Seen by a Resident Instead of Assigned PCP while on HMO – Will This Be an Issue?

Hi everyone, I have a question and would really appreciate some advice. I have a High Deductible Health Plan (HDHP) with an HMO from Blue Cross Blue Shield (BCBS), which I got through healthcare.gov. I'm generally healthy and haven't needed much medical attention over the past few years.

However, a couple of months ago, I finally had some time to schedule a regular wellness check-up. When I checked my insurance website, I noticed they had already assigned me a Primary Care Physician (PCP) at a specific location (let's call them Dr. S). I scheduled an appointment there and made sure to tell the front desk that my insurance had assigned me to Dr. S. The front desk assured me that everything was fine.

On the day of my visit, I realized that the doctor I saw was not Dr. S. Instead, I was seen by a different doctor (let's call them Dr. A), who turned out to be a resident at the clinic. Since Dr. A is a resident, they are technically not in my network.

For context, Dr. A was nice, and I didn’t have any major medical concerns. The appointment involved some vaccine updates, basic blood work, and wellness lab tests—all of which are generally covered under my insurance as preventive care.

Now, I have two main questions:

Not Seeing My Assigned PCP: I never actually saw Dr. S, my assigned PCP. Could this be a problem with my insurance? Has anyone else had a similar experience? If it does become an issue, is it possible to ask the clinic to file the claim under Dr. S’s name, indicating that Dr. A was under their supervision, so the insurance will cover it?

Referral from the Resident (Dr. A): During my appointment, I mentioned to Dr. A that I had recently visited an optometrist who suggested I get my retina checked by an ophthalmologist, just to be safe. Dr. A promptly gave me a referral to see an ophthalmologist of my choice. However, the referral is in Dr. A's name, not Dr. S's, who is technically my PCP from the insurance company’s perspective. Should I still use Dr. A's referral to schedule an appointment with the ophthalmologist, or could this cause issues with my insurance coverage?

I'm starting to feel a bit anxious because I haven't seen any claims appear on my insurance portal yet (I know it can take several months, but still). I really don't want to receive a surprise bill in the mail and have to fight with the insurance company or the clinic over this. I had a similar experience with a simple dental cleaning once, and I really hated it.

Any advice or similar experiences would be greatly appreciated! Thanks in advance!

submitted by /u/Former_Copy_3074
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