Question 1: How do I choose a primary care doctor for my child?
Answer: It is recommended that you choose a pediatrician as your child's primary care doctor. A pediatrician has years of training and experience in children's health care. If your pediatrician is not in the plan, you can ask the plan to include him or her. If you go to a pediatrician who is not in the plan, your plan may not fully or even partially pay for your care. Ask your pediatrician which plans he or she is in and try to join one of those plans. Before choosing a plan, you also should think about the hospitals to which your pediatrician is able to admit patients and pediatric medical subspecialists and/or pediatric surgical specialists to whom he or she refers. If you don't have a pediatrician, ask your managed care plan for a current list of pediatricians whose practices are open to new patients.
Question 2: What is my pediatrician's role in managed care?
Answer: A pediatrician provides primary care for newborns, infants, children, adolescents and young adults through age 21. As a primary care doctor, he or she provides preventive care, takes care of illnesses and injuries, and diagnoses and treats acute and chronic disorders. A pediatrician makes referrals to pediatric medical subspecialists and/or pediatric surgical specialists when needed and coordinates other services for the total care of your child. Your plan may require that your pediatrician serve as a "gatekeeper" to authorize or approve certain services. Without these approvals, you may have to pay for part or all of these services yourself.
Question 3: What if I want to change doctors?
Answer: Finding a pediatrician who meets your family's needs is important. It is also best to stay with that pediatrician once you have made your choice. However, situations change and you may need to choose a new pediatrician. All plans allow you to choose another doctor from those participating in the plan. Check with your plan to get information on how to do this. You must let your plan know if you change your pediatrician. Some plans only allow you to change doctors during a specific period of time.
Question 4: How is primary care covered?
Answer: Managed care plans usually pay for primary and preventive care visits, including well child checkups, immunizations, and care for illnesses or injuries. Many plans require families to pay a share of their primary care services, such as $5 to $20 for each visit to the doctor. Remember to bring your insurance card with you to each visit.
This information should not be used as a substitute for the information found in your own health insurance plan contract
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