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FAQs for Members
How does the Coop really work?
By agreeing to become a member of the Coop, Patient/Physician Cooperatives (PPC) you agree to an annual membership, year by year 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 do the primary care plans cover?
A You have access to basic family care or practice. It may include the diagnosis of and treatment of common infections and illness. It will cover you for any services that are provided within the practice. The services have to be provided by the PCP or clinic that you choose as your primary care as they will receive payment and have entered in agreement with you for a year of service.
Does the plan cover hospitalization?
The Coop, Patient/Physician Cooperatives (PPC) plans only offer you access to that primary care specialist or clinic that you have chosen. In the event that you need a hospital or have to go to the emergency room we can offer you a Medicare rate at one of our partner 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 the hospital if it is a major expense.
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.
How much will it cost me?
The monthly cost will depend on the plan you chose because the benefits offered under each plan vary. Here is are our plans and rates that will explain in detail your choices and the plans to choose from.
How will I make the monthly payment?
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 withdrawal 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. There is a $0 copay. But, there is a plan where you may have to pay a $25 co-pay at the time of your visit, if that is the one you choose.
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). You are a prepaid exclusive member and will not be billed. You are covered as long as your doctor sends the samples to CPL 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 Main Imaging, Gulf Coast Cancer and Diagnostic Centers, (Houston-off Beamer road), or to their Pasadena location. 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.
What hospitals does PPC partner with?
for a list of the hospitals we partner with.
Can I change my PCP?
Yes you may change your PCP as long as there is a legitimate or valid reason why you can't continue with the doctor that you originally chose. All you have to do is contact member services and we will be able to help you make that change. The change will go into effect on the 1st day of the next month. 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. 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 one.
Can I switch my diagnostic facility?
Yes you may as long as there is a legitimate or valid reason why you need to make that change. If you contact member services they can help you make that change. The change will go into effect on the 1st day of the next month. 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 that we partner with. 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 our partners have agreed to take the rates that the insurance company pays eliminating extra bills to pay out of pocket.
Can I get a mammogram with this program?
If you have the group policy with New Era Life Insurance, Main Imaging can perform the mammogram at their second location. 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 because it is part of a basic or routine visit. As long as the doctor that you have chosen does the exam in his office it will be covered at the routine visit. The Pap smear will be sent to the Clinical Pathology Laboratories (CPL) 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 partners will give you the best and lowest 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 group policy the insurance will cover the copay of $25.00 with the specialist 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.
THIS PLAN IS NOT AN INSURANCE WE ARE A MEDICAL COOPERATIVE.Copyright © 2010 PPC. All Rights Reserved.