Your Primary Care

When you become a member of our Plan, you must choose a plan provider to be your PCP. Your PCP is a health professional such as a physician, who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Each member of our Plan must choose a plan provider as your Primary Care Provider (PCP). Your PCP is your personal doctor. Your PCP is trained in general practice, family practice or internal medicine. Your PCP will work with you to direct your health care needs. If needed, your PCP will send you to other doctors (specialists) or admit you to the hospital.

The 2012 Central Region Ohio Provider Directory, 2012 Southwest Region Ohio Provider Directory, 2012 Northeast Region Ohio Provider Directory, or 2012 Northwest Region Ohio Provider Directory is a list of doctors and other health care providers who accept our Plan members. If you haven't chosen a PCP yet, please choose one from the directory or call us for help in selecting one. It is important that you start to build a good doctor/patient relationship with your PCP as soon as you can.

The name and office telephone number of your PCP is printed on your membership card. You may change your PCP at anytime for any reason by calling Member Services 1-800-708-8729, Monday through Friday, 8 a.m. to 8 p.m. (TTY users should call 1-800-750-0750 or 711).

Your PCP will also coordinate the rest of the covered services you get as a member of our Plan. In most cases, you must see your PCP to get a referral before you see any other health care provider. For example, in order for you to see a specialist, you usually need to get your PCP's approval first. Your PCP will provide most of your care and will help you arrange or coordinate the rest of the covered services you get as a member of our plan.

This includes:

  • your x-rays
  • laboratory tests
  • therapies
  • care from doctors who are specialists
  • hospital admissions, and
  • follow-up care

Coordinating your services includes checking or consulting with other plan providers about your care and how it is going. If you need certain types of covered services or supplies, you must get approval in advance from your PCP. In some cases, your PCP will need to get Prior Authorization (prior approval) from us. Since your PCP will provide and coordinate your medical care, you should have all of your past medical records sent to your PCP's office.

 

 

 

 

H6178_OHMSNP607
CMS Approved 12/20/2011