Choosing a Primary Care Provider
So now that you know a bit more about the fee structure of the Advantage HMO plan, how do you actually use it to visit a doctor?
It’s pretty easy, actually. First, you must choose a Primary Care Provider (PCP), and you must choose one from our network. Your Primary Care Provider can be a primary care physician, a nurse practitioner or a physician assistant, but you cannot choose a specialist as your primary doctor.
Take a look at our provider directory to view our network. We have an extensive network that stretches throughout Massachusetts and Rhode Island, and extends to parts of New Hampshire, Vermont and Connecticut, as well.
If your current doctor is part of our network, you may choose them. If they’re not there or you would simply like a new PCP, select a new one. Then when you visit your PCP, you present your member ID card and pay any applicable copay.
If you need specialist care, you will normally need to get a referral from your Primary Care Provider, who will refer you to a specialist within our network.
Generally speaking, when you need to visit a specialist, your PCP must refer you to one. There are exceptions, however. For example, you can choose your own OB/Gyn, and don’t need a referral. For detailed guidelines on which types of specialists your plan allows you to see without a referral, read your Benefit Document or access your secure member account at mytuftshealthplan.com.