In 2017, we will be selecting a primary care physician (PCP) for you so you can begin building a relationship with your doctor. As a PPO member, read our frequently asked questions about choosing a PCP.
What is a primary care physician?
A primary care physician (PCP) is the doctor that you consider your go-to doctor when you need medical care. PCPs can be internal medicine doctors, family practice doctors, general practice doctors or pediatricians. Each enrolled family member can have his or her own PCP.
Primary care physicians manage preventive care, treat common illnesses and injuries, and can help you determine if you need more specialized care. As a PPO (Preferred Provider Organization) member, you are not required to visit your PCP or consult with your PCP before receiving care. You can also visit any doctor without a referral from your PCP. Although you can see any doctor that you want, you will save money when you choose providers in your plan’s network.
Why should I select a PCP?
Having a PCP means you have a doctor you can turn to for healthcare advice—whether it’s preventive care, treating common illnesses and injuries, or help in determining if you need more specialized care. You have the flexibility to see any doctor that you want and do not need a referral from your PCP to see a specialist, but you will save money when you choose providers in your plan’s network.
How did we select your PCP?
We selected a general practitioner, family practitioner, internist or pediatrician for you and your dependents from the Exclusive PPO Network.
If you are an existing Blue Shield of California member that is not on a grandfathered PPO plan*: We looked at your claims history and selected the PCP that you visited most often in the Exclusive PPO Network.
If you are new to Blue Shield or recently transferred from a grandfathered plan*: We selected your PCP from the Exclusive PPO Network and considered your location, primary language, gender and age.
*Grandfathered plan members are those who have been on the same Blue Shield plan since March 23, 2010.
When will I receive information about the PCP selected for me?
Blue Shield will send you information in February 2017 about the PCP that has been selected for you.
How do I make a change to my PCP?
You will receive instructions in February 2017 on how to make a change to your PCP.
What should I consider when selecting a PCP?
When selecting a PCP, you should consider:
The doctor that you see today?
Are you pleased with the care that you receive or would you be more comfortable with a different doctor for your overall care?
The doctor’s network
With a PPO plan, you can visit any PCP that you want, regardless of network, but you will save money if you see one that participates in Blue Shield’s Exclusive PPO Network. For example, some services such as preventive health services are not covered unless provided by a network doctor. You would be responsible for all billed charges. Please review your Evidence of Coverage for full details about covered services. To find doctors in your plan’s network, visit blueshieldca.com/networkifpppo and see “How do I know if my preferred PCP is part of my plan’s network?” for further instruction.
The type of doctor you need
- PCPs can be internal medicine doctors, family practice doctors, general practice doctors or pediatricians.
- Internal medicine doctors typically treat patients 18 and older and specialize in the prevention, diagnosis and management of disease and chronic conditions.
- Family practice doctors see patients of all ages. They treat a wide variety of conditions and can often treat sports injuries and provide women’s health needs.
- General practice doctors are like family practice doctors and can treat patients of any gender or age.
- Pediatricians typically treat patients under the age of 18.
Other criteria that may be important to you
- Gender preference
- Language preference
- Bedside manner
- Hospital affiliations
- Reviews or recommendations from someone you know and trust
How do I know if my preferred PCP is part of my plan’s network?
Starting October 1, you can see if your doctor is in our network by using our Find a Doctor tool at blueshieldca.com/networkifpppo.
1) Under Step 2, select Doctors.
2) Under doctor type or specialty, choose any of the following to narrow the results to eligible primary care physicians:
- Internal Medicine
- General Medicine, General Practice
- Family Practice
- For children, select Pediatric Specialists or General Pediatrics
3) Choose your location.
4) Click the find now button.
I can’t find my preferred PCP in the Exclusive PPO Network. What do I do now?
The Find a Doctor tool only displays PCPs that participate in the Exclusive PPO Network. Although your preferred PCP may not appear in your search results, you can continue to see your preferred PCP.
Will my PCP appear on my ID card?
No, your PCP will not be listed on your ID card.
Do I need to do anything at this time?
No. You will receive more information in February 2017. In the meantime, please feel free to see any doctors you want, but remember you will save money when you choose providers in your plan’s network. Although you are not required to see your PCP, it’s always good to build a relationship with one who can manage your overall health care. Your PCP can also help you determine if you need more specialized care.