Your medical home
As a plan member, you get to pick a primary care physician (PCP) to give you the care you need or suggest you see another doctor. Your PCP is your medical home.
Your primary source for healthcare
As your medical home, your PCP will:
- Be your primary source for healthcare
- Get prior authorization (when required) from us for services you may need
- Help manage any health condition(s) you have
- Help you be as healthy as possible
- Refer you to a specialist if needed
Having a medical home is important because your PCP:
- Gets to know you and your healthcare needs well
- Makes sure you understand your healthcare needs and how to get and take medicine (if needed)
- Works with your other healthcare providers—such as specialists, behavioral health providers, and hospitals—to coordinate your care
Picking a medical home
Your PCP can be one of the following types of healthcare providers:
- Family doctor
- Federally qualified health center or rural health center
- General practitioner
- Internist
- Specialist (in some cases)
- Women’s healthcare provider or OB-GYN
- Can be a doctor, nurse practitioner, or other provider who specializes in obstetrics, gynecology, or family practice
- Female members can see a women’s healthcare provider as needed and without a referral
Members who identify as American Indian/Alaska Native may choose to see providers who are designated as Indian healthcare providers. For help finding an Indian healthcare provider, call Customer Care at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time.
You can pick a PCP from our network of doctors. Use our , opens new window to find doctors in our network who can serve as your medical home. Once you pick a PCP, call Customer Care at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time, and let us know.
Changing your medical home
You may pick a new PCP at any time during the year, for any reason. To change your PCP, call Customer Care at 800-787-3311 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Central time. You must pick a PCP who is in our network.
Your PCP also may leave our plan’s network. We will:
- Let you know if your PCP leaves our network
- Help you pick a new PCP
- Assign you a PCP if you do not pick one
As possible, we will notify you by mail within 45 days of your PCP’s last day in our network.
For more information about medical homes and PCPs, refer to your Member Handbook.