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;
- If you need medically necessary, covered urgent care services when traveling out of our service area; or
- When specifically authorized by CareSource.
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.
Your Primary Care Provider (PCP)
Each member of CareSource has a Primary Care Provider (PCP). Your PCP is an individual physician, physician group practice, advanced practice nurse or advanced practice nurse group practice trained in family medicine (general practice), internal medicine or pediatrics. Your PCP is your personal doctor. He or she will:
- Work with you to direct your health care
- Treat you for most of your health needs
- Send you to a specialist, if needed
- Admit you to the hospital
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.
If you haven’t chosen a PCP yet, you can call Member Services at the number on the back of your ID Card or log on to My CareSource for more information.
You may be a new patient to your PCP. If so, you should call to schedule a visit. This will help your PCP get to know your health needs right away. You should go for your 1st visit within 90 days of joining CareSource.
Please keep all appointments you make. If you need to cancel or change times, call your doctor. You should call at least 24 hours in advance.
Your PCP helps you get preventive care. Make regular visits to your PCP. You should do this even if you do not feel sick. Routine checkups can help your PCP find problems early so they can be treated before they get worse.
Preventive care includes:
- Regular checkups
- Immunizations for children
- Tests and screenings, when needed
You should see your PCP for all routine visits. Some examples are:
- Routine checkups and tests
- Sore throat
- Removal of stitches
- Pain management
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.
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 sick or hurt, you have options. You can see if your provider can give you a same day appointment, or call the office’s after-hours phone number. Other options are:
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:
1-866-206-0554 (TTY: 1-800-750-0750 or 711) The number is also on your ID card
Our nurses can help you:
- Assess your symptoms and 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
With MYidealDOCTOR™ telemedicine, you can use your phone, a mobile app or computer to talk with a doctor anywhere, anytime. It is easy for you and your family to get the care you need.
If you’re not sure if telemedicine is right for your situation, 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 transfer you to MYidealDOCTOR if that is the right option for you.
MYidealDOCTOR gives you 24/7/365 on-demand access to doctors who will consult, diagnose and, if necessary, prescribe medicine for you through your phone or computer. Members are normally contacted within 15 minutes of requesting a visit.
Convenience Care Clinics
If you are not able to see your PCP, we want to make it easy for you and your family to get medical help when you need it most. CareSource members can go to select clinics inside of CVS (MinuteClinic®), Kroger (The Little Clinic®) and Walgreens to see board-certified family nurse practitioners for basic care. At the clinic, you can*
- Get vaccines
- Get health screenings and physicals
- Get care for aches and pains, illnesses and minor injuries
Most clinics are open into the evening, 7 days a week. Appointments are usually available the same-day, and walk-ins are welcome. Retail Convenience Care 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.
*Children’s immunizations are not recommended and 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/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.
If you have an emergency situation now, call 9-1-1 or go to the nearest emergency room. Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. We cover care for emergencies both in and out of the county where you live. 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.
When You Are Outside of Our Service Area
If you have additional questions about where to get care after hours or outside the service area, refer to the member handbook for your CareSource plan.
Walmart Vision Centers
CareSource is partnering with Walmart Vision Centers to offer vision services to CareSource Medicaid members in Ohio. All Walmart Vision Centers will offer optical goods to CareSource members; select Walmart Vision Centers will offer eye exams to CareSource members.
- You must contact your desired location to verify that the optometrist is in-network prior to scheduling an appointment.
To find a Walmart Vision Center you can use our Find a Doctor/Provider tool or visit the Walmart website. To use Find a Doctor/Provider:
Step 1: Enter your zip code
Step 2: Select Vision – Optometry under Specialty from the menu on the right side of the page.
Always call the desired location to verify the optometrist is accepting CareSource Medicaid (in-network) prior to scheduling an appointment. While CareSource strives to keep our records up-to-date, members must call before having services to make sure the vision provider takes CareSource Ohio Medicaid.
Member Services: 1-800-488-0134 (TTY: 1-800-750-0750 or 711), 7 a.m.to 7 p.m., Monday through Friday.