On February 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.
Your Options for Getting Care: When to Visit Urgent Care, the ER, and More
Always call 911 and go to the ER if you think you’re experiencing a serious or life-threatening injury or illness.
It can be difficult to know what to do when you aren’t feeling well and need care. This webpage can help you learn more about your options and make the right choice for your health.
You have many options available to get care including:
- Your Primary Care Provider (PCP), also called your “personal doctor”
- Walk-In Clinics
- Urgent Care Center
- Hospital or Emergency Room
- The 24/7 Nurse Advice Line
- Telehealth and Virtual Care
Watch this video to learn more about your healthcare options »
Appointment
Needed: Yes
Your Primary Care Provider (PCP)
Your Primary Care Provider (PCP) is your personal doctor that can help you with your healthcare needs.
Your doctor is your go-to provider when you aren’t feeling well or have a concern about your health. Appointments are needed and your doctor may only be available during normal business hours.
Your Primary Care Provider is your first stop for getting care.
You should schedule an appointment with your doctor any time you aren’t feeling well or need general medical care, like when you need an Annual Wellness Visit, a check-up, Annual Physical, or are experiencing other health issues.
Primary care doctors can diagnose and help you to manage medical conditions like high blood pressure, diabetes, and heart disease.
Your doctor can also:
- Give you personalized health advice
- Write prescriptions for medications
- Schedule health screenings, tests, and bloodwork
- Refer you to specialists when you need them
Appointment
Needed: No
Walk-In Clinic
Walk-in clinics offer fast, convenient access to medical care.
Walk-in clinics are also called “retail clinics,” and can often be found inside stores or pharmacies. Some walk-in clinics include CVS MinuteClinic and MedExpress. These clinics are often staffed by physician assistants and nurse practitioners.
If you have a minor illness or injury, you can visit a walk-in clinic.
Walk-in clinics are a good option when you are not feeling well, but it’s not serious enough for the emergency room or urgent care.
A walk-in clinic may provide a more affordable option for basic medical care than an emergency room. Walk-in clinics do not take appointments and offer care on a first come, first served basis.
Walk-in clinics can help with most minor illnesses and injuries, such as:
- Cough and cold symptoms
- Mild flu-like symptoms
- Sore throat
- Ear pain
- Rashes without fever
- Eye redness, discharge, or itchiness
- Painful urination
Appointment
Needed: No
Urgent Care Center
Urgent care centers are same-day clinics. They can handle a variety of medical problems and injuries that need to be treated right away but are not life-threatening emergencies.
Urgent care centers usually have extended hours and may be open on evenings and weekends.
Many urgent care centers do not take appointments and offer care on a first come, first served basis.
If you’re sick or injured and need same-day care, you should visit an urgent care center.
Urgent care centers are a great option if you can’t get an appointment with your doctor. Make sure to visit an urgent care center that’s in your plan’s network to save on any out-of-pocket costs.
An urgent care center can help with symptoms like:
- Sprains and strains
- Small cuts that may require stitches
- Cough and cold symptoms
- Sore throat
- Ear pain
- Moderate flu-like symptoms
- Fever without a rash
- Vomiting
- Abdominal pain
- Dehydration
Make sure that any urgent care center or walk-in clinic you visit is in your plan’s network to avoid out-of-pocket costs.
To find an in-network urgent care or walk-in clinic near you, visit the Find a Provider tool in your secure member portal.
Walk-in clinics and urgent care centers offer quick service and low-cost options to get care, but they are not a replacement for your primary care doctor.
Urgent care centers and walk-in clinics are not emergency care.
Appointment
Needed: No
Hospital or Emergency Room (ER)
If you think you’re experiencing a serious medical problem or mental health crisis that may result in the loss of life or limb, call 911 or go to the emergency room right away.
Hospitals and emergency rooms handle the most serious illnesses and injuries that need urgent medical attention.
