Why Choosing a PCP is Important

What is a PCP?

A Primary Care Provider also referred to as a PCP or your family doctor, is a 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 healthcare 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. If this is your first appointment with a new provider, it is commonly called a New patient visit*. This is done once, usually at your first visit, to set up a relationship with the PCP and the office. During this visit you will go over your past medical history, 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. Another common appointment type is an Annual wellness exam*. This is a yearly visit to have a physical and complete your annual preventive screenings. It may include:
    • Review of your blood pressure, heart rate, height, weight and body mass index (BMI).
    • 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.

    You will also have time to have a conversation with your doctor about new issues or concerns that you may have about your health.

    An annual wellness visit is free to you, as a covered preventive service. It is done yearly to see if there are any problems or signs of future issues. This is a safety net to keeping you healthy.

  3. You also may need an Office visit/sick visit. This appointment could be for many reasons. Examples might be if you are 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. Office visits can occur often or not, depending on what you are being treated for.

*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. This is your health! You need to be in charge!

  • First, choosing an in-network doctor saves 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. This can be used for primary care doctors, specialists, hospitals and more.
    • Ask people you trust like family, friends, and neighbors for a recommendation.
    • Do you want the doctor to have a special certificate/training?
    • Can the doctor treat your medical condition?
    • Do you want the doctor to be affiliated with a certain hospital?
    • Who will treat you if your doctor isn’t available? Are there other doctors in the practice?
    • Do the appointment times work with your life? Do they have evening or weekend appointments?

Once you narrow down your search, call the provider’s office. First, make sure they are still in-network with CareSource Marketplace. Sometimes there is a delay in updating contract information with our Find A Doctor system. Then ask if they are taking new patients, if the answers are yes, you can set up your first appointment!

Prepare for Your Appointment

  • Keep a notebook handy! Write down the questions and concerns you want to discuss with your PCP. Sometimes when we are face to face with our PCP, we get nervous, or we forget. Make a list before your appointment.
  • Write down your medical history. List:
    • Any past surgical procedures and their dates.
    • Medications and the dosage
    • Over-the-counter 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.
  • Make sure to have a copy of your identification document (driver’s license, passport, visa, or birth certificate – confirm with the doctor’s office what they will accept), and a copy of your insurance card to take with you 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.
  • We have created this Navigate medical history formfor you to use. It will help you keep track of your medical history, medications, and more. If you can’t print it out, you can write the topics on a blank piece of paper and take those to your provider.

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