Where To Get Care
CareSource Dual Advantage plans offer a focused network of health care providers. In order to have your health care services covered by your CareSource plan, you must get them from a network provider.
You can use our Find a Doctor 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, as well as search by specialty and more.
It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. The only exceptions are:
- In cases of emergency
- If you need medically necessary, covered urgent care services when traveling out of our service area
- Out-of-area dialysis services
- If the Governor of your state, the U.S. Secretary of Health and Human Services, or the President of the United States declares a state of disaster or emergency in your geographic area
- Cases in which CareSource authorizes use of out-of-network providers
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 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.
Help Us Improve Our Provider Network
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.
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 CareSource24 toll-free 24 hours a day, 7 days a week, 365 days a year at:
1-833-687-7331 (TTY: 1-800-750-0750 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
Convenience Care Clinics
If you are not able to see your primary care doctor, a retail Convenience Care clinic can provide medical help when you need it most. A clinic visit is quicker and much less expensive than an emergency room visit for basic care.
At a Convenience Care clinic, members can get a flu shot, get care for aches and pains, or get treatment for minor illnesses and injuries from a board-certified nurse practitioner.*
Most clinics are open into the evening, 7 days a week. Appointments can be scheduled in advance, and walk-ins are welcome. Retail clinics are part of the CareSource commitment to providing convenient health care access. You can find these network providers through Find a Doctor, our online search tool.
*physicals are not covered at the clinics; some immunizations are not covered by insurance.
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 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 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
- Shortness of breath
- Loss of consciousness
- Uncontrolled bleeding
- Severe vomiting
- 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
If you get sick or hurt while traveling outside of our service area, you can get medically necessary covered services from a provider not in our network.
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.
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.
Member Services: 1-833-230-2020 (TTY: 1-800-750-0750or 711). We are open 8 a.m. to 8 p.m. EST, seven days a week from October 1 to March 31, and Monday through Friday the rest of the year.
You must use the in-network providers except in emergency or urgent care situations. If you obtain routine care from out-of-network-providers, neither Medicare nor CareSource will be responsible for the costs, unless specifically authorized by CareSource. You must use in-network pharmacies to access the prescription drug benefit, except under non-routine circumstances when you cannot reasonably use an in-network pharmacy.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.