What is a Primary Care Provider (PCP)? A primary care provider (PCP) is your family’s doctor or health professional. Your PCP works with you to keep your family healthy. A PCP will provide all your family’s basic health care, including:
- Wellness check-ups and preventive services such as immunizations (shots), hearing tests, and laboratory tests
- Care when you are sick or injured
- Help with ongoing health problems like asthma, allergies, or diabetes
Also, the PCP will send (refer) you to a specialist and arrange for hospital care if it is needed.
When you think you need medical care, call your PCP first, unless it is an emergency. The PCP will advise you on what to do. Your PCP is available 24 hours a day, 7 days a week. If you need care, your PCP will provide treatment or refer you to a specialist or arrange for hospitalization. Your PCP’s phone number is on your member ID card.
What kind of doctor can be a PCP?
Your PCP can be in:
- Pediatrics: health care for children
- General Practice: health care for the whole family
- Family Practice: health care for the whole family
- Internal Medicine: health care for adults
- Obstetrics/Gynecology (OB/GYN): health care for women and pregnant women
Nurse practitioners, certified nurse midwives, and physician assistants are also available as Primary Care Providers, as long as they practice with an SFHP physician.
Where do PCPs work?
Your PCP may work in a:
- Private office
- Health center
- Hospital clinic
- Federally qualified health center
- Native American Health Service Facility (Indian Clinic)
Your PCP’s Medical Group: Every PCP and clinic in SFHP is part of a medical group. A medical group is made up of many doctors and other health professionals who work together. Each medical group works with a particular hospital.
When you choose a PCP, you are also choosing the specialists in the PCP’s medical group and the hospital they work with. Your PCP will refer you to those specialists for most specialty care. If you have to go to the hospital, you will go to the hospital that works with the PCP’s medical group. Your PCP will obtain the necessary prior authorizations for specialty care that you need. If you go to a specialist without a prior authorization from your PCP, it may not be covered by SFHP. Refer to page 30 of the Evidence of Coverage section for a thorough description of the prior authorization process. If you prefer a particular specialist or hospital, make sure your PCP and their medical group works with those providers.
Choosing Your PCP: Every member has a Primary Care Provider (PCP). You may have already chosen a PCP for yourself when you joined SFHP. If not, follow these instructions or call Customer Service for help at 1(415) 547-7800 or 1(800) 288-5555. Here are some things you may want to think about when choosing a PCP:
- Is the PCP close to home, school, or work?
- Is it easy to get to the PCP by MUNI, bus or BART?
- Does the office staff speak your language?
- Does the PCP work with a hospital that you like?
- Does the PCP see children of all ages?
Call us at 1(415) 547-7800 or 1(800) 288-5555 and tell us which PCP you would like to choose. If you have more than one child, you may choose a different PCP for each child. We will send you a member ID card that includes the PCP’s name and phone number. SFHP wants you to have a PCP who is right for you and your family. If you do not choose a PCP, SFHP will choose a PCP for you.