About our Physicians and Practitioners:
Primary care physicians/practitioners include General Practice, Family Practice, Internal Medicine, Pediatrics, Nurse Practitioners and some Obstetricians and Gynecologists (OB/GYNs). These physicians/practitioners are listed as primary care physicians/practitioners in this directory. ONE Primary Care Physician (PCP) needs to be selected for EACH family member. After choosing a new PCP - and contacting that provider to verify that they are accepting new patients - you may click here to be taken to a form to notify PHPMM of your choice.

Open Access vs. Referral Process

Physicians Health Plan of Mid-Michigan no longer requires a referral for commercial members seeking treatment from physicians or specialists within the PHPMM network. If you wish to see a specialist, you may self refer to any physician within the PHPMM network. You may determine which physicians are within the PHPMM network by viewing the Provider Directory or by calling PHPMM Customer Service at 1.800.832.9186.

It is important to note that while PHPMM does not require a referral to physicians within our network, there are certain specialists who may require a referral from the members primary physician before setting up an appointment with you. PHPMM supports this process as we feel it is within your best interest to coordinate your health care through your primary physician. In this way, there is one medical professional that is aware of your total health history and can then be helpful in coordinating your total care.

Specifically, the following services do not require a referral:

• Any services provided by a physician within our network, including:
• Specialist visits
• Routine vision examinations for refractive error from a network provider
• General pediatric care
• Emergency or urgently needed health services

If your PCP decides that it is necessary for you to receive care from a physician, practitioner or other provider who does not participate with PHPMM, your PCP must arrange for written approval from PHPMM before making your appointment. Use of non-participating physicians or practitioners is limited to services that are covered benefits and cannot be provided to you by a participating physician or practitioner. If you obtain services from a non-participating health care provider without a referral from your PCP and approval from PHPMM, you will be responsible for payment for the care that you receive. You can contact Customer Service to verify the participation status of the provider.

If you are covered under the PHP Plus benefit plan, you are able to see non-participating providers without a medical referral. However, deductibles and coinsurance would then apply.

Help! I Need a Doctor

Are you new to the area? Has your insurance provider changed? Are you facing a health concern that requires the services of a specialist?

At some point in your life, you'll be looking for a new doctor. With a little extra effort on your part, finding a physician whose personality and credentials make you happy can be as easy as relearning your ABCs.

First determine whether your prospective physician offers the three A's — affability, availability, and ability. B e aware of your responsibility to provide and gather pertinent health information. And finally, research the C 's — credentials, certification, competence, and convenience.

Here are some of the ways you can assess physician candidates.

• Professional education (medical school/residency training) — Has he or she attended an accredited medical school and fulfilled his or her residency requirements? Call the American Medical Association at 800.665.2882 for information on training, specialties and certification or access the Web site at www.ama-assn.org/aps/amahg.htm, then click on Physician Select.
  
  
• Current board certification — Being "board certified" means a doctor has completed a training program in a specialty and has passed an exam to assess his or her knowledge, skills, and experience to provide quality patient care in that specialty. Primary care physicians also may be certified as specialists. While board certification is a good measure of a doctor's knowledge, it is possible to receive quality care from physicians who are not board certified. There are two certifying umbrella organizations: the American Board of Medical Specialties (http://www.abms.org/) and the American Osteopathic Association (http://www.osteopathic.org/).
  
  
• Years in practice — To many people, experience speaks volumes. To others, signing up with a new doctor who just put out his or her shingle means they are receiving the most up-to-date care. Choosing between years of experience and a fresh face hinges more on personal preference then professional ability since all physicians must meet strict standards to practice medicine.
  
  
• Experience performing certain procedures — Does this physician regularly perform the procedure you need? How many of these procedures does he or she perform each year? You may feel more comfortable engaging the services of someone who not only routinely performs the procedure you need, but also has excellent patient outcomes.
  
  
• Languages spoken — Do you or a member of your family have special language needs? Make sure your physician of choice either speaks the necessary language or has immediate access to an interpreter.
  
  
• Can we talk? — The ability to comfortably converse with your physician makes a distinct difference in your perception of quality health care. Talking with your doctor allows for a free exchange of information and gives you time to ask important questions that affect you and your family.
  
  
• Etc. — Other considerations include office hours and location, availability of preventive medicine programs, hospital privileges, and health plan participation.