Understanding the difference between primary care physicians (PCPs) and urgent care centers

In areas of Texas where there are no urgent care centers available, some primary care physicians (PCPs) are calling their clinics “urgent care centers,” even though they are not credentialed as such. Members, most likely unaware of the difference, are utilizing these PCP clinics and offices as urgent care centers, only to find later that the services they received will not be paid at in-network benefit levels. Please let your employees know they need to either verify that the urgent care center they plan to use is truly a credentialed in-network urgent care center or change their designated PCP to the PCP operating the credentialed urgent care clinic prior to receiving services.

HealthSelectSM of Texas members can get guidance on whether to visit a PCP, an urgent care center, or a hospital emergency room by calling myNurseLineSM toll-free at (877) 731-8306. Registered nurses are available to help 24/7, at no extra cost to members. Community First Health Plans and Scott & White Health Plan also have nurse lines; information is available on their websites.