Blue Shield Ca How to Change Primary Care Physician

Choosing a Provider

Just as every doctor has a different style, every patient has different needs. We created these guides to help you choose providers with whom you'll be comfortable.

Choosing a physician Things to consider: Return to top Questions to ask: Before you meet with a doctor for the first time, make yourself a list of questions to ask. Ask about other physicians or nurse practitioners in the practice. You may occasionally be seen by them if your doctor is unavailable. What are the office hours? This is especially important if your job requires you to schedule doctor's appointments after work or on Saturday. While you're there, notice: Is the office staff courteous and helpful? The way the staff treats patients is often an indication of how a doctor treats patients. Do you have to wait a long time past your scheduled appointment? If there is a delay or an emergency, the staff should let you know. About the doctor When you meet the doctor, does he or she seem warm, polite and attentive, or rushed and preoccupied? Are they attentive? Do they listen to you? Do they take the time to make a connection with you? Do they both solicit and answer your questions? Is everything explained to your satisfaction? Do you understand their explanations? Does the physician train medical residents, medical students, nurses or physician assistants? If so, this experience may enhance their ability to explain things more clearly to their patients and be aware of the latest medical research. Return to top PPO plan considerations With our PPO plans, you have the option to go to a preferred or non-preferred doctor or hospital each time you access care. Preferred providers are in our PPO network while non-preferred providers are not within our PPO network. Preferred providers Whenever possible, you should choose a doctor or hospital from our preferred provider network. When you go to a preferred provider, you can save money and receive the highest level of benefits available to you. Non-preferred providers When you decide to go to a non-preferred provider, you should be aware that Blue Shield of California has no contract with these non-network providers concerning "allowable amounts." You'll be responsible for paying a percentage of the amount a non-preferred provider charges you, as well as the amount above Blue Shield's allowable amount for the services you were provided. Also, your copayments and deductibles may be higher and your calendar-year copayment maximum is set at the highest level for you PPO plan. You'll need to pay the non-preferred provider directly for the entire cost of your care, and then you must file a claim with Blue Shield within one year of the month you receive these services. We will keep track of these charges and apply the appropriate amount toward your calendar year deductible and calendar-year copayment maximum, or reimburse you at the applicable benefit level if you've already met your deductible or copayment maximum for the year. We will notify you of our coverage decision within 30 days of receiving your claim. For more information about allowable amounts, copayments, and deductibles, please refer to your Evidence of Coverage or Certificate of Insurance. When you need specialist care Our PPO plans give you the flexibility of being able to go to a specialist, such as a dermatologist or cardiologist, without obtaining a referral. You also have the option of seeing a specialist who is not in our preferred provider network. However, to keep your medical costs down, it's wise to go to a specialist who is in our preferred provider network. When you want or need a second opinion Your PPO plan has the same benefits for second opinions as you do for other physician office visits. For more specific details about your benefits, please refer to your Evidence of Coverage or Certificate of Insurance. Return to top HMO plan considerations What your personal physician does for you Unless you need emergency care, urgent care outside of your service area, or mental health or substance abuse services, your Personal Physician is the person to call whenever you need health care. For information about obtaining the mental health and substance abuse services that are available to you, please refer to your Evidence of Coverage. In general, these are the services your Personal Physician provides for you: Provides and coordinates your medical care, including referrals to specialists. Orders lab tests, X-rays and other medical tests. Arranges your admission to a hospital or skilled nursing facility. Focuses on improving your health through preventive care services, including periodic exams, immunizations and well-child and well-baby care. Assists you in obtaining approval for mental health and substance abuse. Assists you in applying for hospice care. It is important to note that when you are enrolled in a Blue Shield HMO plan, Blue Shield will only cover your medical care when it is provided or coordinated by your Personal Physician. The few exceptions to this policy include: Emergency care Mental health care Substance abuse care Access+ Specialist exceptions (see below for further information) Urgent care delivered outside of Blue Shield of California's service area Obstetrics/Gynecology (OB/GYN) care obtained from an OB/GYN or family physician at your Personal Physician's medical group or IPA Return to top

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Source: https://www.blueshieldca.com/bsca/provider/provider_choose.sp