Your primary care manager (PCM) knows you best — your medical history, your individual health care needs and your health goals. Your PCM sees you for all your routine health needs, monitors the medications you receive, orders tests or special services like physical therapy and maintains your medical records.
If you have a complex health condition, your PCM may refer you to one of Johns Hopkins USFHP’s many qualified specialists. Your PCM and the specialist will work together as a team to meet your health care needs, but it’s important to keep a few key things in mind:
- A referral from your PCM is required before you can see a specialist — the only exceptions are: life-threatening medical emergencies; outpatient, office-based mental health visits; and routine annual vision screening exams
- You and your PCM will choose the right specialist for your care — either a network specialist in your community or one of any participating world-class Johns Hopkins physicians.
- Diagnosis and treatment of eye disease is considered specialty care and requires a referral from your PCM.
- Intensive Outpatient Programs and Partial Hospital Programs require a referral from your PCM.
Getting Hospital Care
If you require hospitalization, your PCM or specialist will make the necessary arrangements for you. Inpatient care will be provided at any of our participating hospitals. Your hospital care will be coordinated by your PCM or another Plan provider.
Emergency care is covered at any hospital. If you are admitted to a hospital as an emergency, your PCM must be notified as soon as possible or the next business day. If you are hospitalized for a mental health or substance use disorder concern, please follow up with your provider within seven (7) days.
If you require follow-up care such as removal of stitches or X-rays after your ER visit, your PCM will provide or coordinate your care. Do not return to the emergency room for follow-up care unless your PCM refers you there. Reduced or no payment will be made for unauthorized follow-up care.
Military Treatment Facility Privileges
Keep in mind that USFHP members are not permitted to use a military treatment facility (MTF) for non-emergency care, including the MTF pharmacy. MTF pharmacies are not included in the USFHP network and cannot be used. However, should you experience a life- or limb-threatening emergency, you are permitted to use the nearest civilian or military emergency facility. You must notify your primary care manager within 24 hours of receiving care. Be sure to submit claims for payment for emergency treatment.
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