A primary care physician (PCP) refers to a doctor within a managed healthcare network whom a particular patient has been assigned to receive healthcare services from.
The are the first point of contact for members suffering from illness and health conditions, and seeking medical help.
Members in a managed care plan would have to adhere to this arrangement in order to receive the maximum benefits that come with their plans. This can include low co-payments.
In some circumstances, member patients can engage the services of healthcare service providers as well. But the share of medical costs might be higher than if they use the appointed PCP.
Who are PCPs?
Professionals who take on the role of primary care physicians are most often general practitioners who have a wide array of experience attending to, diagnosing and treating common medical conditions that don’t necessarily require specialist attention.
They play a critical part in the smooth operations of managed healthcare (MHC) in that after members have been registered, PCPs are often the person who has the most contact with members and knows them in a more personal manner.
Because patients go to them regularly and might even see them as their personal physicians, it enables PCPs to build professional and personal relationships.
This can also play a critical in the decisions members make about treatments they might need later in life.
And since a PCP would have attended to patients for a long time, he or she would have credible information on the patient regarding health history, treatments that were used in the past, and even their preferences.
For example, a PCP doctor would have the records of a person’s medical history as the patient has been going to him or her for the last several years.
There is also every chance that the PCP’s clinic is within the neighborhood of the member’s residence. This gives them opportunities to run into each other like neighbors on a regular day.
Because of geography reasons, family members tend to have the same PCP if they have the same healthcare network. This can make the doctor somewhat of a family doctor since every member in the family sees the same doctor for their health problems.
It’s no surprise to find members to see PCPs as their most trusted “friend” concerning their personal health.
If a particular medical condition a patient suffer from requires additional care, then he would refer the member to a specialist who has the required expertise and equipment to attend to the patient.
This referral would also be to a service provider within the healthcare network so that the member can continue to draw on the benefits and features of their health care plans.
A referral from a PCP is necessary for members to enjoy the perks of their health plans to the max.
It must be noted that referrals might not be to other doctors or surgeons. They could also be for services such as x-rays, blood test, chiropractors, etc.
People who are members of such networks tend to be because of group MHC insurance policies that their employers have purchased for them as employee benefits.