What is a Primary Care Physician (PCP)?

A Primary Care Physician (PCP) is a doctor you select under your health insurance plan to be your personal physician. A PCP can be specialized in Family Practice, General Practice, Family Practice or Pediatrics. The relationship you have with your PCP is very important because he/she is responsible for managing all aspects of your care. Your PCP is responsible for referring you to specialty physicians.

What is a medical group?

When you choose a Primary Care Physician (PCP) you also choose his/her medical group. A medical group is formed when primary care physicians come together to contract with health plans and serve the community. These physicians have contracted with specialist physicians, hospitals and other health care providers to form a network.

What if I need care after hours?

In the event of an urgent situation, or when medical advice is needed after hours contact the Health Line below or contact your PCP.  An urgent situation is defined as a sudden illness or injury which may, if services delayed, result in serious medical complications.

The Health Line

(661) 716-7100 or toll free (800) 414-5860

Weekdays from 5pm to 10pm

Weekends from 8am to 10pm

*During the hours that The Health Line is not in operation,

patients should call their physicians directly for advice.

In a life threatening emergency situation, dial 911 or go to the nearest emergency room. 

How do I change my Primary Care Physician (PCP)?

You may change your PCP by calling MCS Customer Service at (661) 716-7100 or (800) 414-5860.

How do I know if my plan provides coverage for the care my physician wants to prescribe?

You may contact MCS Customer Service at (661) 716-7100 or (800) 414-5860. It is your responsibility to know your benefits.

What should I do with my new ID card?

Please review it for accuracy and carry it with you at all times.  Each person covered under EPO Plus should have an ID card that shows the member's PCP and other information.  Use the card when you go to the doctor or when filling prescriptions at the pharmacy.

What if the information on my card is not correct?

Please call the Customer Service department to report any errors, (661) 716-7100 or (800) 414-5860.

Where can I have my prescriptions filled?

Go to any participating NPS pharmacy.  For a list of participating pharmacies, see the Pharmacy section of this website.  Many independent pharmacies also participate.  Call Customer Service (661) 716-7100 or access NPS's website, www.pti-nps.com, to locate participating pharmacies.  These pharmacies include those in other parts of the country.

What if the pharmacy won't fill a prescription?

In most situations you will not have a problem filling a prescription.  Listed below are situations that could arise and suggestion to help you.

• You are not showing eligible in the pharmacy's computer system.  Call Customer Service at (661) 716-7100, Monday through Friday, 8:00 am to 5:00 pm, to correct the problem.  Outside of business hours, pay for the prescription and contact Customer Service the next day to correct eligibility and request reimbursement.
• You have a prescription written by an out-of-network provider.  Only prescriptions written by participating providers will be honored.  If you were referred/authorized to see a non-participating provider, call Customer Service at (661) 716-7100.

Will my prescriptions be covered if I go to an out-of-network provider or a dentist?

Your prescriptions will not be covered if you go to a provider who is not in the EPO network.  NPS will be able, on a case-by-case basis, to authorize payment for prescriptions written by non-network providers but this will be the exception rather than the norm.  For dentists, you will have to contact Customer Service at (661) 716-7100 to add the provider to the NPS network.  After that, prescriptions for that dentist will process like other prescriptions.

If I am taking chronic medications, can I get them through the mail order service?

Yes, you can get them through mail-order with a lower copayment per month by doing so.  You will need to have an original prescription from your provider in addition to the Integrated HMO Pharmacy Order Form.

What should I do if I am on a medication with a high copayment (nonpreferred) and wish to get a medication with a lower copayment?

You should contact your physician to find out about switching to a medication with a lower copayment.  For the vast majority of the nonpreferred medications there are very good alternatives with lower copayments.

Why is there a CCN logo on my ID card?

CCN is a nationwide network of providers contracted to provide urgent and emergent care whey you are out of the area.  Whenever possible, see a CCN network provider when you need medical services away from home.

Will I be covered when away from home?

Yes, the EPO Plus plan covers care for emergency conditions at any licensed emergency care facility.  If care is not a true emergency, your care will not be covered if you seek services from an emergency room.  Refer to the Summary Plan Description for the definition of an emergency.

Whenever possible have your emergency care authorized by your PCP or MCS before you receive it, but no later than 48 hours after seeking care.  Some facilities may require payment up front.  If services were a true emergency, contact Customer Service at (661) 716-7100 for reimbursement information.