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. It also includes giving you advice when you need it and referring 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.
Your PCP is always available. Call your PCP when you have a medical question or concern. If you call after hours or on weekends, leave a message and 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, if it is a new provider, 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.
Bring your medicines and supplements with you that you are taking. In most cases, your first visit should be within three months of you joining the plan.
Prepare for your first visit with a new provider
- Request a transfer of medical records from your current provider to your new PCP.
- Make a list of problems you have now, as well as being prepared to discuss your general health, past major illnesses, surgeries and so forth.
- Make a list of questions you want to ask your PCP.
- Bring medications and supplements you are taking to your first appointment.
- It’s best to visit your PCP within three months of joining the plan.
It is important to AmeriHealth Caritas North Carolina that you can visit a PCP within a reasonable amount of time. The table below lets you know how long you may have to wait to be seen.
Appointment guide
| If you call for this type of service: | Your appointment should take place: |
|---|---|
| Adult preventive care (services like routine health checkups or immunizations) | Within 30 days |
| Pediatric preventive care (services like well-child checkups) | 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) | Within 24 hours |
| Emergency or urgent care requested after normal business office hours | Go to a hospital emergency department immediately (available 24 hours a day, 365 days a year) or go to urgent care clinic |
| First prenatal visit (first or second trimester) | Within 14 days |
| First prenatal visit (third trimester or high-risk pregnancy) | Within five days |
Mental health
| If you call for this type of service: | Your appointment should take place: |
|---|---|
| Routine services | Within 14 days |
| Urgent care services | Within 24 hours |
| Emergency services (services to treat a life-threatening condition) | Go to a hospital emergency department immediately (available 24 hours a day, 365 days a year) or go to urgent care clinic |
| Mobile crisis management services | Within 30 minutes |
Substance use disorders
| If you call for this type of service: | Your appointment should take place: |
|---|---|
| Routine services | Within 14 days |
| Urgent care services | Within 24 hours |
| Emergency services (services to treat a life-threatening condition) | Go to a hospital emergency department immediately (available 24 hours a day, 365 days a year) or go to urgent care clinic |
If you are not getting the care you think you need within the time limits described above, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).
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 North Carolina Member Services, 24 hours a day, seven days a week, at 1-855-375-8811 (TTY 1-866-209-6421).