7 Tips for Picking a Primary Care Doctor in an HMO Plan
Primary care physician coordinates all your care in an HMO
Primary care physician coordinates all your care in an HMO
Choosing a primary care physician is one of the most important health decisions you can make — especially if you have a Health Maintenance Organization (HMO) health insurance plan.
HMO plans require you to choose a primary care physician (PCP) from within your plan’s network. This doctor can be a family medicine doctor, internal medicine physician or pediatrician.
Your PCP is your primary point of contact for health-related issues, including preventive care, routine screenings and treatment for illnesses. They coordinate your care and provide referrals to specialists when needed.
“Primary care doctors are the quarterback of your health care team,” says Scripps Clinic vice president of primary care and internist Siu Ming Geary, MD. “If you develop a serious condition that might require specialists, your primary care doctor can ensure that all appropriate care is given and there are no gaps.”
Good communication is essential. Your relationship with your primary care doctor often lasts for years.
“We form relationships with patients over many years, so we know their health history,” Dr. Geary says. “We can take care of them physically, and also mentally. And if a physician takes care of multiple family members, there’s an even greater impact from our lifestyle and health recommendations.”
What to know about HMO insurance
HMO health insurance plans usually have:
- Lower monthly premiums – the set amount you pay each month to keep your coverage active
- Lower out-of-pocket costs compared to Preferred Provider Organization (PPO) health plan, another popular health insurance plan
- Limited networks – care is only covered when you see in-network doctors, except in emergencies
While HMOs save money, they offer less flexibility than PPOs, which allow you to see out-of-network doctors and specialists without referrals.
When you might need a new primary care doctor
You may need a new primary care doctor if you:
- Move to a new area
- Changed jobs or insurance providers
- Turn 26 and leave your parents' health plan
- Want a doctor whose approach better matches your health needs
Seven things to consider when choosing a primary care doctor
1. Determine what kind of doctor you need
Pediatricians treat children; family physicians treat people of all ages and internal medicine physicians care for adults.
2. Research the doctor’s background and training
It’s important to pick a doctor whose education and interests fit your needs.
Most insurance company websites include a “find a doctor” tool to help you locate in-network providers.
At Scripps, you can use our Find a Doctor feature to find the right primary care provider for you. There, you can check their education, training, languages and more.
3. Understand the doctor’s care philosophy
Different doctors have different ways to treat patients. Some doctors use research-based methods that focus on one body part or condition. Others prefer a holistic approach that combines eastern and western ideas.
At Scripps, you’ll find a diverse range of doctors and care philosophies that can fit your lifestyle.
4. Make sure the doctor accepts your health insurance
If you find a doctor you are interested in seeing, make sure they take your insurance. You can either contact the doctor’s office directly or use your insurance company’s website search tool. Scripps accepts most health plans.
5. Check the location and office hours
For many, it’s easier to have a doctor who’s close to home or work. In addition to location, make sure the office hours work with your schedule. Most Scripps primary care physicians have extended hours for convenience, including early morning, evening and Saturday appointments.
Also, check whether the doctor is currently accepting new patients — this information is often available on the provider’s profile or your insurance website.
6. Ask about communication and virtual care options
Virtual care, including video visits, provides convenience and easy access to get non-emergency medical help. You can use virtual care for follow-up appointments, prescription refills and minor health problems. Ask your primary care doctor if they offer this service and how easy it is to use.
7. Choose a doctor you feel comfortable with
Beyond the basics, pick a doctor who makes you feel at ease and with whom you are able to discuss your medical concerns openly. You may prefer a male or female doctor, a doctor that speaks a different language, or even a doctor that shares the same interests as you.
How to prepare for first doctor visit
Before the first appointment with your new doctor:
- Contact to confirm your records have been received
- Bring a list of current medications and supplements
- Arrive early to complete paperwork
- Be ready to share your personal and family medical history
A little preparation will help your new doctor understand your health and start building a relationship right away.