Chances are high that at some point in your life you’ll have to see a doctor for a medical event. The primary care physician-to-patient (P2P) relationship lies at the heart of Healthcare Highways and as a valued health-plan member, we encourage you to establish a relationship with a primary care physician (PCP).
Having a primary care physician who knows your medical history results in more tailored care. Data from routine checkups can help your PCP formulate a snapshot of your health status and treat and/or diagnose illnesses more precisely. In addition, your PCP can coordinate care with specialists so that you get the most appropriate care, at the most appropriate time.
An established relationship with a PCP empowers you as a member to be proactive in managing your family’s wellness journey, resulting in cost savings. In fact, studies show that having a PCP results in 33% less healthcare costs compared to people without a PCP i. Additionally, in the event of a non-life-threatening condition, having a PCP makes it more likely that you’ll go there for care instead of an emergency room or urgent care, which can be more costly.
Having an established PCP enables your doctor to address health care concerns more quickly and effectively, given that they are familiar and knowledgeable with your medical history. To begin, you’ve heard the term ‘network’ before. In the context of your health plan, a network refers to the hospitals, clinics, and doctors that a plan has contracted with to provide medical care to its members. Providers can fall into one of two categories: in-network providers or out-of-network providers.
In-network providers are those that have contracted with your health plan and agreed upon the rates the provider will be paid. You receive the highest level of coverage (least out-of-pocket costs) when you receive in-network care from providers in your health plan network.
On the other hand, out-of-network providers refer to providers with which your health plan has not negotiated a discounted rate. If you get care from an out-of-network provider, you may have to pay the entire bill yourself or just a portion. Your portion of out-of-network charges should be indicated in your beneﬁt summary guide.
The biggest difference between the two is cost—staying in-network will save you money. Another difference is how much your plan helps with the cost of care when you see an out-of-network provider.
We’re here for your health plan needs. To ﬁnd an in-network provider, use our online Find a Medical Provider tool on www.HCHHealthPlan.com or call the Customer Experience Team at 1-844-869-5640 for any questions, 8 am to 5 pm Monday through Friday.