Insurance Glossary

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Insurance Term - Primary Care Physician (PCP)

Under a health maintenance organization (HMO) plan, the primary care physician is usually an insured personís first contact for healthcare. This is often a family physician, internist or pediatrician. A primary care physician monitors patient health, treats most patient health problems, and refers patients, if necessary, to specialists. Thus, a Primary Care Physician is responsible for the management of all aspects of care for a health care plan member. In many health insurance plans, medical care administered by specialists is only paid for if you are referred by your primary care doctor (PCP). An HMO or a POS plan will provide the customer with a list of doctors from which he/she will choose his/her primary care doctor (usually a family physician, internists, obstetrician-gynecologist, or pediatrician). This means that the individual has the freedom to choose a new primary care doctor if his/her current doctor does not belong to his/her concerned healthcare insurance plan. PPOs allow members to use primary care doctors outside the PPO network but at a higher cost. Indemnity plans allow any doctor to be utilized for rendering medical services. In short, Primary Care Physician is a physician who serves as a group memberís primary contact within the health plan. In a managed care plan, the primary care physician provides basic medical services, coordinates, and if required by the plan, authorizes referrals to specialists and hospitals.

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