Patient First as Primary Care Physician

Our Responsibility as a Primary Care Physician

Patient First provides a full range of preventive, primary, and urgent care services. When specialty care is required we refer patients to outside physicians in the appropriate specialty. We do not serve as a primary care physician for patients under the age of seven. The special needs of patients in this age group are better met by pediatricians, whenever available.

Health Benefits Plan Guidelines

Each managed care plan has its own rules and regulations for both physicians and patients, but the following general guidelines apply when you choose Patient First as your Primary Care Provider:

Urgent Problems Regardless of which Patient First physician you select as your primary care physician, you may visit any Patient First physician at any Patient First center at any time for urgent problems.

Emergency Care If you feel you are experiencing a life-threatening emergency at any time of day or night, please go to the nearest hospital emergency room or dial 911. If you feel you need to visit a hospital emergency room for any other reason between 8 a.m. and 10 p.m., please speak in advance with a Patient First physician on duty at your center of record. Between 10 p.m. and 8 a.m., please contact the center for pre-recorded instructions on how to reach the after-hours, on-call Patient First physician to request an immediate emergency referral. The Patient First physician may authorize a referral or may advise you to be seen at Patient First promptly the next morning.

If you are seen at an emergency room for a non-life-threatening problem without having obtained a referral from your PCP in advance, your insurance plan may not pay for the visit. Most insurance plans do not allow retroactive referrals. Your insurance plan determines what it will reimburse.

Chronic Conditions If you have an ongoing medical condition, like high blood pressure or diabetes, you should try to see the same Patient First physician each time. To insure continuity of care, chronic conditions are best handled by a single physician. Feel free to call the center to determine your primary care physician's work schedule or check the schedule on line. Physician Schedules

Referrals In general, you must be evaluated by a Patient First physician for any problem before you will be referred to a specialist. Please consult your insurance plan for exceptions to this rule. If your Patient First physician refers you to a specialist, please call the Patient First Referral Center at (800) 370-8197 at least two weekdays prior to your appointment so that approval for your visit with the specialist can be obtained from your insurance company. If you do not have your visit approved in advance, your insurance plan may reduce the payment or may not pay for the specialty services.

Allergy injections and Vitamin B12 injections are routinely administered at Patient First. You may receive a referral for an initial evaluation for allergy testing at the allergist's office, but you will be expected to return to Patient First for routine injections.

Hospitalizations Patient First physicians practice in the office setting only. If you need hospital care, we will arrange for a specialist or hospitalist to care for you during your hospital stay. That physician will follow you and keep your Patient First PCP up-to-date on your progress. He or she will also send a written report to your PCP for your medical record.

Co-insurance Most managed care plans require that you be responsible for an out-of-pocket charge each time you visit your PCP for evaluation or treatment. Out-of-pocket charges vary with different policies and may change depending upon the circumstances of a visit: time of day, day of week, and visit type (medical or injury). These payments are your responsibility and are due at the time of service.

Please consult your individual insurance policy for a complete explanation of your out-of-pocket responsibilities.