How to Choose a Primary Care Doctor in Your HMO Network
Seven tips to help you choose the right primary care doctor
Seven tips to help you choose the right primary care doctor
Key Takeaways
- Choose a PCP who participates in your HMO network.
- Check the medical group and specialist network.
- Consider location, availability and digital care options.
- Look for a doctor whose experience fits your health needs.
Choosing a primary care physician is an important part of managing your health, especially if you have a health maintenance organization (HMO) plan.
With most HMO plans, you select a primary care physician (PCP) from your plan’s network to serve as your main point of contact for care.
Your PCP provides preventive care, routine screenings and treatment for illnesses, and helps manage your ongoing health needs. Depending on your plan, they may also coordinate referrals to specialists.
“Primary care doctors are the quarterback of your healthcare team,” Siu Ming Geary, MD, an internal medicine physician and vice president of primary care at Scripps Clinic. “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.”
How HMO networks work
HMO plans use a network of doctors, medical groups, hospitals and other healthcare providers. Except for emergency care and certain other situations, out-of-network care generally is not covered.
HMOs often have lower costs than preferred provider organization (PPO) plans, but they typically offer less flexibility in choosing providers.
Depending on your plan, you may also need referrals or authorizations for certain specialists or services. That makes choosing the right primary care doctor and medical group especially important.
When you may need a new primary care doctor
Changes in your insurance, location or health needs may mean it’s time to choose a new primary care doctor.
Common reasons include:
- Moving to a new area
- Changing health plans or insurance networks
- Aging out of parent's health plan, usually at 26
- Learning that your current doctor is no longer in your HMO network
- Wanting a doctor who better fits your needs
If you need a new primary care doctor, the next step is to decide which type of primary care doctor best fits you.
1. Choose the right type of primary care doctor
Pediatricians care for children. Family medicine physicians care for people of all ages. Internal medicine physicians focus on adults.
Once you know which type of doctor you need, use your health plan’s provider directory to find options in your HMO network. Then confirm that the doctor you’re considering participates in your plan.
2. Make sure the doctor is in your network
Insurers may offer several plans with different provider networks, so check your plan’s directory or contact your health plan to verify coverage and whether the doctor is accepting new patients.
Scripps accepts many health plans, but participation can vary by plan, physician and medical group.
3. Consider the medical group and specialist network
Your primary care doctor may refer you to specialists and services within a specific medical group or network.
Before choosing a doctor, check which specialists, hospitals and other services are available through that network, especially if you already see a specialist or may need specialty care.
Choosing a primary care provider connected to the care you need can make referrals and follow-up easier to coordinate.
4. Learn about the doctor’s background and approach
Review the primary care doctor’s education, training, clinical interests, experience and languages spoken. Look for experience that matches your health needs, such as preventive care, chronic conditions, women’s health or sports medicine.
At Scripps, the Find a Doctor tool can help you compare primary care physicians by training, clinical interests, location, languages spoken and other details.
5. Check location, availability and office hours
Choose a doctor whose location and schedule make it easier to get care when you need it.
Consider:
- Distance from home or work
- Office hours
- Appointment availability
- Whether the doctor is accepting new patients
- Access to same-day or urgent care
Many Scripps primary care physicians offer extended hours, including early morning, evening and Saturday appointments.
6. Ask about online scheduling and digital care
Digital tools can make it easier to manage your care between visits. Look for options such as online scheduling, secure messaging and virtual visits.
At Scripps, the MyScripps patient portal lets you schedule appointments, view test results and message your care team. Scripps also offers scheduled Video Visits and same-day On-Demand Video Visits.
Ask which digital services are available and when you may need an in-person visit instead.
7. Choose a doctor you feel comfortable with
Because your PCP may be your main point of contact in an HMO, choose a primary care physician you feel comfortable seeing for ongoing care.
Personal preferences can matter too. You may prefer a male or female doctor, someone who speaks your preferred language, or a physician whose communication style makes you feel at ease.
Use your first visit to see if the doctor is a good fit. Look for someone who listens, explains things clearly, answers your questions and involves you in decisions about your care. You should feel respected and comfortable discussing your health.
Over time, a strong doctor-patient relationship can help your primary care doctor understand your health history and needs.
“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 can be an even greater impact from our lifestyle and health recommendations.”