For those enrolled in a Preferred Provider Organization (PPO) or Exclusive Provider Organization (EPO) plan, your health insurance company assigns you a primary care physician. You have the flexibility to change doctors if you wish.
If you haven’t received information from your health insurance company about your assigned primary care physician, it’s important to contact them directly.
Your primary care doctor plays a crucial role in supporting you and guiding you through the healthcare system. They can assist you in choosing the right specialist when needed, coordinate your care among different providers, and ensure you understand your treatment options. Having a primary doctor means you have a go-to person for health advice, whether it’s for preventative care, treatment for common illnesses and injuries, or referrals to specialists when necessary. Despite having an assigned primary care physician, you retain the ability to navigate the healthcare system independently and don’t require permission from your primary doctor to seek medical attention or be referred to a specialist.
Rest assured that having a primary care physician does not alter your PPO or EPO benefits. You still have access to any provider within your network, and referrals to specialists are not mandatory. PPO members also retain the option to see out-of-network providers, although this may involve higher out-of-pocket costs.
Frequently Asked Questions
Will my medical history be sent to my primary care physician?
No, your medical history is not automatically sent. However, you can request that your medical records be sent to your primary care physician once you establish a relationship with them.
Can I change my primary care physician?
In most cases, yes. Here’s how it typically works: After your health insurance company assigns you a primary care physician within your network, you should also receive instructions on how to change your primary care physician if desired. The insurance company will attempt to assign a primary care physician you have seen previously, if they are still in-network. Remember, not all doctors (such as specialists) qualify to be designated as a primary care physician. However, you can still receive medical care from any provider within your network.
Is it mandatory to see the recommended primary care physician?
No. While you can schedule appointments with your assigned primary care physician at any time, it is not mandatory to see the recommended primary care physician. You have the freedom to choose and find a primary doctor that best suits your needs and preferences, and importantly, find a “Doctor Primario Cerca De Mi” – a primary doctor near you – who is convenient and accessible.
