Transition to Adult Care — Outpatient Specialty Care and Primary Care

For Patients: Steps for Finding an Adult Provider and Insurance

Changing doctors or insurance plans can be tricky. Fortunately, there is a lot of helpful information on the internet if you know where to look.

1. Find the correct website.
   Your insurance card should have a phone number you can call and the correct website on it. If you have Medicaid, you can usually find the website by searching for “Pennsylvania Medicaid _______”, filling in the name of your insurance carrier in the blank space. Once you found the website, look for the “Providers” section. From here you should be able to search for a new doctor.
2. Know what you’re looking for.
   You can look for a specific doctor, group of doctors, or health care system. You can also look for all available doctors in a certain area. Most adults see a Family Practice doctor (trained in caring for babies through adults) or Internal Medicine doctor (trained in caring for adults). It is important to find a doctor that is accepting new patients. See the second page for some examples in the Philadelphia area.
   There might be other options that are important to your particular needs, such as evening hours or a language other than English. If your child sees multiple specialist doctors, it is often easier to have all the doctors in one medical system.
3. Is there anything else I should know?
   If your health insurance is through a Pennsylvania Medicaid Managed Care Organization, such as Keystone First or United Health Care Community Plan, and you need help finding an adult health care provider, contact your plan’s Special Needs Unit to assist. You should keep the name of your pediatrician as your primary doctor until you find and see an adult doctor that meets your needs. This practice is allowed through something called the OPs Memo. For more information review the OPs Memo Summary via the PEAL Center, which is a parent-run organization dedicated to helping children with special health care needs and disabilities.
4. Who can help me if I have any questions?
   Insurance can be a confusing topic. You can ask your doctor or someone from the social work team. You can also visit the Billing and Insurance page on CHOP.edu for more information.