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Doctors & the Network

What is a PCP?
PCP stands for, “Primary Care Physician.” This is your child’s main doctor. It could be a pediatrician. It could be a family practitioner. Your PCP provides general health care. This includes check-ups and shots. PCPs refer to specialists when your child needs special care.

How do I change my child’s PCP?
Call us. The number is 1-866-376-2456. Ask for Member Services. We’re open Monday through Friday from 8:00 a.m. to 5:00 p.m.

If you change by the 15th of the month, it will be effective the 1st of the current month. However, any changes requested after the 15th of the month will not be effective until the 1st of the following month. For example: A PCP change made January 10th will be effective January 1st; but a PCP change made January 20th will be effective February 1st.

If you change PCPs, you need to call your new doctor and ask them to get your child’s records from the old doctor. Schedule a visit so the new doctor can meet your child.

How often can I change my PCP?
There is no limit.

If I change my child’s PCP, what happens to my current referral?
You may continue to go to that specialist. Ask them to send your medical records to your new PCP. Your new PCP needs this in case a new referral is needed.

Do I have to use only University of Florida providers?
No. You may use any provider in our network. We have a large network with all kinds of providers. There are more than 11,000 to choose from. Some are PCPs. Some are specialists. Some are in private practice. Some are at universities. The Provider Directory has a list of them all.

Click here for the Title 19 (MMA) Provider Directory.

Click here for the Provider Directory – Title 21 (CHIP) – June 20 2017.

Click here to access the Concordia directory for a listing of behavioral health providers.

If there is no in-network provider in my area, can I go to an out-of-network provider?
Yes, if it is medically necessary and authorized by Ped-I-Care. Your PCP will take care of getting the authorization first.

What happens if I need to go to an out-of-network provider?
Your PCP will request an authorization. Once authorized, you can schedule your visit. Then you can get the services. Work with your PCP. If you go to an out-of-network provider and don’t have approval before you go, you may have to pay for those services.

My provider said that they don’t know what Ped-I-Care is. They aren’t sure if they are in-network providers. Who do they need to call?
They can call our Network/Provider Relations department at 352-627-9100 or 1-866-376-2456.

My provider wants to contract with Ped-I-Care so that my child can still receive services through them. Who should they contact?
They can call Ped-I-Care’s Network/Provider Relations department at 352-627-9100 or 1-866-376-2456. We will be happy to speak to them about joining our network.