When you join AmeriHealth Caritas Louisiana Health Plan, you choose a Primary Care Provider (PCP). Think of this as your medical home.
Your PCP is your family doctor, or the doctor you regularly see. This is your medical home. Your PCP takes care of your health care and will help you get care from other health care providers when needed. This is called "coordination of care." Coordination of care makes sure you get the care you need when you need it. This is why having a medical home is so important.
You can choose the same PCP for your whole family or you can have a different PCP for each family member. There are different kinds of providers who can be PCPs, including:
Some PCPs have trained health care assistants that you may see during an appointment, such as:
Please call Member Services if you need help finding a PCP.
PCP Auto Assignment
If you do not choose a PCP for you and your family within 10 days of enrollment, a PCP will be assigned to you. If we need to assign a PCP to you we will:
You can change your PCP at any time and for any reason.
In some cases, if you have a life-threatening, degenerative or disabling disease or condition, or if you have other special needs, you may be able to choose a specialist as your PCP. For more information, please call Member Services.
As your medical home, your PCP will help you stay healthy.
By having regular visits with your PCP, he or she will be able to:
You can call your PCP for medical problems 24 hours a day, 7 days a week.
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 ahead of time and let the office know. Try to give the PCP's office at least 24 hours notice if you need to change your appointment. Your time waiting to see the provider should not regularly be more than 45 minutes.
AmeriHealth Caritas Louisiana covers your visits to PCPs in our network. There is no limit to how many times you can visit your PCP.
To stay healthy, you should get check-ups on a regular basis. Your PCP must schedule your check-up within 6 weeks of when you call to make an appointment for a check-up. When you have regular check-ups, it helps make your PCP your medical home.
Non-urgent sick care is when you need to see your PCP, but it is not urgent or an emergency. Call your PCP to make an appointment. Your PCP must schedule an appointment for you within 72 hours of your call. Your PCP will need to see you sooner if your condition gets worse.
If you have a special health problem, your PCP may send you to a specialist. A specialist is a doctor trained to treat certain health problems. Specialists can include:
A referral is not a prescription. You will probably need a referral to see a specialist. Talk to your PCP.
In most cases, you will need to get a referral from your PCP to see a specialist. Please see the "Referrals" for more information. Your PCP can help you choose a specialist and make an appointment. You can get a list of AmeriHealth Caritas Louisiana specialists by calling Member Services.
If you would like to have more information about our AmeriHealth Caritas Louisiana providers, call Member Services. You can find out information like where they went to medical school, where they did their residency and if they are board certified.
AmeriHealth Caritas Louisiana covers your visits to specialists in our network. There is no limit to how many times you may see the specialist. Remember to get a referral if one is needed from your PCP before you visit a specialist. The specialist should schedule your first visit within 1 month of the referral, or sooner if medically needed.
If the specialist thinks you need surgery or other special treatment, you can ask to see another specialist. This is called a “second opinion.” If you want a second opinion, ask your PCP for a referral to another specialist in a different practice within the AmeriHealth Caritas Louisiana network. A second opinion is a covered service.
Visits to specialists who are not in the AmeriHealth Caritas Louisiana network will need to have prior authorization (prior approval) from AmeriHealth Caritas Louisiana. Your PCP has a special number to call to get prior authorization. Ask your PCP to help you.
If AmeriHealth Caritas Louisiana does not have at least 2 specialists to choose from who can treat your health problem, you have the right to ask to see a specialist who is not in the AmeriHealth Caritas Louisiana network. Talk to your PCP about this.
If you have questions about out-of-network specialists, please call Member Services.