Using Your Benefit

Although you can get health care many different places, including the emergency department, it’s best for you to get routine care and recommended preventive services from a primary care provider.

You can find primary care providers in offices, clinics, and health centers nationwide. Depending on your coverage and personal circumstances, you might find a primary care provider in:

• Private medical groups and practices
• Ambulatory care centers and outpatient clinics
• Federally Qualified Health Centers
• Community clinics and free clinics
• School-based health centers
• Urban Indian clinics and tribal health centers
• Veterans Affairs medical centers and outpatient clinics.

A primary care provider will help manage your overall health and is the starting point for your using the health care system. Your primary care provider will determine if you need to be treated by a specialist for a specific condition. Types of specialists include cardiologists, gastroenterologists, orthopedists, and oncologists.

To see a specialist, you may need a referral from your primary care provider for your health plan to cover the costs of the visit. Check with your health plan before your appointment with a specialist to determine if a referral is necessary. 

Finding a primary care provider 

Check with your health plan to find providers that are in your network. Remember that you will have to pay more to see a provider that is out-of-network.

Call the Member Services number on your insurance card for a list of providers or to check if a particular provider is in your network. You can also go to your health plan’s website and search for providers.

There are several things that you might want to take into consideration when choosing a provider, including:

• Is the provider accepting new patients, or patients with your health coverage?
• Is the office close to your home or your work? How would you get there?
• Which hospital(s) does the provider work with and can you get there?
• Will the appointment times work with your schedule?
• Does the provider speak your language or have an interpreter available?

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Making an appointment

When you are ready to make an appointment with a provider call, be ready to tell them:

• Your name and insurance information (be sure to tell them that you are a new patient)
• Why you want to see the provider. You might want to tell them you are looking to find a new primary care provider and ask for a “yearly exam,” or a “wellness visit,” or you might ask to come in because you have a specific concern, like the flu, allergies, or depression.
• If you have a specific need—like translation or accessible medical equipment—ask whether the provider and the office can meet that need. If they cannot, ask if there’s another provider in the office

You should also ask:

• If they can send you any forms you need to fill out before you arrive. This will save you time on the day of your visit.
• If you need to bring anything to the visit, like medical records or current medications.
• What to do if you need to change or cancel your appointment. Some offices charge a fee for missed appointments, late appointments, or appointments canceled less than 24 hours before they start.

When you get to your provider’s office, check in with the front office staff. You may be asked to provide the following:

• Insurance card or other documentation.
• Photo identification (e.g., driver’s license, government or school ID, passport, etc.).
• Completed forms.
• Your copay, if you have one. Ask for a receipt for your records.

Source: Centers for Medicare & Medicaid Services