Getting Care
AmeriHealth Caritas Ohio will pay for your care for covered services when you meet required terms and conditions and go to one of our healthcare providers. We call these providers our "network" providers. Network providers are providers that we have contracted with to provide healthcare services. You can find a network provider in our online provider directory.
A provider who is not one of ours is called "out-of-network." If you go to one of these providers, you may have to pay for the care you get.
When you are sick
- Using your primary care provider (PCP)
Your PCP is your regular doctor. Visit your PCP for checkups, exams and more. - Emergencies and urgent care
Urgent care is for conditions that are serious, but are not emergencies. If you have a health emergency, call 911 now. If you or someone you know is experiencing a mental health or addiction crisis, call, text, or chat 988 in order to reach a trained specialist who can offer help and support. Your call is confidential and free 24/7. - Care when you are away from home
There are times when you will need care while you are away from home. Here is what you should do. - How to stay healthy after your hospital stay
Some people end up back in the hospital soon after their stay. Here are some tips about how you can work to stay healthy. - 24/7 Nurse Call Line
Do you have a question about your health? Call our 24/7 Nurse Call Line at 1-833-625-6446 (TTY 1-833-889-6446). - MDLIVE and telehealth services
Specialized care
- Healthchek children's services
Help to make sure your children get the medical care they need and find out about childhood diseases and illnesses early. - Care for pregnant members
Get information about finding care while you're expecting. - Your Care Manager
Our Care Managers can help you to manage your physical or behavioral healthcare needs. - Seeing a specialist
Your PCP may send you to a specialist for some of your care. - Preauthorizations
We may need to approve some services before you visit a provider. - Coverage types and services not covered
Find out more about what is and isn’t covered by our plan. - Clinical practice guidelines
These help us when making your treatment decisions. - Continued care
- If you get ongoing treatment from a provider who is not in the AmeriHealth Caritas Ohio network, you may be able to continue that treatment under certain circumstances.
- Lead screenings
Exposure to lead, a toxic metal, can be dangerous. Lead screenings are an important measure to keep you and your family healthy.
New technology
AmeriHealth Caritas Ohio wants members to have safe and effective care.
- AmeriHealth Caritas Ohio evaluates new technology, including medical procedures, drugs and devices, and the new application of existing technology, for coverage determination.
- The AmeriHealth Caritas Ohio Medical Director and/or medical management staff may periodically identify relevant technological advances for review pertinent to the AmeriHealth Caritas Ohio population.
- The Clinical Policy Committee (CPC) reviews requests for coverage of new technology or new uses for existing technology to determine whether they are medically necessary.
- AmeriHealth Caritas Ohio uses nationally recognized technology guidelines from scientific journals and the Centers for Medicare & Medicaid Services (CMS).
- When a request is received for coverage of new technology that has not been reviewed by the CPC, the AmeriHealth Caritas Ohio Medical Director will review the request and make a one-time determination. This new technology request will then be reviewed at the next regularly scheduled CPC meeting.
- If you have any questions about your membership or what AmeriHealth Caritas Ohio has to offer, please call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.
If you have any questions about your health, you can call our 24/7 Nurse Call Line at 1-833-625-6446 (TTY 1-833-889-6446).
If you have questions about your benefits or AmeriHealth Caritas Ohio, call AmeriHealth Caritas Ohio Member Services at 1-833-764-7700 (TTY 1-833-889-6446).