Visiting the doctor
How to find a doctor
Each enrolled family member must be assigned to a doctor, also known as a Primary Care Physician (PCP) or provider. Families may choose a different doctor for each enrolled family member.
Here are the types of doctors you can choose to be your PCP:
- Family medicine provider: This option is for adults and children.
- Internal medicine providers: This option is for adults only
- OB-GYNs: This option is for women only.
- Pediatricians: This option is for children only.
When to see your doctor
Routine care is regular health care. It includes preventive care, also called wellness or well care. It helps you stay
healthy and helps keep you from getting sick.
Preventive care includes regular checkups and health education and counseling. In addition to preventive care, routine care also includes care when you are sick.
Community Health Group (CHG) covers routine care from your PCP.
Your PCP will:
- Give you all your routine care, including regular checkups, shots, treatment, prescriptions, and medical advice
- Keep your health records
- Refer (send) you to specialists if needed
- Order X-rays, mammograms or lab work if you need them
When your PCP thinks that you need specialized treatment, he or she will give you a referral to see a plan specialist. A specialist is a doctor who provides health care services for a specific disease or part of the body.
**IMPORTANT** You must get a referral before you get specialized health care or treatment at a hospital (except for emergency care, urgent care, or to see an OB/GYN). If you don’t have a referral before you get services from a specialist, you may have to pay for these services yourself.
How to see a specialist
Plan members cannot choose a specialist as their PCP. In some instances, you need a referral from your PCP and CHG approval to see a specialist. You do not need a PCP referral or prior approval from CHG to visit an OB-GYN.