What is PCN?
PCN stands for primary care network. Participation in a PCN requires the selection of a primary care physician (PCP). The covered persons must consult first with their PCP, who will handle their treatment or, if necessary, refer them to a specialist or admit them to a hospital. The benefit structure of the PCN differs somewhat from both a comprehensive major medical (CMM) plan and a preferred provider organization (PPO). A PCN commonly offers 100-percent reimbursement after an office-visit copayment for any services billed by the PCP (with the exception of inpatient surgery and obstetrics). Typically, specialist benefits are not eligible for reimbursement without being referred, ordered, arranged and authorized by the PCP (except for life/limb-threatening emergencies or other exceptions defined by the health plan).
