Common use of Your Primary Care Provider Clause in Contracts

Your Primary Care Provider. When you enroll in Network Blue New England, you must choose a primary care provider (PCP) who is available to accept you and yourfamilymembersand participates in our network of providers throughout the New England states. For children, you may designate a participating network pediatrician as the PCP. For a list of participating PCPs or OB/GYNs: visit the Blue Cross Blue Shield of Massachusetts website at xxx.xxxxxxxxxxx.xxx; consult the Provider Directory; or call our Physician Selection Service at 0-000-000-0000. If you have trouble choosing a doctor, the Physician Selection Service can help. We can tell you whether a doctor is male or female, the medical school(s) he or she attended, and if any languages other than English are spoken in the office. Your PCP is the first person you call when you need routine or sick care (see Emergency Care–Wherever You Are for emergency care services). If you and your PCP decide that you need to see a specialist for covered services, your PCP will refer you to an appropriate network specialist, who is probably someone affiliated with your PCP’s hospital or medical group. You will not need prior authorization or referral to see a HMO Blue New England network provider who specializes in OB/GYN services. Your providers may also work with Blue Cross Blue Shield concerning referrals, and the Utilization Review Requirements, which are Pre-Admission Review, Concurrent Review and Discharge Planning, Prior Approval for Certain Outpatient Services, and Individual Case Management. Information concerning Utilization Review and services requiring referral from your PCP is detailed in your benefit description.