A primary care provider is usually a family practitioner or a general internist. For a women, it might be a gynecologist. For younger patients, a pediatrician or family practitioner usually handles routine care. Under some managed care plans, the member is expected to contact their primary care provider before receiving any health care. This is where the term gate keeper comes from.
Many plans require that the individual's primary care doctor make a formal referral to a specialist.
If the individual makes an appointment for a specialist without the referral, he may be responsible for all or most of the specialist's bill. There are some advantages to having a primary care provider. Since primary care doctors typically charge less, the cost of health care is reduced. Under ideal conditions, the primary care provider functions much like the traditional family doctor. He focuses on the health of the whole person rather than on a single organ system in the body.