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West Virginia
West Virginia

My Health Care Partners

WHERE TO GET CARE

CareSource offers a focused network of health care partners. In order to have your health care services covered by your CareSource plan, you must get them from a network provider. The only exceptions are:

  • In cases of emergency; or
  • If you need medically necessary, covered urgent care services when traveling out of our service area.

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.

CareSource24® Nurse Advice Line

CareSource24 provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call the CareSource24 toll-free number located on their ID card 24 hours a day, 7 days a week, 365 days a year.

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

Telemedicine

With telemedicine, you can use your phone, a mobile app or computer to have a consultation with a board certified physician anywhere, anytime. It’s a good idea to call the CareSource24 Nurse Advice Line first.  They can help you determine the best course of action for your symptoms. They may refer you to MYidealDOCTOR®.

MYidealDOCTOR is CareSource’s telemedicine provider. It provides members with 24/7/365 on-demand access to board certified physicians for consulting, diagnosing and prescribing with interactive audio or video for common illnesses. Members are normally contacted within 15 minutes of requesting a consultation, and best of all, a visit with MYidealDOCTOR is the same copay as a regular primary care visit. More Details.

Urgent Care

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 CareSource24, our nurse advice line.
  • Go to a network urgent care center listed in our Find a Doctor/Provider tool. 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

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 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 the CareSource24 Nurse Advice Line or your doctor.  

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, you will need to submit the bill you receive to CareSource with a claim form. You may obtain a claim form on the Forms page or by calling Member Services at 1-855-202-0622 (TTY for the hearing impaired: 1-800-982-8771 or 711).

If you have additional questions about where to get care after hours or outside the service area, refer to the evidence of coverage for your CareSource plan.