Thursday, June 28, 2012

What Does Using a Primary Care Physician Mean for Me?

Guest Blogger: Tonya Williams, Employee Relations Specialist
School District of Janesville


There is no better time than now to begin a relationship with a Primary Care Physician (PCP)!  A PCP can be a family physician, a general practitioner, or an internal medicine doctor.  Your children may have a pediatrician as a PCP, and while she is pregnant, a woman may have her OB/GYN as her PCP.  All members in your family do not need to have the same PCP. 

Under the District’s Coordinated Health Care Plan (CHC), you will have your deductible waived, and your office visit covered at 85 percent when you use a PCP.  If you go to a specialist without a referral, you will pay $100 for your deductible and 80 percent for your office visit.  If you use the referral process, your office visits continue to be covered at 85% and your deductible is waived.  Currently there is only 27 percent of District staff utilizing a PCP compared to the CHC norm of 48 percent.  As of November 1, 2011, the District saved $529,257 in claim costs by staff using CHC’s referral service and utilizing PCPs.  The School District of Janesville will save even more if we can increase our PCP utilization and decrease specialist usage, so begin a relationship with a PCP today!

*Actual claims from my family to illustrate the savings I experience by using a PCP, and even a nurse practitioner, versus a specialist.

Provider
Claim Cost
Network Savings
Deductible Paid
Paid %
Patient Responsibility
Nurse Practitioner
$85.70
$23.36
Waived
85%
$9.35
PCP
$179.50
$39.23
Waived
85%
$21.04
Specialist
$255.60
$18.43
$100
80%
$147.43 (Inc. Ded.)


If you would like assistance in finding a PCP, please contact CHC at 1-877-550-3455 or go to http://www.sdjhealthplan.com/.

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