Why is my new plan making me select a primary care provider?
Hello,
Me, my wife, and daughter have been on my wife's health plan (obtained via her company) for a few years now. It was an HDHP with Cigna that we have used so we can max out an HSA each year. We have only ever hit the plan's deductible once (the year my wife delivered our daughter), so in every other year we have paid 100% of the cost of medical care (after negotiated plan discounts). There was differing theoretical coverage (after hitting the deductible) for in-network vs out-of-network providers, but as we were never hitting the deductible (either for in-network or for out-of-network), for us that was never really relevant. Nonetheless, almost every provider we used was in-network.
My wife is no longer working for the company, so we are switching over to a health plan offered by my company. My company offers multiple plans, and the plan I would like to go with is (again) the high-deductible option that makes me eligible to have an HSA.
I am noticing that my company's plan (with Empire Blue Cross) is an EPO (while my wife's was a PPO). One thing I am noticing is that while my wife's plan had limited/lower coverage on out-of-network healthcare, this plan with my company has no coverage on out-of-network (other than in an emergencies). This doesn't present an issue for us, since we've always essentially paid for 100% of care. And I fell pretty fluent in what in-network and out-of-network care means, so that if we ever had a large medical expense we could find an in-network provider.
But… for some reason when trying to my company's plan would require that I select a Primary Care Provider, and I don't understand why. As in: why is this information is needed? and how/if it will impact my plan's coverage?
I figured I would simply see a provider and either it's in-network (and therefore covered) our out-of-network (and therefore not covered). Is a primary care provider some new variable I need to consider? As in… seeing my in-network primary care provider is covered but seeing another in-network-provider who is not my primary care provider is not covered?
Or is the plan simply "trying to be helpful" by helping you ensure that the care provider you plan on using is in-network?
And we primarily use One Medical for everything (and other providers that they refer us out to). How would I go about getting a PCP ID for that?
submitted by /u/beefninja
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