Tag Archives: specialists

Types of Providers

Types of Providers

If you have complicated health issues or your doctor has called another doctor an industry term you’ve never heard before, you may be left wondering what all these health care names really mean. We can help you make sense of the different types of providers.

Your Doctors

Primary Care Provider (PCP)

A primary care provider, or PCP, is your main doctor. It’s who you visit for routine checkups, preventive care, and general health problems. Each person in your family can have a PCP, or you can all see the same one.

If you’re on an HMO or POS plan, you have to choose an in-network PCP who will oversee your care and refer you to specialists. If you’re on a PPO plan, you don’t have to choose a PCP to get referrals, but you can to get personalized care and savings.

And if you’re a woman, you can set a doctor as your PCP or choose another in-network doctor, like an OB-GYN, to oversee free preventive care, your yearly well-woman visit, or a pregnancy.

Setting and changing your PCP is easy. Just log in to Your Health Alliance to update your PCP.

Specialist

A specialist is a doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.

Usually, you’ll be referred to a specialist when your personal doctor wants you to check on specific issues or problems. You’ll also be sent to a specialist when you’re diagnosed with something serious, like a heart condition or cancer, or if you find out you’re pregnant. 

Surgeon 

A surgeon is a doctor who is qualified to perform surgery, and they have their own specialties. If you have a heart attack and need surgery, your surgeon will be an expert in heart surgery.

If you’re sent to the ER because of an emergency or diagnosed with a condition or disease, you might be sent into surgery. But if you need a minor procedure, like having your wisdom teeth out, you’re seeing a surgeon too. 

Hospitalist

A hospitalist is a dedicated, in-patient doctor who works only in a hospital or network of hospitals. If you’re taken to the hospital in an emergency or accident, you might be treated by a hospitalist.

Help with Your Care

Care Coordinator

Care coordinators help you figure out your health care in lots of ways, especially after a hospital stay, diagnosis, or if you have a chronic or complex condition.

They can help provide you with resources, educational materials, and self-care techniques, help you understand your doctor’s instructions, connect you to resources in your community, and help you plan for the future.

Health Coach

Health coaches can help you or your family plan for better health. Our health coaches can help you get the best care possible from your healthcare team and get the most from your coverage.

They’ll partner with you to help in areas like nutrition, weight and stress management, and preventive screenings and immunizations.

Nurse Navigators

You might get help handling your care from a nurse navigator when you’re discharged from the hospital if you get a serious diagnosis. For example, a cardiac nurse navigator will help patients with a primary diagnosis of heart failure or myocardial infarction.

They will usually start the process by visiting you before you leave the hospital, then they’ll stay in-touch to walk you through the first 30 days after discharge. 

Nurse navigators can help you organize your appointments, connect you to education on your diagnosis, medications, exercise, diet, therapies, and when to call the doctor. And they might host support groups that can help people like you.

Other Kinds of Care

Home Health Care

Home health care is medical care, treatment, or skilled care you can get in your home. You doctor might recommend this in situations where care in your own home will be easier for your case and condition.

Skilled Nursing Facility

You doctor might order medical care that must be given or supervised by a licensed health care professional in a skilled nursing facility. This type of care could include:

  • X-rays and other radiology services
  • Physical, occupational, and speech therapy
  • Storage and administration of blood
  • Use of appliances, like wheelchairs
  • Meals, including special diets
  • A semiprivate room or private room if medically necessary

Hospice Care

Hospice care is special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.

Other Help

Pharmacist

Pharmacists are healthcare professionals who practice pharmacy, which focuses on safe and effective medication use. You might not think about your pharmacist’s skillset when you pick up your drugs at the pharmacy, but they’re trained to know how drugs work.

They know which drugs can interact to protect you from dangerous drug combinations, they can explain the side effects of your drug to you, and they make sure you’re getting the right dosage of your drugs on the right schedule.

Social Worker

Social workers are there to help you with social problems that can affect your quality of life and health care. They can help you and connect you to resources for domestic violence, sexual assault, abuse and neglect, housing and food insecurity, home-delivered meals, substance abuse, mental health issues, advance directives, and more.

Other Providers

Medical Director

A medical director is a leader who recruits and manages doctors, nurses, and other personnel. They also examine and coordinate processes within their organizations to improve and guarantee the medical quality of the facility. 

 

If you need to find covered providers, use our Find a Doctor or Hospital tool to search for covered doctors, hospitals, and more.

Going to Your Well-Woman Visit

You and Your Well-Woman Visit

Your insurance covers an annual well-woman visit. But what exactly does that mean?

Your yearly well-woman visit can be either a combination of your annual physical and care specific to you as a woman or a separate appointment for just that care.

