Trio HMO primary care physician FAQs | Blue Shield of CA (2024)

A primary care physician (PCP), also known as a Personal Physician, coordinates care and is the doctor that you consider your go-to doctor when you need medical care. PCPs can be internal medicine doctors, family practice doctors, general practice doctors or pediatricians. Each enrolled family member can have his or her own PCP.

A PCP in a Health Maintenance Organization (HMO) plan is your first point of contact for your health care. Your PCP coordinates your care and shares critical information with other providers such as specialists. As an HMO member, you need a referral from your PCP to visit any other care providers.

Your PCP is your first point of contact for health care and manages your common illnesses and injuries. You must get a referral from your PCP to see a specialist and to have your services covered. You will, however, always be covered for emergency medical care.

We selected either a general practitioner, family practitioner, internist, or pediatrician for you and your dependents based on such factors as location, primary language, and age.

If you want to change your PCP, you can see if a PCP is in our Trio HMO network by logging in at blueshieldca.com and using ourFind a Doctortool.

1. Under "What are you looking for?," selectPrimary Care Physician.
2. Enter the city, state, or ZIP code for the location of your doctor's office, then clickContinue.
3. On the Search Doctors screen, select a specialty.
4. Click theSearchbutton.

You can also view theTrio HMO network. You will also be able to see the PCP's medical group.

If this is the first time you’re seeing this doctor, make sure the PCP is accepting new patients. You can change your PCP online when your plan is effective or call Shield Concierge for assistance.

To change your PCP online, you must wait until your plan’s effective date to do the following:

1. Log in to your account atblueshieldca.com.
2. On the Dashboard, clickManage Health Teamunder "My Physician." The My Profile page appears where you’ll see your PCP and medical group.
3. On the My Profile page, selectChange PCP.
4. On the Change primary care physician page, select the members for whom you want to make a change and clickContinue. (For families, you can assign one PCP at a time for each member.) This takes you to the Choose a primary care physician page.
5. Select a specialty and clickSearch. The tool will display available physicians who meet your search criteria and who participate in the Trio HMO Network†. Click on a physician’s address to see details about that doctor and all medical group locations.
6. On the details page for the doctor you want, clickMake PCP.
7. Once you select a PCP, a pop-up window will appear. Verify the information, select the appropriate medical group,and then clickConfirm and Continue.
8. A new page will appear to review and complete your request. Enter your phone number and select the reason for change from the dropdown menu. If you are changing your assigned PCP, selectBlue Shield pre-assigned.
9. Answer the questions on the screen.
10. ClickSubmit Changes.

You will receive a confirmation email with your new PCP information.

When evaluating a PCP, you should consider:

• Your satisfaction and comfort with the doctor that you see today
  Are you pleased with the care that you receive, or would you be more comfortable with a different doctor for your overall care?
  
• The doctor’s network and medical group
  You must see a PCP that participates in the Trio HMO Network. Also, make sure that the PCP is part of a medical group that you want to use. Shield Concierge can assist you with the medical group information.To find doctors in your plan’s network, log in to blueshieldca.com and use ourFind a Doctortool or see below for step-by-step instructions.
  
• The type of doctor you need
  PCPs can be internal medicine doctors, family practice doctors, general practice doctors or pediatricians.
  • ​Internal medicine doctors typically treat patients 18 and older and specialize in the prevention, diagnosis and management of disease and chronic conditions.
  • Family practice doctors see patients of all ages. They treat a wide variety of conditions and can often treat sports injuries and provide women’s health needs.
  • General practice doctors are like family practice doctors and can treat patients of any gender or age.
  • Pediatricians typically treat patients under 18.
    
• Is your selected doctor accepting new patients?
  If this is the first time you’re seeing this provider, please remember to call the provider’s office to ensure that they are accepting new patients.
  
• Other criteria that may be important to you
  • Location
  • Gender preference
  • Language preference
  • Bedside manner
  • Specialty
  • Education
  • Hospital affiliations
  • Reviews or recommendations from someone you know and trust

You can view your PCP on your ID card. You can also check your online member account atblueshieldca.comwhen your new plan becomes effective.

If you need to see a specialist, you must first see your PCP and receive a referral. Your PCP will refer you to a specialist in the Trio HMO Network; however, if a specialist you need is not in the network, your PCP can refer you out of network, and your services will still be covered.

Yes, your ID card lists the PCP selected for you.

You will receive a new ID card with your new PCP listed.

If you make a change on or before the 15th of the month, then your new PCP will be effective the first day of the following month. For example, if you make a change on February 14, your new PCP will be effective March 1. If you make a change after the 15th of the month, then your new PCP will be effective on the first day of the second month following the request. For example, if you make a change on February 16, your new PCP will be effective April 1.

You can change your PCPup to once per month.

If you make a change on or before the 15th of the month, then your new PCP will be effective the first day of the following month. For example, if you make a change on February 14, your new PCP will be effective March 1. If you make a change after the 15th of the month, then your new PCP will be effective on the first day of the second month following the request. For example, if you make a change on February 16, your new PCP will be effective April 1.

A medical group is an organization of medical professionals, generally located in the same facility, who provide a range of healthcare services. You will be able to view your PCP’s medical group in your online account, and it is also listed on your ID card.

• Doctors who participate in an HMO network are affiliated with one or more medical groups.

• The medical group for your PCP must be part of the Trio HMO Network.

• Your PCP will refer you to specialists that are part of the same medical group. If you need a specialist who is not in that medical group, you may be referred out of network and still receive covered benefits.

• If you make a change to your PCP online, you will need to select the medical group for your PCP.

• If you make a change through Shield Concierge, the representative will select a medical group that your chosen PCP participates in and which is in the Trio HMO Network. If they cannot find a medical group for the PCP you have selected that is in the network, you will have to select a different PCP.