Being a member of the Physician Choice PPO plan means you have the best of both worlds: access to a large network of doctors and hospitals and choices to lower cost for care. With Physician Choice PPO, your primary care doctor will coordinate your care through an Organized Systems of Care (OSC), which are communities of doctors, specialists and hospitals that work together to provide customized, coordinated care that’s right for each patient.
Once you’re enrolled in the plan, electing a primary care doctor in a Level 1 OSC is not required, but recommended for the lowest costs in the plan. Then you should get to know the name of your OSC. To make sure you and your doctor are on the same page, make a point to bring up these three questions during your first visit:
- What specialists are in your OSC? The most cost-effective way to get care is to see doctors who are in the same OSC as your primary care doctor. The group will likely include all of the specialists you would normally see, like allergists, dermatologists, cardiologists and more.
- Where should I go if I need urgent care? Each primary care doctor has designated hospitals within his or her OSC. Find out which ones are in their OSC so that you know where to go if something happens. Keep in mind that you don’t always need to go to an emergency room, so find out if there are urgent care centers in the OSC that you can go to outside of normal office hours.
- What is the process for getting a referral? While you automatically pay the lowest costs if you see a specialist in your primary care doctor’s Level 1 OSC, you aren’t limited. If you want to see a specialist that’s within the PPO network but outside of your primary care doctor’s OSC, you can keep your costs at Level 1 if you get a referral from your primary care doctor. Every doctor has a slightly different process for getting a referral, so find out what you’ll need to do. You can also see other doctors in the PPO network but outside your primary care doctor’s OSC without a referral, but you would be subject to the higher Level 2 cost share.
To learn more about Physician Choice PPO, head here. For more on finding a primary care doctor and improving your patient-doctor relationship, check out these other posts: