Why Choosing a PCP is Important

What is a PCP?

A primary care provider (PCP) is a HAP CareSource network health care provider. A PCP offers a range of general medical care. Your goal is to find one you trust so they can get to know you and be involved in your care for a long time. They can share ways to stay healthy, supply preventive care, treat you when you’re sick, and help you find medical specialists when needed.

You can choose a PCP from many types of providers:

  • Family practice providers: Providers who care for children and adults of all ages and may include obstetrics and minor surgery.
  • Nurse practitioners (NP) and physician assistants (PA): Providers who go through a slightly different training and certification process than doctors. They can provide care, diagnose and treat your illnesses and prescribe medication.
  • Internists: Providers who care for adults and elderly patients but not usually children. Internists have extra training in the body’s internal organ systems.
  • Pediatricians: Providers who care for infants, children, and adolescents, usually to age 18.
  • OB/GYN (Obstetricians/gynecologists): Providers who may serve as a PCP for women, particularly those of childbearing age. Obstetricians (OB) focus on pregnancy and its health issues. Gynecologists (GYN) are focused on women’s reproductive health in general.
  • Geriatricians: Providers for older adults with complex medical needs related to aging.
  • Specialists: Sometimes a Specialist may be needed as your PCP. If you and/or your Specialist believe that he or she should be your PCP, you should call Member Services.

What Does a PCP do?

Your PCP can take care of most of your health care needs. If you have a more serious issue than they can manage, they can refer you to an appropriate specialist. However, you don’t need a referral to see a specialist.

There are different types of visits you’ll have with your PCP:

  1. New Patient Visit*: Your first appointment with a new provider to set up a relationship with the PCP and the office. During this visit you will go over your past medical history and talk about concerns you may have. You’ll be given an exam and you may be sent for preventive or diagnostic services, such as labs.
  2. Annual Wellness Exam*: This is a yearly visit to have a physical and complete your annual preventive screenings. An annual wellness visit is free to you, as a covered preventive service. It may include:
    • Review of your blood pressure, heart rate, height, weight and body mass index (BMI).
    • Discuss any new health issues or concerns
    • Physical exam.
    • Review your current medications, including over the counter medications, vitamins and supplements.
    • Blood tests.
    • Any shots you may need (flu, COVID, tetanus, measles, etc.).
    • Talk about diet, nutrition and physical activity.
    • Talk about preventive screenings indicated for your age, risk factors and family history.
    • Talk about tobacco use, if needed.
    • Talk about preventing future health issues.
  1. Office Visit and/or Sick Visit: This appointment could be for many reasons. Office visits can occur often or not, depending on what you are being treated for. You may need this type of visit if:
    • You are feeling ill
    • Have a medical problem that was found in your new patient or annual exam and need a follow up for those issues.
    • You could be put on medication that needs follow up visits to ensure it is working.

*These visits may have some exclusions. For a complete description of covered benefits, please read your Evidence of Coverage.

Finding the Right PCP Is Important to Your Health Care Journey

Establishing a relationship with your PCP can go a long way toward getting and staying healthy. When you choose a PCP make sure you are comfortable and trust your new provider. You should feel you are treated with respect, are being listened to, that you have options and that you understand your care.

  • First, make sure they are in the HAP CareSource network. This will save you money. Only in-network providers can give you covered services in non-emergency situations.
  • If you have trouble finding a PCP, call Member Services at 1-833-230-2099 or use our Find a Doctor/Provider This can be used for PCPs, specialists, hospitals and more. Make sure to find a provider that meets all your expectations. Ask people you trust like family, friends, and neighbors for a recommendation.
  • Once you narrow down your search, call the provider’s office. Ask if they are taking new patients and if they are still in the HAP CareSource Marketplace network. Once they confirm both, you can set up your first visit.

Prepare for Your Appointment

  • Before your visit, write down the questions and concerns you want to discuss with your PCP. You can make a list of areas you want to cover at your visit. Make sure you are prepared to discuss your medical history. Outline:
    • Any past surgical procedures and their dates.
    • Medications and the dosage
    • Over-the-counter (OTC) medications, vitamins or herbal remedies.
    • Known allergies.
    • Known medical issues.
    • Family medical history
    • Date of last preventive screenings like, mammogram, colonoscopy, A1C blood sugar screening.
    • Recent vaccines.
    • Any other doctors or specialists you have seen for other types of care.
  • Bring a copy of your identification document and a copy of your HAP CareSource member ID card to your appointment.
  • Find out if you will need to pay any out-of-pocket cost for your visit. Do you have a copay? You can find that information on your Schedule of Benefits or call Member Services to confirm.

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