How is my doctor assigned in an HMO or EPO plan?

Most plans will allow you the option of choosing a primary care physician (PCP) that is within your HMO/EPO network. You can go to your plan’s website and search for doctors accepting new patients and sort the options based on their location or other criteria that are important to you (such as gender or specialization). We recommend choosing a physician close to your home or work. You will also be able to choose from one of four types of doctors:

1. Family/general practice doctors work with patients of all age groups, from birth to death. They are a good all-around choice unless you have special needs or preferences.
2. Internal medicine doctors specialize in working with adults, usually aged 18 and older.
3. Obstetricians/gynecologists specialize in the female reproductive system and care during pregnancy and childbirth.
4. Pediatricians specialize in children’s health (usually until 18 years of age).

If you do not choose your primary care physician, one will be assigned based on a variety of criteria that vary for each insurance company. Typically, this is based on location (you will be assigned to a physician close to your home) and “physician load” (you will be assigned to a physician who is less busy and therefore easier to schedule visits with).