Primary Care Physician

If you have not received a letter matching you with a primary care physician by April 1, contact your health plan.

For those enrolled in a PPO (Preferred Provider Organization) or EPO (Exclusive Provider Organization) plan, beginning Jan. 1, 2017, your health insurance company will be matching you with a primary care physician. Once your primary care physician has been matched, you will be able to change to another one at any time you choose. If you do not receive information from your health insurance company about your match by April 1, 2017, contact your health insurance company.

Why did Covered California add this feature?

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, but is an added feature. 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.

What do I need to do?

Nothing at this time. Your health insurance company will match you with a primary care physician, in part and when possible, based on the physician you have been seeing. If you have not been seeing a specific physician or have renewed your coverage with a new health insurance company, that company will match you with a physician as near to your home as possible. You can change this match at any time by contacting your health insurance company.

If you have questions, please call our Service Center from Monday to Friday between 8 a.m. to 8 p.m. at (800) 300-1506 (TTY: [888] 889-4500).

Frequently Asked Questions

What will happen once I am matched with a primary care physician? How will I be notified? What do I need to do?

By April 1, 2017, your health insurance company will match you with a primary care physician based on the primary care physician you have been seeing most frequently. Or, if you are a new member, a primary care physician will be matched with you based on your location, gender, language and ethnic preferences, if provided. You will be able to contact your health insurance company to change your primary care physician after receiving notification of your match in writing.

Will my medical history be sent to this new 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.

I already have a primary care physician, and I do not want to switch. Can I keep my current doctor?

Yes, in most cases. Here is how it works: Your health insurance company will match you with a primary care physician who is in its network. It will try to match you to a primary care physician you have seen before, if the doctor continues to be an “in-network” physician. Your health insurance company will provide directions on how to change your primary care 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. Covered California believes that the relationship you build with your primary care physician is important to your overall health and well-being. Having a primary care physician means you 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 needed.

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