The Role and Significance of Primary Care Doctor in Health Insurance

Health Insurance

People on the mission of their health insurance shopping should be aware of different terms and technicalities that play a crucial role in helping them choose a perfect health plan. One such term that people often hear while shopping for health insurance is “primary care doctor”. Thus it is essential for them to clearly understood the role played by the primary care doctor in their personal health. Individuals should have a clear understanding of primary care doctors, their significance in health insurance, how to choose a primary care provider, and the types of plans in which people need to choose a primary care doctor.

About Primary Care Doctor

Earlier people used to have family doctors, who look after all the healthcare needs of the entire family. As a result, the family doctor was aware of the medical history of all the members in the family and the doctor was consulted for any medical concerns. The tradition of having one medical practitioner handling all basic medical needs is currently being achieved with a primary care doctor. Following types of doctors generally serve as primary care practitioners:

General Practice Doctors

Similar to traditional family doctors, these doctors are qualified to treat the entire families and can handle patients of all ages and genders. These doctors hold experience in a variety of medical subjects.

Internal Medicine Doctor

These doctors look after the medical care of adults and are well capable of diagnosing and treating diseases with medicine. Some internal doctors are also sub-categorize based on their specialization in a specific organ, disease, or age-group.

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Pediatrician

People who have children included in their family health insurance plan will probably have a pediatrician as their primary care provider. Generally, pediatricians treat children from birth to adolescence. During a child’s early life, the doctor’s visits are common for the child to track early development.

Health Plans in which People Require to Choose a Primary Care Doctor

In some type of health plan, people are required to choose a primary care doctor such as a Health Maintenance Organization plan. People enrolled in an HMO plan typically need to have a primary care physician because enrollees of this plan can visits specialists only after obtaining a referral from their primary care provider. Some vital aspects related to HMO plan

  • In an HMO plan, there is an entire network of healthcare providers who agree to render healthcare services, but enrollees need to select a primary care provider who manages their healthcare services.
  • HMO plans offer coverage for the majority of preventive care that also includes a specialist visit, which generally happens only after a referral from their primary care provider.
  • HMO plans are best suited for individuals and families who want to save money and do not mind using a limited provider network.

How to choose a Primary Care Provider?

It is vital for people to choose a primary care doctor and people usually are quite possessive about their primary care provider that they do not want to change their PCP despite a change in health insurance. There are several health insurance portals that help people in choosing a primary care doctor. People who are looking for a new primary care provider in their area can also take the help of these health portals to find a new primary care provider. Some of the other ways through which people can find a new primary care provider include:

  • Personal referrals
  • Hospital referrals
  • The doctor suggested by the health insurance plan
  • Current physician referrals
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Health insurance plans regularly update its list of in-network providers and doctors, so people are advised to check coverage with the health plans as well as their doctors before incurring medical expenses.

What are some of the benefits of having a primary care doctor?

Though it may not be mandated by the health plans for people to choose a primary care provider, still people should choose a PCP for some good reasons. Some of the reasons for choosing a PCP include:

Medical history

Patients’ medical records are kept by hospitals, so if people visit the doctors within the same network, then probably their medical history will be stored in their system. However, if a person visits a health care provider, then that particular PCP will be completely aware of the person’s medical history. A regular visit to the PCP will also help the doctor to personally know about the person and his medical history. It greatly helps in keeping the person healthy and in finding the source of a health problem that the person may be experiencing.

Health plan

With a PCP, people will have a doctor with whom they are familiar. This will further ease the health plan for both insured as well as the medical practitioner. People, who wish to have a long term plan for a healthy lifestyle, should have familiarity with their healthcare provider.

Annual Check-up

Some of the health plans available today provide the benefit of the annual check-up that doesn’t have a copayment. However, even if there is a copayment, then also people should timely go the annual check-up. People who have their PCP usually go for the annual check-up, so that in case of any medical problem it gets quickly identified. Besides, people also feel comfortable visiting a PCP, because they don’t hesitate to ask any queries or share any concerns from PCP than compared to doctors to whom they have never met before.

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