Symptoms that should be seen in an emergency room include:
- Chest pain or difficulty breathing
- Wheezing or shortness of breath
- Weakness or numbness on one side
- Slurred speech
- Fainting or a change in mental state
- Serious burns
- Head or eye injury
- Broken bones and dislocated joints
- Fever with a rash
- Seizures
- Severe cuts that may require stitches
- Severe cold or flu symptoms
- Vaginal bleeding
- Suicide attempts or thoughts
Appointment
Needed: No
24/7 Nurse Advice Line
As a member, your plan includes access to the free 24/7 Nurse Advice Line. When you need medical advice or have basic health questions, you can call the Nurse Advice line at any time to speak to a registered nurse.
The nurse line is available 24 hours a day, 7 days a week.
The nurse will provide a clinical assessment to help you make the best choice for your health, whether it’s a doctor's appointment, a telehealth referral, or a visit to the emergency room.
The nurse line is available 24 hours a day, 7 days a week so you can call any time to get medical advice.
Whether you have a general health question, a question about medications, or a health issue and don’t know where to go, a registered nurse can help.
Registered nurses can answer your questions about:
- Your symptoms and how you’re feeling
- Deciding between going to urgent care center, doing a telehealth virtual visit, going to the emergency room, or waiting to go see your doctor
- Home treatment options and advice
You can call the phone number listed for the Nurse Line on the back of your Member ID Card at any time 24 hours a day, seven days a week.
Appointment
Needed: Yes
(Same-day apointments
are usually available)
Telehealth (Virtual Care)
Telehealth, or virtual care, allows you to speak with a doctor, nurse, or therapist by phone or video. With telehealth, you don’t need to leave the comfort of your home for some healthcare services.
During your virtual visit, you use your computer, phone, or tablet to meet with a doctor or another medical professional. They will discuss your symptoms, recommend treatment, and can write a prescription if you need one. You can choose to meet with the doctor over the phone or on a video call—whichever works best for you!
As a member, you have access to Teladoc. With Teladoc, you can access care 24/7 from the comfort and safety of home. During the visit, you will speak with a medical provider over the phone or by video call.
Learn more about your telehealth options.
Telehealth appointments are a good option if you don’t have a reliable way to get to the doctor or live far away from your doctor’s office.
Telehealth appointments are also a great way to get care if you’re traveling and are away from home.
Some common issues a telehealth appointment can help with include:
- Minor cold and flu symptoms
- Rashes and other skin issues
- Ear infections
- Urinary tract infections
- Heartburn and digestive issues
- Mental health struggles, like stress, anxiety, depression, and grief
Frequently Asked Questions (FAQs)
Always keep your Member ID Card with you – it’s the key to receiving the care you need. If you’re dually enrolled in Medicare and Medicaid, make sure to bring both ID cards* with you.
You will also need your photo ID, like a driver’s license or state ID card, and a form of payment if you have a copay, need a prescription or have other costs for care.
Wherever you go for a medical visit, you should bring lists of:
- Your medications, including over-the-counter medicine, like pain relievers, vitamins, and supplements
- Your allergies, including any food, drug, or material allergies (for example: peanut allergies, penicillin allergies, latex allergies)
- Any major medical procedures or surgeries you’ve had, like heart bypass surgery or joint replacement surgery
*Some dual eligible special needs plans (D-SNP) use a single ID card for both Medicare and Medicaid
An urgent care center is very similar to a walk-in clinic, but with more resources. For example, urgent care centers usually have X-ray equipment on site and can handle more serious problems like broken bones or burns. Both walk-in clinics and urgent care centers are there to help patients get medical care without having to go to a hospital or emergency room.
Urgent care centers usually have at least one medical doctor available to see patients anytime they are open. Walk-in clinics are usually staffed by nurse practitioners and physician assistants.
If you visit a provider, clinic or facility that is not part of your plan’s network, any services you get may not be covered by your plan. Make sure any medical facility or provider you visit is in your plan’s network to save on out-of-pocket costs.
You can call the office before your appointment to confirm they accept your insurance and are in network. If you have a PPO plan, these limitations may not apply.
You can find details about what your plan covers by checking your plan’s Summary of Benefits document. You can also contact Member Services at the number on the back of your member ID card.
Learn more about what you can find in your member documents.