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PCP Rider

The Primary Care Physician (PCP) Rider is offered to employers located in Unity's Service Area (except Dane County) who select a Unity HMO plan and who want the freedom to use providers who are not Unity participating PCPs.

With this rider, employees can choose either a participating or non-participating PCP. When choosing a non-participating PCP, employees are responsible for charges that exceed Unity's Fee Schedule.  A Fee Schedule lists the maximum amount Unity will reimburse providers for covered services.

To assist employees in determining what their financial responsibility may be when receiving care from a non-participating PCP, Unity provides the following guidance:

• Employees should make certain that the PCP they have selected is listed on their Unity ID Card
• Employees should call the provider's office and request the CPT* (procedure) codes that will be used to bill for services and the charge for each code
• Employee's should use the PCP Rider Worksheet to help gather pertinent information
• Call Unity Customer Service to review the Fee Schedule amounts and determine the employee’s estimated financial responsibility

*CPT/HCPCS Codes - CPT is an acronym for Current Procedural Terminology. These codes are used for professional services, such as services rendered by physicians who treat patients in an office setting, during an inpatient hospitalization, or for outpatient hospital services. HCPCS stands for Healthcare Common Procedure Coding System. These codes are used for billing supplies, materials, injections and durable medical equipment.  

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