Seeing a Specialist

Your Primary Care Physician (PCP) gives you most of your care. You should always go to your PCP first. Sometimes your PCP will send you to a specialist. Specialists work on specific parts of the body. For example, some specialists care for skin (dermatologists). Some care for bones (orthopedists). Others care for the heart (cardiologists).

Your PCP and specialist will work together so you get the care you need. Your PCP will tell you what to do if you need a specialist.

We will pay both your PCP and your specialist.

Information about your provider

A PCP is the short name for primary care provider. A Primary Care Provider (PCP) is the doctor or nurse practitioner who manages your medical care.

A specialist is a doctor who is trained to treat a certain medical condition, like the heart, bones or brain.

Specialty care refers to the health care services given by a specialist. Some special health care needs may require that you see a specialist as part of your primary care (health care services). If you have any questions, please call Maryland Physicians Care (MPC)’s Member Services department at 1‑800‑953‑8854.

Your PCP will set up or give you all of the covered services you need. Make sure you talk to your PCP about any health problem you have. It is important to have a good relationship with your PCP. That way your provider gets to know you and your medical history.

Always follow your PCP’s advice about your health care and check with your PCP before you get medical care or services from other providers. Your PCP will also refer you to a specialist for specialty care services when necessary.

When you join MPC, you can choose the PCP you want for yourself and your eligible family members. You must select a PCP who participates with MPC. You can use our Provider Directory or our online Find a Provider search tool to find a PCP in your area.

Note: You do not have to choose the same PCP for every family member.

If you do not choose a PCP, we will select one for you. If you want a different PCP than the one we assigned for you, please call MPC’s Member Services department at 1-800-953-8854 to change your PCP.

MPCs Member Services can also help you if you need:

  • Help choosing a PCP
  • More information about the provider assigned
  • More information about other providers on our plan
  • Care and cannot reach your PCP
  • A provider directory or listing of participating providers in your area.

Your PCP is an important part of your health care team. We want you and your PCP to work together. If you want to change your PCP, you can call our Member Services department at 1-800-953-8854 to request a change. You will get a new ID card within 10 days of the requested change date.

Note: If you call before the 15th of the month, your new PCP will be made effective the day of the call. For all calls on or after the 15th of the month, your new PCP may be made effective the 1st of the next month.

It is very important that you work with your PCP. Your PCP keeps records of all your health care services. Medical decisions about your health are based on your health history. MPC monitors the number of PCP changes a member requests to determine if assistance is needed to help with selecting a PCP that the member can build a long relationship with.