Benefit Types and Services
Benefits you can get from AmeriHealth Caritas Ohio or a Medicaid provider
For some services, you can choose where to get the care. You can get these services from providers in the AmeriHealth Caritas Ohio network or from another Medicaid provider. You do not need a referral from your primary care provider (PCP) to get the following services. If you have any questions, talk to your PCP or call Member Services at 1-833-764-7700 (TTY 1-833-889-6446), 24 hours a day, seven days a week.
Early and Periodic Screening, Diagnostic, and Treatment
Plan members younger than 21 can get any treatment or health service that is medically necessary to treat, prevent, or improve a health problem. This special set of benefits is called Early and Periodic Screening, Diagnostic and Treatment (EPSDT).
Healthchek is Ohio’s EPSDT benefit. It is available at no cost to members.
If you have questions or need help with accessing benefits you can only get through Medicaid, talk with your PCP or call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
Services not covered
These are examples of some of the services that are not available from AmeriHealth Caritas Ohio or Medicaid. If you get any of these services, you may have to pay the bill:
- Behavioral health services for members enrolled in the OhioRISE plan, including those rendered by federally qualified health centers (FQHCs) and rural health clinics (RHCs)
- Abortions except in the case of a reported rape or incest, or to save the life of the mother.
- Biofeedback services
- Experimental services and procedures, including drugs and equipment, not covered by Medicaid and not in accordance with customary standards of practice
- Infertility services for males or females, including reversal of voluntary sterilizations
- Plastic or cosmetic surgery
- Services determined by Medicare or another third-party payer
- Sexual or marriage counseling
- Voluntary sterilization if member is under 21 years of age or cannot legally consent to the procedure
This list does not include all services that are not covered. To determine if a service is not covered, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
A provider who agrees to accept Medicaid generally cannot bill you. You may have to pay for any service that your PCP or AmeriHealth Caritas Ohio does not approve or cover. Or, if before you get a service, you agree to be a "private pay” or “self-pay” patient, you will have to pay for the service. This includes:
- Services not covered (including those listed above)
- Unauthorized services
- Services provided by providers who are not part of AmeriHealth Caritas Ohio