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. Contact your health insurance company if you have not received information about your primary care physician match.
Your primary care physician will help you navigate the health care system when you need assistance selecting the proper specialist, coordinating your care with other providers and ensuring you understand your treatment options. 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. While having a primary care physician is important, you can choose to navigate the health care system on your own and do not need permission from your primary care physician to seek treatment or a referral to see a specialist.
Rest assured, having a primary care physician does not change your PPO or EPO. You may still access any provider inside the network and do not need a referral to access specialists. PPO members can still choose to go out of network for a higher, pre-defined cost share.
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.
Can I switch my primary care physician?
Yes, in most cases. Here is how it works: After your health insurance company matches you with a primary care physician who is in its network, you should also receive directions on how to change your primary care physician. If possible, your health insurance company will try 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.