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The difference between PCPs and specialists

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, they also know YOU. It’s your personal doctor.

Are you a penny pincher? See a PCP

The type of provider you see impacts how much you pay. Primary Care Providers (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 or 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 in 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.

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.

“I may sound like a broken record,” says Dr. Tim Gutshall, chief medical officer at Wellmark Blue Cross and Blue Shield. “But having a personal doctor you know and trust is one of the most important things you can do for your health. This relationship increases the likelihood that you will engage in activities to improve your health, because your provider — who knows you well — will make recommendations that are relevant to you.”

According to Gutshall, the smartest patients know they play a key role in the relationship. “It’s a two-way street. You need to do your part. For it to work, you need to be your own health care advocate.”

To designate a personal doctor, just call Wellmark Customer Service at the phone number on your ID card. Need advice? Find five tips for choosing a personal doctor that's right for you. 

myWellmark®: your best bet for health insurance information

Knowing your options and knowing your cost share changes everything.

And it’s easy with myWellmark. Simply log in or register for myWellmark. Here, you have access to all your health plan information and tools, including the myWellmark® Care Finder. The Care Finder allows you to search for both personal doctors and specialists in your area, so you can shop and compare options for quality care.