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 in most cases.
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.
We have a broad health partner network to serve your physical and behavioral health needs. There are a few exceptions when you may be able to see a non-network provider. In some instances, prior approval may be needed.
- In cases of emergency (prior approval is not needed)
- If you need medically necessary, covered urgent care services whentraveling out of our service area
- During a defined “transition period” when you first join MyCare Ohio
- During a declared disaster
- When specifically authorized by CareSource
Your Primary Care Provider (PCP)
If you have both your Medicare and Medicaid from CareSource MyCare Ohio you must choose a primary care provider (PCP) who is a network provider. Your PCP is an individual physician group practice, certified nurse practitioner or physician assistant. 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. Your PCP will also:
- Coordinate your preventive care and checkups
- Send you to other doctors (specialists) when needed
- Admit you to the hospital if necessary
- Get prior authorization from CareSource MyCare Ohio for some 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. If you need help finding a PCP please let us know.
It is best to see your PCP as soon as possible after you become a member of CareSource MyCare Ohio. The name and office telephone number of your PCP is printed on your member ID card. 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. It is still important to contact your PCP before you see a specialist or after you have an urgent or emergency department visit. This allows your PCP to manage your care.
Visit My CareSource to choose or change your PCP. You may also call Member Services.
Important Note: If you have your Medicare coverage through another plan (and only Medicaid through CareSource MyCare Ohio), your PCP must be designated through your Medicare plan. Contact your Medicare plan to choose your PCP. Make sure that any specialists you see are part of your Medicare plan’s network of providers.
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 location on the back of their CareSource member ID cards 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
- Prepare questions for doctor visits
- Find out more about prescriptions or over-the-counter medicines
- Learn about nutrition and wellness
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/Provider, 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.
- When possible, 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 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. You don’t need to get approval or a referral from your doctor. As soon as possible, typically within 48 hours, you or someone else must tell us about your emergency. 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.
CareSource covers emergency services needed during a declared disaster. Prior authorizations would not be necessary. We know that the situation may require you get care outside of our network. There would be no charge to you if a non-contracted provider was used. A non-contracted provider may not bill you for the service.