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MAMSI > Government
Employees > Federal Employees
What is a Primary Care Physician (PCP)?
A PCP is your "family doctor" and coordinates
all your medical care (except 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 your medical care must be coordinated
or arranged by your PCP. If you have any questions about your health,
call your PCP.
How do I choose a PCP?
First, look in our directory to find the physicians
conveniently located and available to you. You may call the PCP
directly to find out information about his or her practice. Once
youšve identified the physician you would like to have as your PCP,
call our Member Services Department 24 hours a day, seven days a
week at the phone number listed on your health plan identification
card to make your selection. You may select a different PCP for
each person in your family.
It is important to establish a relationship
with your PCP. We recommend that if your PCP is new to you, you
schedule an appointment so that your PCP 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 Member Services
24 hours a day, seven days a week at the phone number listed on
your health plan identification card or by submitting a PCP Change
Form. If our Member Services Department receives 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 identification
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, contact
Member Services and request a Dependent Authorization Form. Please
remember to check your health plan identification card to confirm
your selected PCP. You cannot change your PCP while you are
in the hospital.
Am I covered for emergency care when I am
traveling out of the area?
If you have a medical emergency or urgent care
situation while traveling outside the HMO'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 your HMO. 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 your
HMO. Whenever possible, you should attempt to notify your PCP prior
to receiving services to ensure coverage.
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