Get the care you need, when you need it
Know where to go
Your health care needs don’t always follow a schedule. Learn where to go when you or your family needs care, no matter what time or day it is.
Your primary care provider (PCP)
Your primary care provider (PCP) is the doctor that you’ll see for most of your health care needs. When you’re sick or hurt, always call your PCP first (unless it’s an emergency). Even if you call after hours, someone from the office should be on call and able to help.
Your PCP is listed on your member ID card and in your online profile.
He or she will:
- Get to know you and your health history.
- Work with you to find specialists, treatment plans and medicines when needed.
If you haven’t seen your PCP before, call and make a new patient appointment as soon as you can. It’s a good idea to see your doctor when you’re well, so he or she can better treat you when you aren’t.
Change your PCP anytime
- To find a PCP in your plan, use our Find a Doctor search tool.
- To change your PCP, call the Customer Care Center at 1-866-781-5094 (TTY 1-866-773-9634).
If your PCP or specialist is no longer part of the Healthy Blue network, we will mail a letter to notify you. If we know in advance that the provider is leaving the network, you will receive the letter at least 30 days before the effective date. If we learn the provider is leaving after the fact, we will send the letter as soon as possible. We will make a good faith effort to send notification within 15 days after we learn of the provider’s termination. If we are unable to send the letter within 15 days, you will receive it within 30 days.
Health issues can come up when you least expect them. Our toll-free 24-Hour Nurseline lets you talk with a registered nurse whenever you have health questions or need medical advice — day or night, holidays and weekends.
1-866-577-9710 (TTY 1-800-368-4424)
Our nurses are here to:
- Advise you on where to go when you need care.
- Help you with any health questions you have.
- Find a doctor after hours or on weekends.
An urgent health condition is when care is needed for a sudden illness, injury or condition that is not an emergency but needs to be treated right away. There are no copays for urgent care visits covered by Medicaid.
You may need urgent care if you have:
- Minor burns.
- A very sore throat.
- An injury from a fall.
- Frequent vomiting.
- A cut that’s deep enough to need stitches.
- A fever over 101 degrees Fahrenheit.
- Muscle sprains or strains.
If you need urgent care
- During normal clinic hours, call your PCP. Their number is listed in your online profile.
- After hours and on weekends, visit an urgent care center.
Emergencies are times when there could be serious danger or damage to your health if you don’t get medical care right away. If you need emergency care, call 911 or go to the nearest hospital emergency room (ER). Preapprovals are not needed for emergency care. There are no copays for emergency services covered by Medicaid.
Go to the ER if you:
- Have chest pains.
- Have trouble breathing.
- Are bleeding badly.
- Are pregnant and have signs of harm to yourself or your baby like pain, bleeding, fever or vomiting.
- Feel like you might hurt yourself or someone else.
After an ER or urgent care visit
Call your PCP as soon as you can after you visit the ER or urgent care center. Your PCP can help with your follow-up care. Their number is listed in your online profile.
Not sure if it’s an emergency?
Call our 24-Hour Nurseline at 1-866-577-9710 (TTY 1-800-368-4424). Our nurses can tell you whether you need emergency care or help you find an urgent care center.