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When you sign up for an HMO, your first step is to pick a Medical Group. Then you will choose a primary care physician (PCP) in that group to manage your care. You may already have a PCP, such as your family doctor. A child’s pediatrician and a woman’s principal health care provider can also act as their PCP.
Your PCP will make sure you get the care you need, even when you see another doctor or go to the hospital. When you have a health issue, you’ll first go to your PCP. If the PCP thinks you need to see a specialist, they’ll arrange it for you by getting a referral.
The PCP will:
Three quick things you’ll want to make sure happen:
It’s your right to ask questions to make sure your doctors are using your HMO the right way. If you don’t have a referral or if you have tests that aren’t a covered benefit, your HMO may not cover the costs for you.
If you are getting ongoing treatment for a health issue, your PCP will put in a request for a standing referral. That way you can see your specialist as often as needed without having to request a new referral approval for each visit.
You can get more information about your HMO health plan at any time. Just log in or register for your member account, Blue Access for MembersSM. Visit the My Coverage tab to verify your coverage and identify your medical group and PCP.
Originally published February 17, 2015, Revised 2020
Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association
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