Where To Get Care

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 emergency or urgent care services when traveling out of our service area; or
• If you receive services in an in-network facility (like a hospital or outpatient facility) and you get services from an out of network provider.
• When specifically authorized by CareSource.

You can use our Find a Doctor/Provider search tool to find a network provider or care facility near you. Use the filters in the right column to find in network providers, facilities and pharmacies for your plan. You can search by specific criteria, like a provider’s specialty, foreign language, and more.

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. This form also gives you a chance to tell us about your experience with a provider, like ease of scheduling appointments.

Your Primary Care Provider (PCP)

You must 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 tell us who you choose for a provider, or to change your PCP. You may also call Member Services to let us know.

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 get the most value from your health care dollar. When you tell CareSource who you have chosen to be your PCP, it helps us to make sure that your visits are billed at the PCP cost share level.

Going to the same PCP each time you need care will help your provider get to know you and your needs. The more familiar your provider is with you and your medical history, the better they will be able to treat you. With regular visits, your PCP can help you stay healthy, manage chronic conditions and identify any concerns before they become an issue. Your provider may offer telehealth visits and after-hours care. Talk with your provider’s office to find out more about your options for care.

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 needed, your PCP should prescribe medication on the CareSource Formulary to ensure it will be covered and you get the best price possible. You can also ask your PCP or other prescriber to send 90-day prescriptions to ESI, our mail order pharmacy to get the best cost for medications you will be taking for 90 days or longer.

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 still have options. If you have an emergency, please call 911 or go to the nearest hospital or emergency department.

CareSource24 Nurse Advice Line

CareSource24^® gives you around-the-clock access to a caring and experienced staff of registered nurses.

Call the CareSource24 toll-free number located on your 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

Telehealth

Your PCP may offer telehealth. Telehealth visits can be by phone or computer, giving you the ability to talk to your provider without exposing yourself or loved ones to the office waiting room or other people’s illnesses. Of course, not all visits are appropriate for telehealth. Talk to your provider about whether some telehealth visits may be right for you and how to set up a telehealth visit.

Your PCP’s office may have an after-hours phone number you can call to talk to an on-call doctor. You can also call the CareSource24 Nurse Advice Line. They can help you determine the best course of action for your symptoms. They may transfer you to Teladoc^® if that is the right option for you.

Teladoc is a health care service that offers easy, secure 24/7 access to doctors who will consult, diagnose and prescribe medicine for you (when needed) through your phone or computer. Meet with a doctor anywhere, anytime. It is easy for you and your family to get the care you need. In addition, your telehealth services include general medical and behavioral health visits.

Call 1-800-TELADOC (835-2362), visit www.Teladoc.com/CareSource, or download the Teladoc app from Google Play^® or the App Store from Apple^®.

GET MORE DETAILS ABOUT TELEHEALTH

Urgent Care Clinics

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 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 temporarily 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.

Outpatient and Ambulatory Surgical Centers

You may need a test or surgery that can be performed at an outpatient center, also known as an ambulatory surgical center or ASC. Tests like colonoscopies, mammograms, and MRIs are done at these facilities at much lower costs to you. Simple procedures like knee replacements, shoulder surgeries and more are routinely done at ASCs every day.

You can save over 60% by having tests and procedures done at centers like these.  Learn more about outpatient centers and ASCs.

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:

• Severe chest pain.
• Stroke symptoms like trouble speaking, numbness in face, arm and leg, or severe headache.
• Loss of consciousness.
• Major burns.
• Uncontrolled bleeding.
• Miscarriage/pregnancy with vaginal bleeding.

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 OK 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 PCP or the CareSource24 Nurse Advice Line.

Emergency Services are the most expensive out of pocket cost for members, and should be used only when you have a true medical emergency. If you are unsure of whether you should get emergency care, please call our CareSource24 Nurse Advice Line.

When You are Outside of our Service Area

Prior to seeking emergency care, we encourage you to call your PCP or CareSource24 for guidance, but this is not required. If you need emergency care – please seek immediately. You should get emergency and 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 may need to submit the bill you receive to CareSource with a claim form. You may download a claim form on the Forms page or call Member Services for a printed copy.

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