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Medical Care and Plan Providers
Choosing or Changing Your PCP
What is a "PCP"?
When you become a member of Essence, you must choose a plan provider to be your PCP (Primary Care Physician). Your PCP is a physician who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you need. In most cases, you must see your PCP to get a referral before you see any other health care provider.
Every year, as long as you are a member of Essence, we will send you a Provider Directory which gives you a list of plan providers. If you don't have the Provider Directory, you can request a copy from Member Services or view the Provider Directory on this web site.
How do you choose a PCP?
When you become a member of Essence, you must choose a physician to be your PCP. A PCP serves as your total care coordinator and can refer you to the appropriate specialist when medically necessary. You will fill in the name of your PCP on your enrollment form. In the Provider Directory PCP's are listed by state and then by county, providing an easy way to choose a physician close to your home. There is also an alphabetical listing in the back of the directory. If you want to use a particular Essence specialist or hospital, you should check with your PCP to make sure they can make referrals to that specialist or hospital. The name and office number of your PCP is printed on your membership I.D. card.
How to change your PCP
You may change your PCP for any reason, at any time. To change your PCP, call Member Services at the numbers shown below. When you call, be sure to tell Member Services if you are seeing specialists or getting other covered services that needed your PCP's approval (such as home health services and durable medical equipment). Member Services will change your membership record to show the name of your new PCP and will tell you when the change to your new PCP will take effect. They will also send you a new membership card that shows the name and phone number of your new PCP.
What if Your Doctor or Provider Leaves Essence?
Sometimes, a doctor, specialist, clinic, or other plan provider you are using might leave the plan. If this happens, you will have to switch to another provider who is part of Essence. If your PCP leaves Essence, we will let you know, and help you switch to another PCP so that you can continue getting covered services.