PCP Directed Care
HMO and EPA Members
Sometimes you may need a medical service beyond what your PCP can offer in their office. When specialty services are medically necessary, your PCP will direct you to a specialist. If you are an HMO member and want to see a particular specialist, you must first contact your PCP. In most cases, your PCP will direct you to a specialist with the same hospital affiliation. However, your PCP can direct to any affiliated specialist in the open delivery system if his/her hospital affliation falls within the open delivery system. HMO members may not call a specialist and schedule an appointment on their own without prior contact with their PCP.
What is PCP directed care?
PCP directed care means that you and your PCP have discussed medically necessary services. Your PCP then directs you to the appropriate specialist for the delivery of a defined specialty service or consultation that is a covered benefit for you.
Many physicians are participating in a "paperless" system when directing specialty care. This means you will not have a physical piece of paper to take to the specialist. Don't worry! As long as you have started the process with your PCP, all the information regarding specialty services has been put through proper channels.
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