Where To Get Care
Humana – CareSource offers a focused network of health care partners. In order to have your health care services covered by your Humana – CareSource plan, you must get them from a network provider. The only exceptions are:
- In cases of emergency;
- If you need medically necessary, covered urgent care services when traveling out of our service area; or
- When specifically authorized by Humana – CareSource.
You can use our Find a Doctor/Provider search tool to find a network provider or care location near you. Use the filters in the right column to find providers in network for your plan, search by specialty and more.
Humana – CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form.
The Access Opportunity Form gives you a chance to suggest a doctor for our network, tell us about things like if it is easy to schedule appointments, and more.
Your Primary Care Provider (PCP)
You can choose a PCP who is a network provider. Your PCP will work with you to direct your health care. He or she will treat you for most of your routine health care needs. Visit My CareSource to choose or change your PCP. You may also call Member Services.
You can find the most current list of network providers on the Find a Doctor/Provider tool on the left side of this web page under Quick Links. You can also find a doctor’s professional training by accessing additional sites.
Going to the same PCP each time you need care will help your PCP get to know you and your needs. The more familiar your PCP is with you and your medical history, the better your PCP will be able to treat you.
If needed, your PCP will help you decide if you need to see other doctors (specialists) or admit you to the hospital. However, you are not required to get a referral from your PCP before you see many types of specialists.
Where to get Care after Hours
We want you to get the right care from the right health care provider when you need it. If your doctor’s office is closed or if you are very sick or hurt, you have options.
24-Hour Nurse Advice Line
Our 24-Hour Nurse Advice Line provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call our 24-Hour Nurse Advice Line toll-free 24 hours a day, 7 days a week, 365 days a year at 1-866-206-9599 (TTY: 1-800-648-6056 or 711).
Our nurses can help you:
- Decide when self-care, a doctor visit or the emergency room is appropriate
- Understand a medical condition or recent diagnosis
- Find out more about prescriptions or over-the-counter medicines
Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency but needs care right away.
If you think you need to get urgently needed care, you can:
- Call your PCP for advice.
- Call our 24-Hour nurse advice Line (1-866-206-9599).
- Go to a network urgent care center listed in our Find a Doctor/Provider
After you go, always call your PCP to schedule follow-up care.
When you are outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.
Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. Some examples of when emergency services are needed include:
- Miscarriage/pregnancy with vaginal bleeding
- Severe chest pain
- Loss of consciousness
- Uncontrolled bleeding
- Major burns
Emergency care is covered both in and out of our service area, within the United States. You do not have to contact Humana – CareSource for an okay before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting. If you are not sure whether you need to go to the emergency room, call your primary care provider or our 24-Hour Nurse Advice Line.
When you are outside of our service area
Prior to seeking urgent care, we encourage you to call your PCP for guidance, but this is not required. You should get urgent care from the nearest and most appropriate health care provider.
If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, and you paid for the service out of pocket, you will need to submit the bill you receive to Humana – CareSource with a claim form. You may obtain a claim form on the Forms page or by calling Member Services. If you did not pay out of pocket, the provider will work directly with Humana – CareSource and you will not need to submit the bill or form to us.
If you have additional questions about where to get care after hours or outside the service area, refer to the member handbook for your Humana – CareSource plan.
Member Services: 1-855-852-7005 (TTY: 1-800-648-6056 or 711) 7 a.m. – 7 p.m., Monday – Friday EST.