Common use of Your Primary Care Physician Clause in Contracts

Your Primary Care Physician. In an HMO plan, you are required to have a Primary Care Physician (PCP). Your PCP is your first point of contact for any health concern and for Preventive Health Services. Your PCP will also manage other aspects of your care, including: • Prior authorization requests; • Health education; • Specialist referrals; • Hospital admissions; and • Hospice program admissions. Blue Shield will initially choose a PCP for you, but you can change this selection. You do not need to choose the same PCP for each Member in your family. To change your PCP, visit xxxxxxxxxxxx.xxx. PCPs may be: • General practitioners; • Family practitioners; • Internists; • Obstetrician/gynecologists; or • Pediatricians. Your PCP must be a Participating Provider. If your PCP leaves this plan’s network, Blue Shield will choose a new PCP for you and notify you. The relationship you have with your PCP is an important element of an HMO plan. Your PCP has a unique holistic view of your medical care. He or she will know your health history, which may help identify problems before they become serious. Your PCP will work with you to ensure you receive Medically Necessary professional services and accommodate your preferences to the extent possible. This relationship also allows for more open communication between you and your PCP. If you are unable to establish a satisfactory relationship with your PCP, you can choose a new one.

Your Primary Care Physician. In an HMO plan, you are required to have a Primary Care Physician (PCP). Your PCP is your first point of contact for any health concern and for Preventive Health Services. Your PCP will also manage other aspects of your care, including: •  Prior authorization requests; •  Health education; •  Specialist referrals; •  Hospital admissions; and •  Hospice program admissions. Blue Shield will initially choose a PCP for you, but you can change this selection. You do not need to choose the same PCP for each Member in your family. To change your PCP, visit xxxxxxxxxxxx.xxx. PCPs may be: •  General practitioners; •  Family practitioners; •  Internists; •  Obstetrician/gynecologists; or •  Pediatricians. Your PCP must be a Participating Provider. If your PCP leaves this plan’s network, Blue Shield will choose a new PCP for you and notify you. The relationship you have with your PCP is an important element of an HMO plan. Your PCP has a unique holistic view of your medical care. He or she will know your health history, which may help identify problems before they become serious. Your PCP will work with you to ensure you receive Medically Necessary professional services and accommodate your preferences to the extent possible. This relationship also allows for more open communication between you and your PCP. If you are unable to establish a satisfactory relationship with your PCP, you can choose a new one.