Your Primary Care Practitioner (PCP)

When you join AmeriHealth Mercy Health Plan, you choose a Primary Care Practitioner (PCP). Your PCP oversees your health care. He or she is responsible for taking care of your health and, when necessary, arranging care for you from other health care providers. This is called “coordination of care.” Coordination of care by your PCP helps to make sure you are getting the type of care you need.

You can choose the same PCP for the entire family or you can have a different PCP for each family member. There are different kinds of practitioners who can be PCPs, including:

• Family Practice and General Practice doctors, who treat adults and children,
• Internal Medicine doctors or Internists, who treat members older than the age of 18,
• Pediatricians, who treat children from birth to age 21, or
• Some Certified Registered Nurse Practitioners (CRNPs).

If you also have Medicare coverage, you have the right to seek Medicare-covered services from the Medicare provider of your choice.

For questions about changing your PCP, see the section “Changing Your PCP” on page 9 of the Member Handbook.

In some cases, members with a life-threatening, degenerative, or disabling disease or condition, or members with other special needs, may be able to choose a specialist as a PCP. For more information call Member Services.

Some PCPs work with trained health care assistants. The types of assistants that may help your PCP are:

• Physician Assistants
• Medical Residents
• Nurse Practitioners
• Nurse Midwives

Your PCP can help you and your family stay healthy.  By having regular visits with your PCP, he or she will be able to:

• Learn your health history and keep your health records
• Provide regular care
• Answer questions about your health
• Get you information about healthy eating and diet
• Get you the shots and screenings you need
• Arrange other types of health care for you, if needed
• Refer you to a specialist, if needed
• Find problems before they become serious
• Serve as a patient advocate
• Provide Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services for members younger than 21 years of age
• Provide preventive treatment for conditions, like:
  • Diabetes
• High Blood Pressure
• Asthma
• Allergies

When you become an AmeriHealth Mercy member, it is important to make an appointment with your PCP right away.  If this PCP is new for you, call your old PCP and ask that your medical records be sent to your new PCP.  It is important for your new PCP to know your medical history.

You should also see your PCP for regular check-ups for preventive care.  AmeriHealth Mercy covers regular check-ups.

Getting In Touch With Your PCP

Regular appointments with your PCP will help you and your family stay healthy.  You can call your PCP for medical problems 24 hours a day, 7 days a week.