charge the Medicare rate for the services or procedures that you need. You will need to make an out of pocket payment at the time of service. If you have the Association’s group policy the insurance will cover the charges above a copay of $25.00 with specialists that are in our group. The provider’s office will file a claim for your visit and take care of the rest.
•What if I have the insurance and the specialist is out of network?•
You will still be able to use the insurance but you will be responsible for the difference and for any out of pocket charges you incur that may not be covered by the insurance.
•What is Patient Advocacy?•
We will help you handle any unresolved medical issues that may arise. We will help negotiate and lower the fees that you have incurred for any medical or hospital bills that are out of network and more.