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MAMSI
> Government Employees > District of Columbia
Employees
What is a Primary Care Physician (PCP)?
A PCP is your "family doctor" and coordinates all your medical
care, except for emergencies. Your PCP will guide you through tests and treatments.
If you need to see a specialist or receive specialty services, your PCP will refer you
to the appropriate physician or facility. A PCP may be trained in internal medicine,
pediatrics, family practice or, in some cases, obstetrics and gynecology. PCPs must
be available to you 24 hours a day, seven days a week by telephone or make arrangements
for another physician to be available.
All of your medical care must be coordinated and arranged by your PCP.
If you have any questions about your health, call your PCP.
How do I choose a PCP?
If you have not already selected a PCP, you are encouraged to do so.
You may access our online Directory of Health Care Professionals
to locate a physician near
your home or work. You may call the PCP directly to find out information about his or her
practice. Once you’ve identified the physician you would like to have as your PCP, call our
Member Services Department at the telephone number listed on your health plan identification
(ID) card or register and log on to eMAMSI, our suite of online services, to make your
selection. You may select a different PCP for each member of your family.
If you wish to receive a printed copy of our Directory of Health Care
Professionals, contact the Member Services Department.
It is important to establish a relationship with your PCP. We recommend
that if your PCP is new to you, you should schedule and appointment so that he or she may
become acquainted with you, your individual health care needs and your medical history.
What if I want to change my PCP?
You may change your PCP by calling the Member Services Department at the
telephone number listed on your health plan ID card or by submitting a PCP Change Form.
You may also log on to eMAMSI at any time to make your choice.
If we receive your PCP change information on or before the 20th of
the month, you can start using your new PCP at the beginning of the next month. A new
health plan ID card will be issued to you with the name of your new PCP.
If you change your PCP and have a referral to a specialist, you must request a referral
from your new PCP.
In general, only a subscriber can make these changes. To authorize another
family member to make changes, you may contact Member Services and request a Dependent
Authorization Form. Please remember to check your health plan ID card to confirm your selected
PCP. Please note, you cannot change your PCP while you are admitted in a hospital.
Am I covered for emergency care when I am traveling out-of-town?
If you have a medical emergency or urgent care situation while traveling outside M.D.
IPA's service area, you are covered if you comply with the following procedures.
An "urgent care situation" is an unforeseen illness or injury that
requires timely medical care to prevent health deterioration, as determined by M.D. IPA.
If such a medical need arises, you should seek care from a local doctor. Should this prove
difficult, you may then seek care from a hospital emergency room.
Follow-up care is expected to be rendered by your PCP, but will continue
to be covered out-of-area when it is not reasonable to return to the service area, as determined
by M.D. IPA. Whenever possible, you should attempt to notify your PCP prior to receiving
services to ensure coverage.
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