Choosing Your Primary Care Physician
What is a PCP?
When you become a member of our Plan, you must choose a plan provider to be your Primary Care Physician (PCP). Your PCP is a physician
(or in some states a nurse practitioner) who meets state requirements and is trained to give you basic medical care.
As we explain below, you will get your routine or basic care from your PCP. Your PCP will also coordinate the rest of the covered
services you get as a member of our Plan. For example, in order for you to see a specialist, you usually need to get your PCP’s
approval first (this is called getting a “referral” to a specialist). Your PCP will provide most of your care and will help you
arrange or coordinate the rest of the covered services you get as a member of our Plan. This includes:
- your x-rays
- laboratory tests
- therapies
- care from doctors who are specialists
- hospital admissions
- follow-up care
“Coordinating” your services includes checking or consulting with other plan providers about your care and how it is going. If
you need certain types of covered services or supplies, you must get approval in advance from your PCP (such as giving you a
referral to see a specialist). In some cases, your PCP will need to get prior authorization (prior approval) from us. Since your
PCP will provide and coordinate your medical care, you should have all of your past medical records sent to your PCP’s office.
How do you choose a PCP?
You will be asked to select a PCP at the time of enrollment. Your selection is indicated on the enrollment form. You may change
your PCP at any time. That change will be effective the first of the following month. If there is a particular specialist, or
hospital facility that you want to use, check first to be sure your PCP makes referrals to that specialist, or uses that hospital.
The name and office telephone number of your PCP is printed on your membership I.D. card.
How to switch to another PCP?
You may change your PCP for any reason, at any time. To change your PCP, call Customer Service.
When you call, be sure to tell Customer Service 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). Customer Service will help make sure that you can
continue with the specialty care and other services you have been getting when you change your PCP. They will also check to be
sure the PCP you want to switch to is accepting new patients. Customer Service will change your membership record to show the
name of your new PCP and 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, effective the first day of the following month.
What if your doctor or other provider leaves your plan?
Sometimes a network provider you are using might leave the Plan. If this happens, you will have to switch to another provider
who is part of our Plan. Customer Service can assist you in finding and selecting another provider.