PPO primary care physician FAQs

A primary care physician (PCP) is the doctor that you consider your go-to doctor when you need medical care. PCPs can be internal medicine doctors, family practice doctors, general practice doctors, or pediatricians. Each enrolled family member can have his or her own PCP.

Primary care physicians manage preventive care, treat common illnesses and injuries, and can help you determine if you need more specialized care. As a PPO (Preferred Provider Organization) member, you are not required to visit your PCP or consult with your PCP before receiving care. You can also visit any doctor without a referral from your PCP. Although you can see any doctor that you want, you will save money when you choose providers in your plan’s network.

Having a PCP means you have a doctor you can turn to for healthcare advice—whether it’s providing preventive care, treating common illnesses and injuries, or determining if you need more specialized care. You have the flexibility to see any doctor that you want and do not need a referral from your PCP to see a specialist, but you will save money when you choose providers in your plan’s network.

We matched you with a general practitioner, family practitioner, internist, or pediatrician for you and your dependents from the Exclusive PPO Network based on factors as location, age, and primary language.

You can view your PCP in your member account at blueshieldca.com when your plan is effective. Although you are not required to see your PCP, it’s always good to build a relationship with one who can manage your overall health care. Your PCP can also help you determine if you need more specialized care.

If you haven’t had a physical or annual exam in the last 12 months, now would be a good time to schedule one with your PCP. 

When evaluating a PCP, you should consider:

• Your satisfaction and comfort with the doctor that you see today
  Are you pleased with the care that you receive, or would you be more comfortable with a different doctor for your overall care?
   
• The doctor’s network
  With a PPO plan, you can visit any PCP that you want, regardless of network, but you will save money if you see one that participates in Blue Shield’s Exclusive PPO Network. For example, some services such as preventive health services are not covered unless provided by a network doctor. For services received from a non-network doctor, you would be responsible for all billed charges. Please review your Evidence of Coverage for full details about covered services.
  
  To find doctors in your plan’s network, log in to blueshieldca.com and use our Find a Doctor tool or see below for step-by-step instructions.
   
• The type of doctor you need
  PCPs can be internal medicine doctors, family practice doctors, general practice doctors or pediatricians.
  • ​Internal medicine doctors typically treat patients 18 and older and specialize in the prevention, diagnosis and management of disease and chronic conditions.
  • Family practice doctors see patients of all ages. They treat a wide variety of conditions and can often treat sports injuries and provide women’s health needs.
  • General practice doctors are like family practice doctors and can treat patients of any gender or age.
  • Pediatricians typically treat patients under 18.
     
• Is your selected doctor accepting new patients? 
  If this is the first time you’re seeing this provider, please remember to call the provider’s office to ensure that they are accepting new patients. 
   
• Other criteria that may be important to you
  • Location
  • Gender preference
  • Language preference
  • Bedside manner
  • Specialty
  • Education
  • Hospital affiliations
  • Reviews or recommendations from someone you know and trust

If you prefer to see another doctor, you can change your PCP online when your plan is effective. If this is the first time you’re seeing this doctor, make sure the PCP is accepting new patients. Here are the instructions:

1. Log in to your account at blueshieldca.com.
2. On the Dashboard, click Manage Health Team under "Primary care physician." Or go to your profile by clicking Edit Profile in the Popular tasks navigation menu.
3. On the My Profile page, you’ll see your PCP. Select Change PCP.
4. On the Change primary care physician page, select the members for whom you want to make a change and click Continue. (For families, you can assign one PCP at a time for each member.) This takes you to the Choose a primary care physician page.
5. Select a specialty and click Search. The tool will display available physicians who meet your search criteria and who participate in the Exclusive PPO Network†. Click on a physician’s address to see details about that doctor.
6. On the details page for the doctor you want, click Make PCP.
7. Once you select a PCP, a pop-up window will appear. Verify the information and then click Confirm and Continue.
8. A confirmation page will appear showing your change
   
   You will receive a confirmation email with your new PCP information. Your new PCP update is effective immediately.

You can see if a doctor is in our network by logging in at blueshieldca.com and using our Find a Doctor tool.

1. Under "What are you looking for?," select Doctors to search by name.
2. On the Search Doctors screen, click the radio button next to “Doctor name,” then enter the last name of the PCP you like in the search bar.
3. Click the search button. This will display a list of doctors that meet your search criteria.

You can also view the Exclusive PPO Network.

The Find a Doctor tool and your online member account will only display PCPs that participate in your plan’s network. If your preferred PCP is not in the search results list for your plan, that may mean your preferred PCP does not participate in the Exclusive PPO Network.

You can continue to see your preferred PCP and leave your online member account unchanged; however, seeing physicians outside of your plan’s network may increase your out-of-pocket expenses significantly. Be sure to review your Evidence of Coverage to understand what’s covered when receiving care from providers outside of your plan’s network.

Your PCP will not be listed on your ID card, but you can view your new PCP in your member account at blueshieldca.com when your plan is effective.

You will not receive a new ID card because your PCP is not listed on your card. You can view your new PCP in your online member account.

You can change your PCP online anytime, up to once per day.