Preventive Care at Your Well-Woman Visit

Your plan covers a lot of preventive care and screenings, many of which you’ll get at your yearly physical. But for some of the care, you’ll probably want to schedule a separate well-woman visit with a specialist, like a gynecologist, or even multiple appointments with your doctor and different specialists.

Depending on timing and what your doctor recommends, this care includes:

Screenings & Care
  • Osteoporosis screening – For women over age 60, depending on risk factors. Beginning at age 65, you should get this bone density test annually.
  • Domestic and interpersonal violence screening and counseling
Cancer Screenings & Counseling
  • Breast cancer genetic test counseling (BRCA) – For women at higher risk.
  • Breast cancer mammography screenings – Every 1 to 2 years for women starting at age 50 until at least 74. Most clinics require a referral from your primary care provider (PCP) or gynecologist for mammograms.
  • Breast cancer chemoprevention counseling – For women at higher risk.
  • Cervical cancer screening – If you’re between the ages of 21 and 65, your doctor should review your history to choose a Pap smear schedule for you.
Sexually Transmitted Infection (STI) Screenings
  • Sexually transmitted infections counseling – For sexually active women.
  • Chlamydia infection screening – Women age 25 or younger and sexually active should get tested annually. If you’re older, talk to your doctor about being tested.
  • Gonorrhea screening – For all women at higher risk.
  • HIV screening and counseling – For sexually active women.
  • Human Papillomavirus (HPV) DNA test – Every 3 years for women with normal cytology results who are 30 or older.
  • Syphilis screening – For women at increased risk.

And if you’re pregnant or may become pregnant, there’s even more preventive care covered for you.

Prepare for Your Visit

Preparing with questions, and answers to your doctor’s questions, can help you make the most of your visit.

Know Your Family History

Talk to your family members, especially your mom, about your family’s history of women’s health issues. For example, as a woman, you’re more likely to get breast cancer if it’s genetic on your mom’s side of the family. So knowing this information can help your doctor keep an eye out for genetic issues you’re at risk for.

Talk to Your Doctor

Prepare for your appointment by knowing any questions or issues you want to talk to your doctor about. Some things you might want to ask include:

  • What immunizations or shots you need, like the HPV vaccine
  • If you should get STI screenings
  • Help getting pregnant or birth control options
  • How to do self-exams to regularly check for breast cancer
  • Mental and social health concerns, like relationship issues or domestic violence questions
  • Specific issues you might be having, like problems with your menstruation or abnormal pain or cramping

Know What’s Covered

Log in to Your Health Alliance or search by your member number to see what preventive care your plan covers.

Or use our general preventive care guidelines and prescription drugs or our Medicare preventive care guidelines to get an idea of what our plans cover.

If you’re not sure what’s covered and what you’ll need a preauthorization for, you can also check your coverage and preauthorization lists at Your Health Alliance.

Now that you’re ready to go to your well-woman visit, log in to Your Health Alliance to find a covered doctor, or start searching for doctors in our network.

Blaze a Trail as You Age

Vantage Point: Blaze a Trail

An excerpt from North Central Washington Museum’s “The History of a Thriving Anomaly” describes how the local community thought the Wenatchee Valley Clinic, which opened on April Fools’ Day 1940, wouldn’t last 6 months. They couldn’t have been more wrong.

The tiny clinic was founded by a surgeon, Albert Donald Haug, a radiologist, Lloyd Smith, and an internist with a knack for keeping patients happy, Lumir Martin Mares, and it brought together specialists at a time when most doctors worked alone.

Haug and Mares believed that their little clinic could meet the same standards as those in the East, and they brought together a range of specialists and cutting-edge equipment and training to become the second-largest clinic in the region.

“We knew it would grow,” Dr. Smith said, “but none of us had any idea it would grow to what it is now.”

The clinic brought together its doctors then, and it brings together patients and doctors now. Because of their dream, its nearly 170 doctors treat people from around the world today.

In 1963, President John F. Kennedy decided that every May, we would honor older Americans and their contributions to our communities and country. This year’s theme, “Blaze a Trail,” celebrates older adults who are taking charge of their health, engaging in their communities, and positively impacting the lives of others, just like Wenatchee Valley Clinic’s remarkable founders.

Health Alliance will honor older Americans this month by partnering with Confluence Health to hold an educational event about the treatment and prevention of hypertension and strokes on May 25 and by teaming up with community agencies and businesses in planning the 3rd annual senior-focused health fair at Pybus Public Market on June 4.

Health insurance can be challenging, but as I think about those trailblazing doctors, I remember that hard work, progressive thinking, and the camaraderie of partners like you can help turn the dream of making a positive impact through quality care within this wonderful place we all live a reality.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.