Your Guide to Understanding and Choosing a Primary Care Physician

Choosing a Primary Care Physician (PCP) might be one of the most important steps in managing your health. It is the foundation of coordinated, affordable and high-quality care. Here is why finding a PCP should be a top priority:

1. Your PCP is the quarterback of your care.

   In most plans (especially HMOs), your PCP will serve as the central point of contact for your health care. They can:
   • Help you manage your overall care
   • Diagnose and treat common illnesses
   • Manage chronic conditions
   • Provide screenings and Annual Wellness Visits
   Your PCP should serve as a dedicated provider who understands your medical history and guides your health care decisions.

2. We usually don’t require referrals for in-network care, but PCPs coordinate with specialists and can refer you to providers they work with.

   This might help with:
   • Receiving high-quality care
   • Preventing delays in care
   • Coordination of care to ensure smoother access
   Coordination of care can ease frustration a patient might experience if their care is more fragmented.

3. Seeing providers within our provider network keeps your costs predictable and affordable.

   You can see all costs of your benefits and care in your Evidence of Coverage (EOC). To reduce your costs, your PCP can help you:
   • Stay within your network
   • Avoid unnecessary tests
   • Reduce duplicative services
   • Access preventative care that may be covered at $0
   You can find a copy of your EOC and other plan documents on the Plan Documents page of our website.

4. Preventative care is important to keep you up to date in your health and to avoid potential future issues.

   Your PCP will schedule and track:
   • Annual Wellness Visits
   • Vaccinations
   • Health risk assessments
   It’s crucial to stay up to date on these issues early when they are preventable and less costly.

5. Over time, your PCP becomes familiar with your history, lifestyle and personal preferences.

   This can lead to:
   • More personalized care
   • Better trust and communication
   • Recognition of changes in your health
   This relationship and continuity of care is especially important as health needs evolve with age.

Understanding the benefits of a PCP relationship is important, and it’s also important to know how to keep that relationship strong. You and your PCP should work together to cover your health as whole. Here are some tips to maintain an effective relationship:

• Keep track of your medications, your personal health history, and your family health history.
• Be open and honest about your health concerns, health habits, or any changes in symptoms you have noticed. It can be intimidating to talk openly about your personal health, but your provider is there to help and not to judge.
• Ask questions if you don’t understand something or need more information.
• Communicate changes to your medication, symptoms, or health procedures that your provider might not otherwise know about.

How to Choose the Right PCP for You

1. Confirm they are in-network.

   You can choose from any PCPs in our large network. Search in your area using the Find a Provider tool.

2. Check if they are accepting new patients.

   You can see if they are accepting new patients using the Find a Provider tool. You may also call to confirm and schedule an appointment.
3. Review the hours and location to ensure they work with your availability.

4. Use our Member Services and/or Case Management teams for help finding an in-network provider that fits your specific needs.

   Member Services: 1-800-240-3851 (TTY: 711); 8 a.m. - 8 p.m., seven days per week. On certain holidays, your call will be handled by our automated phone system.
   Case Management: 1-800-240-3870 (TTY: 711) and select option 5; 8 a.m. - 4:30 p.m., Monday through Friday.

Finding and getting quality care shouldn’t be a burden but does require attention and action. Conversations about your health with a trusted provider are a cornerstone to positive health outcomes. Use the tools from your health plan above to find the right PCP for you and start your journey to better health.