Thursday, February 21, 2013

Make the Commitment to Always Use a Primary Care Physician



By: 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.  Your 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 waived.  Currently there is 52 percent of District staff utilizing a PCP; this is an increase from 34 percent in 2011.  The District saved $444,568 in claim costs because members are using CHC’s referral service and utilizing PCPs.  The District stands to 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 www.SDJHealthPlan.com.

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