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 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 a PCP is one of the most cost effective ways to access your benefits – ensuring you are getting the most value from of your health care dollar. When you tell CareSource who you have chosen to be your Primary Care Provider, it helps to ensure that your visits are billed at the PCP cost share level.
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
CareSource24® Nurse Advice Line
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
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 MYidealDOCTORTM.
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
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.
If you have additional questions about where to get care after hours or outside the service area, refer to the Member Handbook or Evidence of Coverage for your CareSource plan.