Will a doctor consider himself your doctor if you've never seen him.

[MaggieM]

My son is 18 and his pediatrician suggested he switch to a primary care manager of adult patients close to his college campus.

We have picked out, as his new primary care manager, an internal medicine doctor who is a participating provider with our insurance and willing to accept new patients.  We have initiated the paperwork to make the switch official with the insurance company. (This can take two weeks or more to be official.)

Here is my question - once the transfer is final,  I think my son needs to make an appointment for a checku to get a chart started with this new doctor to make my son officially a patient.  My husband tells him  NOT to make an appointment until he is sick, even if that's six months or a year from now.

My concern is that the doctor might move, retire, stop taking patients or be confused about why a hospital ER would call him about a patient he has never heard of because he has no chart.  This could in turn cause complications with our insurance company.

Can you consider yourself the patient of a doctor if you have never seen the doctor?  

My husband doesn't believe me when I suggest that naming an insurance company's participating provider as your doctor doesn't actually make him your doctor until you've had an appointment.  He insists that other coworkers have signed themselves up as patients of doctors they've never seen and never intend to see until they get sick.  They have never filled out any office paperwork with the doctors or had any contact with these doctors except to name them as their PCM.

I’m embarrassed to ask the doctor’s office if my son could fill out the patient paperwork without making an appointment.  Do doctor’s offices do this?

Thanks for any guidance you can provide.

[Amir Mostafaie]

Dear MaggieM,

Whether you can consider yourself the patient of a doctor if you have never seen the doctor depends on your type of plan. If you have an HMO plan (which sounds like you do) & you have chosen a physician (by submitting a request to your insurance Carrier) to be your PCP (Primary Care Physician) then you can consider them your doctor, but if you have a PPO plan, your physician has no way of knowing about your existence until you see them at least once!
In general, if your son hasn’t had a physical in the past 12 months, it would be a good idea for him to make an appointment & see his new PCP.

Sincerely,

Amir Mostafaie

[MaggieM]

Thanks, Dr. Mostafaie, your answer was very helpful.  We do belong to an HMO, but since we live quite a distance from their hub facility we are allowed to choose a PCM from their Preferred Provider Network of private doctor's offices.  My personal experience with this system is that there is not alot of communication between the insurance program and the Preferred Provider Network.

(As a bit of backstory, my husband "selected" his PCM over five years ago but never went in for an appointment.  He ended up in the ER and admitted to a hospital.  The hospital staff was put out that "his doctor" had never heard of him, and "his doctor's" receptionist told me that they don't have records on people they have never seen.  While it all worked out in the end, I would not want the same thing to happen to my son.)

Your answer helps me understand why my husband assumes everything should work like an HMO while our experience shows that our aspect of the program seems to work more like a PPO.  Thanks!