Primary Care Physician

For those enrolled in a PPO (Preferred Provider Organization) or EPO (Exclusive Provider Organization) plan, your health insurance company has matched you with a primary care physician. You can change to another one at any time you choose. If you have not received information from your health insurance company about who your primary care physician is, contact your health insurance company.

Benefits of a Primary Care Physician

Covered California is working to improve the way health care is provided. PPOs and EPOs may be the best choice for you if you want full access to a wide range of providers without consent or referral from a primary care physician, but finding the right provider can be difficult and confusing. Your primary care physician will be an advocate for you, helping you to navigate the health system when you need assistance selecting the proper specialist, coordinating your care with other providers and ensuring you understand your treatment options. While having a primary care physician is important, you can choose to navigate the health care system on your own and you do not need permission from your primary care physician to seek treatment or a referral to see a specialist.

Research shows that having a relationship with a primary care physician is important to your overall health and well-being. Having a primary care physician means you will have someone you can turn to for health care advice — whether it is preventive care, treating common illnesses and injuries or recommending a specialist when you need one.

Rest assured, having a primary care physician does not change your PPO or EPO. You may still access any provider, inside or outside the network for PPOs and inside the network for EPOs, and do not need a referral to access specialists.

Frequently Asked Questions

Will my past medical history be sent to my primary care physician?

No, but you can request that your medical records be forwarded to your primary care physician once a relationship has been established.

Will my primary care physician reach out to me initially or after an event such as hospitalization?

Your primary care physician may only reach out to you after a relationship has been established.

Can I switch my primary care physician?

Yes, in most cases. Here is how it works: After your health insurance company matched you with a primary care physician who is in its network, you should have also received directions on how to change your primary care physician. Your health insurance company tried to match you to a primary care physician you have seen before, if the doctor continues to be an “in-network” physician. Keep in mind, not all physicians (such as specialists) are eligible to be identified as a primary care physician, but you can access care from any provider in the network.

Am I required to see the recommended primary care physician?

No. While you may schedule an appointment at any time with your primary care physician, you are not required to see the recommended primary care physician.

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