Choosing or Changing your Primary Care Physician (PCP)
The important role of your Primary Care Physician (PCP)
As a member of an Essence plan, you will choose a doctor to serve as your Primary Care Physician (PCP).
Essence has handpicked the primary care physicians in our provider network very carefully, ensuring they
share our commitment to highly personal service. The PCPs in our network not only provide you basic
medical care, but also help you better manage your health and any health conditions you are facing, as
well as, coordinate your care when you are sick or in the hospital. In other words, your PCP is someone
you can count on to help you with anything and everything related to your health and well-being.
Your PCP will serve as your "go-to" person when it comes to coordinating your care when you have a health
issue that may require a specialist, hospitalization, etc. Based on your specific symptoms they will help
you find the best doctor to diagnose or treat you and work with that doctor to monitor how you are doing
and make sure nothing slips through the cracks. Since making sure you get the care you need is an important
part of their job, you are typically required to get their approval before seeing a specialist so they
can make sure you are seeing the right doctor for your specific needs. That approval typically means you
will need a referral from your PCP to see a specialist, but referrals are not applicable in all plans so
please reference the EOC for your plan on details, and discuss this topic when you first meet with your PCP.
You can count on your PCP to:
- Help ensure you get the necessary screenings, tests, and care that keep you well
- Help you manage and control any chronic health conditions you may be dealing with
- Help diagnose you when you are sick and works with you to determine the best treatment options
- Coordinate your care when you are sick or in the hospital to ensure you get the best treatment possible
Choosing a PCP
You will be asked to select a PCP at the time you enroll in an Essence Plan. Your PCP must be a member of the
Essence provider network. Your selection is indicated on your enrollment form. If there is a particular
specialist, or hospital facility that you typically like to use, you should first check to be sure your PCP
makes referrals to that specialist, or uses that hospital.Referrals are not applicable in all plans so please
reference the EOC for your plan on details, and discuss this topic when you first meet with your PCP.
The name and office telephone number of your PCP is printed on your membership ID card.
Changing your PCP
You may change your PCP for any reason, at any time. To change your PCP you will need to call
Customer Service. When you call, be sure to tell Customer Service
if you are seeing specialists or getting other covered services that needed your PCP’s approval (such as
home health services and durable medical equipment). Referrals are not applicable in all plans so please reference the EOC for your plan on details but
Customer Service will help make sure that you can continue with the specialty care and other services you have been getting when you change your PCP. They
will also check to be sure the PCP you want to switch to is accepting new patients. Customer Service will
change your membership record to show the name of your new PCP and tell you when the change to your new PCP
will take effect. They will also send you a new membership card that shows the name and phone number of
your new PCP, effective the first day of the following month.
You can start seeing your new PCP on the first day of month following the change. For example, if you change
doctors on November 12, you can start seeing your new doctor on December 1. Please note that this rule is firm.
Under the contracts we have with the physicians in our network, we are not allowed to retroactively change
your physician or permit changes in the middle of a month. If you choose to see your new physician before
the effective date, the plan will not pay your claim and you may be responsible for all fees for that visit.