Office visits
What is a primary care provider vs. a specialist?
Primary Care Providers (PCPs) are usually your first point of contact for a variety of healthcare needs. PCPs are trained to diagnose and treat a wide variety of medical conditions and can help track your health over time. You typically see a PCP for your annual physical/wellness exam, vaccinations, general non-emergent medical issues, or if you don’t know what specialist you need to see.
Specialists have advanced training in a particular area of medicine. Some specialists perform surgery, depending on the specialty. You typically see a specialist for a specific medical issue. Some common specialties include:
- Pediatrics
- Obstetrics
- Cardiology
- Oncology
- Gastroenterology
- Dermatology
What are my office visit benefits under my Sidecar Health plan?
Your plan’s Benefit Amounts are visible in the Sidecar Health member portal through Estimate Care. Your Member Care team is available to help you navigate your benefits for each option.
Note, the below medical codes (sometimes referred to as CPT, DRG, or procedure codes) are often billed during an office visit, but services and procedures included vary from doctor to doctor. Ask your doctor what services will be included prior to your visit for the most comprehensive view of how much your plan will pay.
| Medical code | Description |
| 99202 – 99205 | New patient office visit |
| 99211 – 99215 |
Established patient office visit |
| 99381 – 99386 |
New patient wellness visit |
| 99291 – 99396 |
Established patient wellness visit |
What should I remember when shopping for an office visit?
- Unlike other health plans that require members to get a referral before seeing a specialist, you can bypass the PCP and see a specialist right away with Sidecar Health.
- Since the services provided by PCPs and specialists can vary depending on care type, we recommend asking your provider for more detailed pricing when scheduling an appointment or during the first visit, especially if there will be follow-up visits.
- If you are experiencing a medical emergency, please go straight to your nearest ER or call 911. If it is not an emergency, consider your PCP or visit urgent care. Some PCPs also have same-day appointments.
