Your doctor/primary care practitioner (PCP)
When you join Keystone First, you choose a primary care practitioner (PCP). Think of this as your medical home.
Your PCP is your family doctor, or the doctor you regularly see. This is your medical home. Your PCP takes care of your health care and will help you get care from other health care providers when needed. This is called “coordination of care.” Coordination of care makes sure you get the care you need when you need it. This is why having a medical home is so important.
You can choose the same PCP for your whole family or you can have a different PCP for each family member. There are different kinds of practitioners who can be PCPs, including:
- Family practice and general doctors, who treat adults and children
- Internal medicine doctors or internists, who treat members older than the age of 18
- Pediatricians, who treat children from birth to age 21
- Certified registered nurse practitioners (nurse practitioners). Under the guidance of a doctor, the nurse practitioner can be your PCP.
Nurse practitioners are allowed to do many of the same things that a doctor is able to do. Nurse practitioners work with a doctor to manage your care.
Some PCPs have trained health care assistants that you may see during an appointment, such as:
- Physician assistants
- Medical residents
- Nurse practitioners
- Nurse midwives
If you also have Medicare coverage, you have the right to seek Medicare-covered services from the Medicare provider of your choice.
For questions about changing your PCP, call us at 1-800-521-6860.
In some cases, if you have a life-threatening, degenerative or disabling disease or condition, or if you have other special needs, you may be able to choose a specialist as your PCP. For more information, please call Member Services.
As your medical home, your PCP will help you stay healthy. Your doctor/PCP is the first place to call with questions about your health.
By having regular visits with your PCP, he or she will be able to:
- Learn your health history and keep your records up-to-date
- Answer questions about your health
- Give you information about healthy eating and diet
- Give you the shots and screenings you need
- Help you get care from other providers, if needed. See referrals for more information.
- Find problems before they become serious
- Be a patient advocate
- Provide Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services for members younger than 21 years of age. See care for your children for more information.
- Provide preventive treatment for conditions like: diabetes, high blood pressure, asthma and allergies
PCP office visits
Keystone First covers your visits to PCPs in our network. There is no limit to how many times you can visit your PCP.
Routine care appointments
Routine care is when you need to see your PCP, but it is not urgent or an emergency. Call your PCP to make appointments for routine care. Your PCP must schedule an appointment for you within 10 business days of your call for routine care.
Getting in touch with your PCP
You can call your PCP for medical problems 24 hours a day, 7 days a week. It is important to be on time for your appointment. If you are going to be late or need to cancel your appointment, call the PCP’s office ahead of time and let the office know. Try to give the PCP’s office at least 24 hours' notice if you need to change your appointment or you may be charged for the appointment.
To stay healthy, you should get checkups on a regular basis. Your PCP must schedule your first check-up appointment within 3 weeks of your enrollment. All other check-ups must be scheduled within 3 weeks of when you call to make an appointment for a check-up. When you have regular check-ups, it helps make your PCP your medical home.
Care after hours or when your doctor’s office is closed
There are several options for when your doctor’s office is closed.
- Call your PCP’s office. You will get the office’s answering service. Leave your name and telephone number. Someone will call you back.
- Call our toll-free Nurse Call Line 24 hours a day, seven 7 days a week, at 1-866-431-1514. Nurses will help you decide whether you need to see a doctor right away.
- Visit an urgent care center, if one is near you. They can help with issues that are not emergencies. The urgent care center does NOT take the place of your PCP. Urgent care centers treat a problem that needs attention right away but is not an emergency. Urgent care centers should be used only when your PCP is not available.
- If it is a true emergency, call 911 or go directly to the emergency room.
Finding a doctor
You can find a doctor close to your home. Go to Find a Provider. Our real-time provider directory is easy to use. You can search for a health care provider or hospital by entering:
- Provider’s name
- Hospital’s name
- Zip code
- Extended office hours
- Languages spoken
You can also print out the results and get driving directions. The provider directory can help you find the provider's:
- Hospital affiliation (hospital the doctor uses)
- Medical group affiliations (other doctors in the doctor’s practice)
- Languages spoken by the provider
- Language services available at the practice site
- Office locations
- Board certification
- If the provider is taking new patients
The provider directory can help you find a hospital’s location and accreditation.
Call Member Services if you need assistance in finding a doctor. We can help you find a provider or send you printed copies of the Keystone First provider and specialist directories. Also, call if you would like to know where a provider went to medical school or where the provider’s residency was completed.