You and Your Doctor: Working Together to Keep You Healthy

When you need medical care, do you have a doctor you can call? If not, find a doctor you can call your own. Don’t wait until you’re sick to become a patient. 

You’ll want to find a Medical Group (MG) and a primary care physician, or PCP, to be your “personal” doctor. A PCP may be an internal medicine doctor, or a doctor in family practice. An OB/GYN may be a woman’s PCP. A general pediatrician or family medicine physician is often a child’s PCP.

The Benefits of Having a PCP

Having your own personal doctor, or PCP, means you’ll have someone in your corner making sure you get the care you need.

• Your PCP will already know your health history, what health problems you have, and what medicines you take. This means you have someone who can make informed choices about your care.
• Your PCP will also provide your routine and medical care such as physicals, annual exams, and treatment for colds and the flu.
• Having a PCP means you can focus on staying healthy, instead of only seeking help when you are sick or hurt. Your doctor becomes your health coach, showing you better ways to stay healthy and live longer.
• Your PCP can guide you to the best place to go if you need more care and will follow your care each step of the way. If you need to be seen by a specialist, your doctor will coordinate the care, especially if you need to be seen by more than one specialist. This keeps your care on track and can help you avoid unneeded visits.
• Early diagnosis and treatment can keep many common health problems from getting worse. Having your PCP manage your care means problems can be caught early, before they become serious or lead to other major illnesses. For example, catching high blood pressure early and getting it under control could prevent you from having a stroke later.
• If you have a chronic health problem such as asthma, diabetes or a heart problem, your PCP can also make sure you have access to specialized care to help keep your condition from getting worse.
• Your PCP will also coordinate your care in and out of hospitals or outpatient programs.

Personal Care. Simplified.

That doctor-patient relationship is at the center of an HMO* plan.  An HMO is designed to provide personalized care coordinated by a PCP. Your PCP becomes that personal doctor who partners with you to keep you healthy and well.

To make the most of your relationship with your PCP and get the most out of your HMO, keep these tips in mind:

• If you are new to an HMO or are choosing a new doctor as your PCP, schedule your first visit as soon as possible. Having a relationship with your personal care doctor will help expedite care when you’re sick or injured, or if you need to see a specialist.
• Each person on your plan can pick their own PCP. Your PCP’s name and contact information will be listed on your member ID card. If you decide later your PCP isn’t right for you, you can change your PCP choice.
• Always call or go to your PCP first when you need care unless it’s an emergency. Your PCP will be able to make informed choices and direct you where you need to go for further treatment. That may mean going in to see your PCP, going to an urgent care center, or heading to an emergency room.
• If you need to be seen by a specialist such as a cardiologist, make sure to start with your PCP. It’s important to get all your care from providers in your HMO network, and have your care coordinated by your PCP. This will help ensure you have fewer out-of-pocket expenses. If you get care from a provider who is not in your HMO plan’s network, in most cases you may have to pay the full cost of your care.

To pick a PCP from your health plan’s network, log on to Blue Access for Members^SM and use our Provider Finder^®,  a search tool that lists all providers in Blue Cross and Blue Shield of Texas provider networks. By logging on first, you’ll only see providers who are in your health plan’s network.

*HMO is the commonly recognized term that refers to a Health Maintenance Organization. If you have an HMO, your PCP will be part of a Medical Group (MG), a group of both primary care and specialty physicians that can address many of your health care needs. This makes it simple to know where to go when you need care.

Originally published 2/4/2020; Reviewed 2022