Choosing and Changing Your Primary Care Provider

Choosing a PCP

As a member of Community Health Plan, you need to choose a primary care provider (PCP). Every covered member in your family can choose his or her own PCP. If you do not choose a PCP, we will choose one for you.
                                   
Your PCP will help you manage all parts of your health. Your PCP is your main health care provider, who helps to manage all parts of your health:

  • Always call your PCP first, except in an emergency.
  • In an emergency, call 911 or go to the nearest hospital. For more information about emergency care, see Emergency Care.
  • To see a specialist, you must get a referral from your PCP. For more information about referrals, see "About Prior Authorizations and Referrals."

If you are pregnant, it is best to choose a PCP in our network for your baby before the birth. If you do not choose one by the time your baby is born, we will choose one for you. You can change your baby’s PCP later if you wish. The new PCP will become effective no later than the beginning of the month after your request. Please note that only Basic Health enrollees who are HCTC members get maternity care coverage from Basic Health. For more information, see When You Are Pregnant.

To see a list of PCPs you can choose, including the PCP’s location, qualifications, languages spoken, and availability:

  • See your 2010 Community Health Plan Provider and Pharmacy Directory. (If you need a printed copy of the directory, please contact Customer Service at the number in this list.)
  • Visit the Provider Directory Search online, which is updated as provider and pharmacy lists change.
  • Contact the Community Health Plan customer service team at 1-800-440-1561
    (toll free). If you are hearing or speech impaired, please call TTY 1-866-816-2479 (toll free) or local 206-613-8875.

For information about a provider's professional qualifications—including medical school attended, residency completed, and board status—please contact the Community Health Plan customer service team at the number in the previous list.

Changing Your PCP

You can change your PCP by calling the Community Health Plan customer service
team at 1-800-440-1561 (toll free). If you are hearing or speech impaired, please call TTY 1-866-816-2479 (toll free) or local 206-613-8875.

The change will be for the first of the month after you tell us you want to change. For example, if you call in October, we will change your PCP in November.

When you change PCPs, referrals from your old PCP will not be good anymore and you will need to get a referral from your new PCP. Tell your new PCP that you have been seeing a specialist. Your new PCP will make sure you get a new referral to keep seeing that specialist.

When a PCP leaves the Community Health Plan network, we will notify you 30 days before that PCP leaves. You can then choose a different PCP.