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PCP vs. specialist: the difference in dollars

Better costs and better care

This article was last updated on July 21, 2021. 

Ever show up for a doctor visit and pay more than you expected? You may have seen a specialist, which is great because they’re experts at treating very specific health issues. But, there’s another type of doctor that not only costs less, but they also know you too. It’s your personal doctor.

Save money with a primary care provider (PCP)

The type of provider you see impacts how much you pay. PCPs are people like your family doctor, who you might visit for an ear infection or strep throat. The PCP category also includes internal medicine practitioners, nurse practitioners, general practitioners, physicians assistants, obstetricians/gynecologists and pediatricians.

Non-PCPs, also known as specialists, are typically used for more specialized care based on their expertise. A dermatologist or an ear, nose and throat doctor would fall into this category.

Generally, going to a PCP will cost you less than going to a specialist. That’s why it’s important to know the difference. When you know what type of doctor you have an appointment with, you can know your copay before you go. A copay is a fixed amount (i.e. $25) that you may have to pay out-of-pocket when incurring medical expenses.

3 ways your PCP can cost you less

  1. They can run a lot of the same tests. You might be surprised by the number of tests or labs your PCP can run. Check with your PCP before seeking additional screenings from a specialist.
  2. They can give you a referral. If your condition falls outside your PCP's scope of care, they may refer you to a specialist. Oftentimes with a referral, you can avoid additional or unexpected costs.
  3. They know your health history. Instead of bouncing around from specialist to specialist paying different amounts everywhere you go, your PCP has your health history and can see the bigger picture. This can save you both time and money.

Choosing a personal doctor: one decision to better health

With some network plans, you have to choose a personal doctor in your network for most preventive benefits — like your annual exam — to pay at 100 percent. Even if your plan doesn’t require you to choose a personal doctor, they’re important to have.

Developing a relationship with your personal doctor can lead to better health outcomes for you. They can oversee all treatments and track your health, as well as manage your prescriptions and treatment options.

To designate a personal doctor, just call Wellmark Customer Service at the phone number on your ID card. To find a provider in your area, log in or register for myWellmark® Opens New Window. Here, you have access to all your health plan information and tools. Find care and costs for both personal doctors and specialists in your area, so you can shop and compare options for quality care.