Using Your Primary Care Provider
How to get regular health care
“Regular health care” means exams, regular checkups, shots, or other treatments to keep you well. Providers give you advice when you need it and refer you to the hospital or specialists when needed. You and your primary care provider (PCP) work together to keep you well or to get you the care you need.
Day or night, your PCP is only a phone call away. Be sure to call your PCP whenever you have a medical question or concern. If you call after hours or on weekends, leave a message with where or how you can be reached. Your PCP will call you back as quickly as possible. Remember, your PCP knows you and knows how your health plan works.
Your PCP will take care of most of your health care needs, but you must have an appointment to see your PCP. If ever you cannot keep an appointment, call to let your PCP know.
Making your first regular health care appointment
As soon as you choose or are assigned a PCP, call to make a first appointment. There are several things you can do to help your PCP get to know you and your health care needs. Your PCP will need to know as much about your medical history as possible. Make a list of your medical background, any problems you have now, and the questions you want to ask your PCP.
If you take any medicines or supplements, bring them with you to your visit. In most cases, your first visit should be within three months of you joining the plan.
If you need care before your first appointment
Call your PCP’s office to explain your concern. Your PCP will try to give you an earlier appointment. You should still keep the first scheduled appointment to talk about your medical history and ask questions.
It is important to AmeriHealth Caritas Ohio that you can visit a PCP within a reasonable amount of time, depending on what the appointment is for. When you call for an appointment, use the Appointment Guide below to know how long you may have to wait to be seen.
| If you call for this type of service: | Your appointment should take place: |
|---|---|
| Adult preventive care (services like routine health checkups or immunizations) | Within six weeks |
| Pediatric preventive care | Within 14 days for members younger than 6 months; within 30 days for members 6 months or older |
| Urgent care services (care for problems like sprains, flu symptoms, or minor cuts and wounds) | 24 hours, 7 days a week within 48 hours of request Within 48 hours of request, available 24 hours a day, seven days a week |
| Emergency or urgent care requested after normal business office hours | Immediately (available 24 hours a day, 365 days a year) |
| Initial prenatal visit (first or second trimester) | First appointment within seven calendar days; follow-up appointments no more than 14 calendar days after request |
| Initial prenatal visit (third trimester or high-risk pregnancy) | Within three calendar days |
| Dental appointment (routine and preventive care; non-urgent or emergency) | Within six weeks |
| Behavioral health | |
| Routine services | Within 10 business days or 14 calendar days, whichever is earlier |
| Urgent care services | 24 hours, 7 days a week within 48 hours of request Within 48 hours of request, available 24 hours a day, seven days a week |
| Emergency services (services to treat a life-threatening condition) | Within six hours |
| Mobile crisis management services | Within 30 minutes |
| Substance use disorders | |
| Routine services | Within 14 days |
| Urgent care services | 24 hours, 7 days a week within 48 hours of request Within 48 hours of request, available 24 hours a day, seven days a week |
| Emergency services (services to treat a life-threatening condition) | Immediately (available 24 hours a day, 365 days a year) |
If you are having trouble getting the care you think you need within the time limits described above, call Member Services at 1-833-764-7700 (TTY 1-833-889-6446).
At your appointment
It is important to be on time for your appointment. If you are going to be late or need to cancel your appointment, call the PCP's office and let the office know. If you need to reschedule, try to let the PCP's office know at least 24 hours before the appointment.
At your visit your PCP may:
- Learn your health history and keep your records up to date.
- Answer questions about your health.
- Give you information about healthy eating and diet.
- Give you the shots and screenings you need.
- Help you get care from other providers, if you need it.
- Find problems before they become serious.
- Give Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for members younger than 21 years old.
- Give preventive treatment for conditions like diabetes, high blood pressure, asthma, and heart disease.
Listen carefully to any directions the PCP gives you. If there is something you do not understand, ask for help.
We can help you pick a PCP or set up an appointment. Call AmeriHealth Caritas Ohio Member Services, 24 hours a day, seven days a week, at 1-833-764-7700 (TTY 1-833-889-6446).
Choose your primary care provider with a click. Sign up for the member portal today.