Primary Care Physicians & their Relevance in Health Insurance

By Laxita Gautam
  | Published: 23 August 2021

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Do you recall rushing to the nearby clinic when you had a mild fever and other few symptoms of the flu? The doctors there who provide you with a primary level of health care are known as Primary Care Physicians or PCPs. Primary health physicians or providers hold significant importance in your general life and health insurance plans too. Hence, you must understand what’s the role of a primary health provider in terms of the kind of services they provide and the influence they have on your health insurance plan benefits. Let’s uncover the subject in detail.

What is a PCP or Primary Care Physician?

Simply put, a primary care provider is your first point of contact whenever you face health issues. There are several kinds of treatments and services that a primary care physician may provide depending on your health condition and symptoms. Many people refer to primary care physicians as general physicians and family doctors as well. A major part of their responsibilities is to provide preventive care for the patients in case of minor health discomfort and chronic illnesses. From vaccinating patients to prescribing medicines, running tests, and referring to specialists when required, a primary care physician takes care of almost everything related to the first point of action during an illness.

Types of Primary Care Physician

There are few different types of primary care providers classified based on who they treat. Most primary care physicians are specialized in a certain type of medicinal training. This means that several different specialists can be considered primary care providers depending on who they are treating. Following are the most common types of PCPs in the UAE:

  • Internal Medicine Doctor or MD: Also known as internists, internal medicine doctors or MDs are those doctors who have completed their medical school as well as three years of training in internal medicine. MDs receive extensive training about the internal organ system of the human body which is why they are referred to as internists as well. An MD is qualified to treat adults and senior citizens. However, they do not have any special training in treating infants.
  • Family Doctors: Any general physician can qualify for this particular category. Family doctors are usually well-trained to treat minor illnesses like viral fevers, colds, flu, rashes, gastronomical conditions, etc. A family doctor or general physician can treat everyone including kids, adults, and seniors.
  • Pediatrician: A pediatrician is a kids’ specialist. Even though pediatricians are specialists, they can still be considered primary care physicians for children.
  • Geriatrician: A geriatrician is a senior citizen specialist who addresses the unique needs of older people, generally over the age of 65. These specialists have training in managing health issues unique to senior citizens such as dementia.
  • Gynecologists: A gynecologist is a specialist for women’s reproductive health. Most women prefer to have a gynecologist to make sure they have immediate access to address every reproductive health issue.

Who Does Not Count as a Primary Care Physician?

Many doctors work with physician assistants and nurses. These medical professionals are not considered primary care physicians. A PCP can only be a full-fledged doctor who has completed medical school and the necessary training. Specialists are also not considered primary care physicians. Some examples can be dermatologists or cardiologists. You generally have to visit your general physician first and if the concerning illness does not seem to be getting better, they refer you to the required specialist. Most specialists only treat patients who have been referred. Some take general cases as well.

Relevance of PCP in Health Insurance Plans

Many health insurance plans require the plan holders to choose a primary care provider and list them in the plan. This is not the case for all health insurance plans and providers though. The requirement can differ as per the type of plan you opt for and the unique requirements set by your provider. This type of health insurance plan is also known as a PCP health insurance plan. You will find that the health insurance card of your PCP health insurance plan has a section dedicated to the primary care provider that you choose.

Health insurance plans are categorized in several ways. One of these ways is based on the kind of network they are offering. Restricted networks like HMO which are offered with essential benefits plans may not let you see a specialist covered by insurance unless referred to by the PCP doctor.

Why Should You Have a PCP?

Even if your health insurance plan in the UAE does not require you to choose a primary care doctor, you should still consider getting one. Finalizing a PCP doctor can be helpful in many other ways. If you have had a certain primary care doctor from the start, they will be able to keep track of your health and the conditions you may have developed along the way. A track of your health history and your family’s health history can help your doctor in suggesting ideal insurance options as well as providing better preventive care. If your family has shown signs of diabetes over many generations, your doctor can offer ideal suggestions on taking a critical health care plan. Hence, for insurance reasons or to simply make sure you get the best possible preventive care in time, it is a wise choice to have a PCP doctor for you and your family.

How to Choose Your Primary Care Physician?

  • Make a List of Your Needs: Figure out what you will need from your primary care doctor. Are there any young children in the family requiring special care, any older members, etc? Make a list of these things first and foremost.
  • Check the Network: See which hospitals, clinics, and doctors are listed in the in-patient network of your health insurance plan. Match the doctors that you have found with the ones on the list and finalize 3-4 options. The PCP doctor you choose must align with the type of health insurance plan that you have. For example, if it is a senior citizen cover, choose a good geriatrician.
  • Find the Clinics: Check the location of the clinics and hospital affiliations of these doctors. You may want to find a doctor who is affiliated with a hospital that you prefer.
  • Interview a Few PCPs: Interview your final options and see which one suits your requirements the most.

Can I Change my Registered PCP on Health Insurance Plan?

Yes, most insurance plans come with an option for the policyholders to change their chosen primary care doctors later when they like. You must confirm this with the provider though. Some providers will only allow you to change and choose a primary care physician from the network list of pre-approved doctors. So, make sure you are familiar with these small things before buying a PCP health insurance plan.

Conclusion

Primary care providers are essential for us in general as well as for our health insurance plans. So, it is a wise step to carefully choose your PCP doctor by taking your time and researching properly. Tally with your family members so that everyone’s needs are met. Finally, choose your PCP doctor as well as the PCP health insurance wisely after proper comparison.

Laxita Gautam
Laxita Gautam137 Posts

Senior Content Writer | She functions on classic British fiction, Japanese manga, and strong americanos. Laxita is tailor-made to create engaging, interactive pieces that offer simplified insights into complex subjects.