What is a Primary Care Provider?
A primary care provider (PCP) is a healthcare practitioner that regularly meets with patients regarding a wide variety of healthcare concerns or for routine checkups. The PCP is usually the first point of contact for a person in regard to any non-emergency health concerns. Typically, the role of a PCP is to conduct health screenings, vaccinations, annual exams, and help you find specialists.
Types of Primary Care Providers
There are a few different types of primary care providers. These types include but are not limited to the following:
- Pediatricians- Usually focused on providing care to teens, children, and infants.
- Internists- Typically focused on providing care to adults of all ages.
- Family Physicians- Can provide care to patients of all ages.
- Nurse Practitioners- Can typically provide care to patients of all ages.
- Adolescent Medicine Specialists- Usually a pediatrician or internist who specializes in care for teens.
Who Needs a Primary Care Provider?
Everyone can benefit from having a PCP. If possible, it is often preferable to have a PCP that is affiliated and in-network with your insurance. The need for a PCP can also stem from the type of plan an individual is enrolled in. Typically, most Health Maintenance Organization (HMO) plans, require their participants to have a PCP. Another form of coverage that usually requires a PCP is a Point of Service (POS) plan. Members enrolled in certain Preferred Provider Organizations (PPO) plans, may not be required to have a PCP, however, it is still beneficial to have a PCP.
Why is Having a Primary Care Provider Important?
Having access to a PCP can help improve the quality and effectiveness of healthcare. There are many potential benefits to having a PCP, including but not limited to: the ability to develop a patient-provider relationship; continuity of care; assistance with health maintenance, medication management, and preventive care; and potential reductions in overall healthcare costs.
How to Select a Primary Care Provider
Finding the right PCP can be daunting. However, there are a few important things to remember when making your selection.
- Make sure the PCP you choose is in-network for the specific plan that you are on. Making sure that you are utilizing an in-network provider can make the visits cheaper as the insurance carrier will typically pick up a larger portion for in-network providers. If you are on an HMO plan, since there is generally no out-of-network coverage, the PCP selected usually must be in network or insurance will not pick up any of the cost for out-of-network providers.
- Consider the commute time from your home to the provider facility when selecting a PCP. Most people prefer to have a close and easily accessible PCP.
- To select a PCP that is in-network for the insurance provider and plan that you are on, you can usually call the member services number on the back of your ID card. Talking to a member service representative will help you navigate the PCP options within your area and ensure that they are in-network and accepting patients.
- Remember that you can always change your PCP. If you select a PCP that is not working for you, whether that be the formality, treatment approach or commute distance, you may have the option to change your PCP until you find one you are comfortable with.
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This article is for general informational purposes only and is not to be relied upon or used for any particular purpose. Cross Insurance shall not be held responsible in any way for, and specifically disclaims any liability arising out of or in any way connected to, reliance on or use of any of the information contained in this article. The information contained or referenced in this article is not intended to constitute and should not be considered legal, insurance, accounting or other professional advice, nor shall it serve as a substitute for the recipient obtaining such advice. The views expressed in this article are that of its author and do not necessarily represent the views of Cross Financial Corp. and its subsidiaries and affiliates (“Cross Insurance”) or Cross Insurance’s management or shareholders.
