Frequently Asked Questions

How and when can I change health care plans?
Open enrollment is during your birthday month. Call Health Care Services at (800) 624-4964 and let them know you choose Capstone Health Plan.

What do I do when I get medical bills?
Contact the billing provider's office to make sure they have your correct Health Plan information. If they insist you are responsible for the charges, contact Member Services for assistance.

Can I choose my own Primary Care Provider (PCP)?
Yes, as long as she/he is contracted with Capstone Health Plan.

Can I change my Primary Care Provider?
Yes, call Capstone to do this. You can change up to three (3) times per year.

Can I choose my own specialist?
Yes, as long as your PCP makes the referral and the service has been authorized in advance by Capstone.

Can a specialist refer me to another specialist?
No, only a Primary Care Provider (PCP) can refer you to a specialist. However, once you have been referred to a specific specialist, that same specialist may request follow-up appointment authorizations through Capstone without getting a new referral from your PCP.

If I have Medicare or other insurance, do I still have to get an authorization from Capstone first?
Yes. Although you may have other insurance, there is usually a co-payment that you are responsible for. If you want Capstone to cover the co-payment, you must have the service prior authorized.

How do I get medical equipment that I need?
Your Primary Care Provider (PCP) needs to send Capstone a prior authorization request form, signed doctor's orders and documentation of medical necessity such as visit notes and therapy notes. Children who are on CRS need to requests mobility equipment (wheelchair, walkers, orthotics, etc.) through CRS.

Are diapers a covered service?
Yes, diapers and pull-ups are covered for Members age 3 through 20. Your primary care provider must submit a prescription and documentation of a disability that causes incontinence of bowel and/or bladder.

How do I get a ride?
Contact Capstone 24 hours before you need a ride. Have all of your information available, including the appointment time and provider's address.

How do I get reimbursed for providing my own transportation?
If you drive or someone you know drives you to a Capstone or CRS covered appointment, we can reimburse miles, meals and lodging expenses. Please call member services for details on completing the Travel Reimbursement Request.

Capstone Health Plan