Selecting a Primary Care Physician?
Understanding your plan and when and how to select the right PCP for you.
Written by: Aaron Garcia.
A Primary Care PhysicianA Primary Care Physician is a doctor that oversees and monitors your medical care under some plan types. PCPs also may be responsible for referrals to specialists. is essential for managing and coordinating your care.
Customers that have HMO, POS and Catastrophic plans are required to have a PCP.
In these plans, policyholders must receive referrals from their PCP to see a specialist.
Some plans require that you choose a PCP from a list of approved, in-networkIn-network refers to the doctors, hospitals and other providers that are inside of your provider network. This is the group of providers that has agreed with your health insurance company to treat its customers. practitioners.
Required under some health insurance plans, a primary care physician (PCP) is a policyholder’s main point of contact for their medical needs. Primary care physicians manage the majority of their patients’ care, from preventative services such as immunizations and screenings to diagnosing and treating illnesses.
The types of health insurance plans that require a PCP are:
These plans also require the policyholder to get a referral from their PCP in order to see a specialist.
A considerable advantage of having a PCP is that primary care physicians train to treat and diagnose conditions and illnesses across a broad spectrum. Although some primary care physicians specialize in certain areas.  The five most common types of PCP practices are:
- Family medicine: These practitioners offer personalized care for everyone in your home, from the babies to the grandparents.
- Internal medicine: Also called “internists”; these doctors are most familiar with treating patients that range from early adulthood to old age.
- Pediatric medicine: These doctors care for patients from birth through childhood while monitoring key developmental milestones.
- Internal Medicine-Pediatrics: Board certified in both Pediatrics and Internal Medicine; these practitioners can treat a wide range of patients.
- OB-GYN: Short for Obstetrics and Gynecology, an OB-GYN specializes in women’s health. Many policyholders also choose to have a more broadly trained PCP in addition to their OB-GYN.
If you don’t select a PCP at enrollment for an HMO, POS or catastrophic plan, the insurance company may choose one for you.
If you’re unsure whether you have a primary care physician, here are a few tips on finding out:
- Check your insurance card. Some insurance companies include the name of the policyholder’s PCP on their cards for easy reference.
- Call your insurance company. A quick call to customer service should answer most of your questions.
The most important steps are to understand your network and choose a physician that’s in-network. You can find this information in the comprehensive lists of approved services and providers. If you’re not sure, know who to ask. Reach out to the benefits specialist at your job or contact GoHealth and speak to a licensed insurance agent.
Next, be sure to check with your preferred doctor’s office to make sure they are accepting new patients; if not, you’ll need to select another doctor and wait until your desired PCP is accepting new patients.
Does everyone need a primary care physician?
No. HMO, POS and catastrophic plans require their policyholders to select a primary care physician, but PPO and EPO plans do not.
Are primary care physicians general practitioners?
Not always. Like general practitioners, PCPs are usually trained broadly enough to care for a range of patients. Some, however, are focused on a specific area of care. PCPs can include the following types of practices:
- Family medicine
- Internal medicine
- Internal medicine-Pediatrics
How can I find out who my PCP is?
This information can sometimes be found on your health insurance card. If not, call your health insurance company.
Can I change my PCP?
Yes, as long as your desired doctor is:
- covered under your plan
- accepting new patients