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Understanding Where to Go for Care
Some visits should be scheduled even when you’re feeling just fine. Others need to be scheduled when
you have a medical problem or concern. These problems can vary in degree of urgency. We think it’s
useful to offer a guide to help you decide where to go for the kind of care you need.
Continuity of Care
If you’re in an active course of treatment with an unaffiliated doctor, we provide continuity of care.
This means we will work with you and your doctor to move your care to an affiliated doctor when it is
safe to do so.
Here’s how it works:
1. Continue to see your current doctor for regular visits to track your condition and receive
direct treatment
2. Your current doctor prescribes your drugs and monitors your treatment plan
3. A nurse will call you and your doctor to talk about the diagnosis, history and current treatment
plan, reviewing the information and coordinating your care
4. We will move you to an affiliated doctor when it is safe to do so
To get things started, call Customer Service. When you call, be sure to have this information
handy, so we can send it to our medical team:
• Your name, address and phone number
• Your ID number
• Active coverage date
• The name, address and telephone number of the doctor who is currently treating you
Hospital Services
You must have prior authorization before being admitted to a hospital. Hospital services should be
coordinated with your PCP. This is a review process to ensure that you meet the criteria for elective or
emergency admissions before going into the hospital.
Where to Go for Care Guide
Visit Type
Care Needed Where to Go
Wait Time
From Phone
Call to Visit
Well Visits/
Annual Exams
Routine checkups
scheduled at
regular times, such
as once a year
Your PCP
Within 30 days
Office Visits
Non-urgent office
visits with mild
symptoms, like a
sore throat
Your PCP
Within 4 days
Care needed
outside of your
PCP’s or doctor’s
office’s normal
business hours
Call your PCP
office to find out
where to seek care
or how to get in
touch with a nurse
or doctor. You
may also go to an
affiliated urgent
care center.
Urgent Care
Serious but
injury or illness,
like sprained
ankles and minor
Your PCP or any
affiliated urgent
care center
Same or next
Go to
or call Customer Service for a
list of affiliated urgent care centers. You can
use any affiliated urgent care center. Check
your ID card for any cost-sharing amounts.
An illness, injury,
symptom or
condition so
serious that
a reasonable
person would
seek care right
away to avoid
severe harm
Go to the nearest
emergency room
immediately or
call 911
You can get
emergency care
right away, 24
hours a day,
seven days a
week, at any
If you are admitted to a hospital not affiliated
with us after an emergency, be sure to call the
number on the back of your ID card within 48
hours to ensure payment for services. You may
be transferred to an affiliated hospital when you
are stable. If you decide to refuse the transfer,
you will be responsible for the payment of your
Specialty Care
with specialists
for care not
provided by your
For a
call your PCP
Talk with your PCP first in order to schedule an
appointment with a specialist. Your PCP has
good working relationships with many highly
qualified specialists.