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PCPs: Your compass to navigate your healthcare experience

 

Signature Tier 1

Anthem PPO Tier 2

Out-of-Network

Preventive Primary Care  Visit1

$0 copay

$0 copay

50% of Maximum Allowable Amount (MAA) after deductible

Primary Care Visit1

$10 copay

$30 copay

50% of MAA after deductible

Specialist Office Visit1

$25 copay

$50 copay

50% of MAA after deductible

Urgent Care / Walk-In Medical Center

$25 copay

$50 copay

$50 copay

Emergency Department

$250 copay

$250 copay

$250 copay

 

1Tests (e.g., some EKGs and lab work) associated with office visits may be subject to a copay or deductible and coinsurance if they are not mandated by the Affordable Care Act. Check with your provider or call Anthem to determine if a specific test is covered at 100 percent.


 
A primary care physician (PCP) can be your ally in health care. Your PCP coordinates care that meets your immediate and ongoing needs. The result – better health, a better overall experience with health care and lower health-related expenses. 
 
“Many people stay with their PCP for decades. They develop a trusted relationship with their PCP, who accumulates detailed knowledge of their medical history. This helps patients receive personalized care based on their individual health needs and preferences,” said Karen Brown, MD, medical director of Primary Care at Northeast Medical Group. 
 
PCPs can be doctors or advanced practice clinicians, such as nurse practitioners or physician assistants. They are trained in family medicine, internal medicine or pediatrics. PCPs help you stay well by ensuring you are up-to-date on healthy habits, health screenings and immunizations. 
 
PCPs also diagnose and treat a broad range of medical concerns, from acute conditions such as upper respiratory illnesses, rashes, urinary tract infections or muscle sprains, to chronic conditions such as high blood pressure, diabetes, heart disease, obesity, anxiety and depression. 
 
“Your PCP oversees your comprehensive care,” Dr. Brown explained. “Chronic medical conditions often require multiple treatments and medications. Your PCP can advise on the best course of action, and coordinate and communicate with specialists on your behalf.”
 
Having a PCP can also save you healthcare costs. Annual preventive visits do not require a copay. Preventing disease, or diagnosing and treating it early, is better for your health and could reduce your medical expenses over the long run, according to Dr. Brown.  
 
YNHHS offers healthcare cost savings with its Signature Tier 1 network. Employees and their dependents enrolled in the YNHHS medical plan can save on out-of-pocket medical expenses by seeing Tier 1 providers, including PCPs. The table on this page shows the cost comparison between tiers and services on the plan.  
 
YNHHS’ patient resource coordinators can help you find a Tier 1 provider who meets your needs. Call 1-844-543-2147 (option 3) Monday through Friday 8:30 am - 5 pm, or email [email protected]