Where to get Care

We want to make sure you get the right care when you need it. The following will help you decide where to go. To get more details, please see the 2012 Evidence of Coverage.

Primary care

You should see your PCP for all routine visits. Some examples are:

  • Routine checkups and tests
  • Colds/flu
  • Rash
  • Sore throat
  • Removal of stitches
  • Pain management

Urgent care

Urgent care is when you need medical help for an unforeseen illness, injury, or condition, but your health is not in serious danger and you are generally outside of the service area.

How to get urgently needed care

If, while temporarily outside the Plan's service area, you require urgently needed care, then you may get this care from any Provider.

Note: If you have a pressing, non-emergency medical need while in the service area, you generally must obtain services from the Plan according to its procedures and requirements as outlined earlier in this section.

Emergency care

A medical emergency is when you believe that your health is in serious danger. A medical emergency includes severe pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much worse.

If you have a medical emergency:

  • Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. You don't need to get approval or a referral first from your doctor or other network provider.
  • As soon as possible, make sure that we know about your emergency, because we need to be involved in following up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Please call us about your emergency care as soon as possible.

 

 

 

 

H0141_MIMSNP607
CMS Approved 12/20/2011