How to Get Primary Care Services

Choosing a Primary Care Provider

All INTotal Health members must have a regular healthcare practitioner (doctor), also called a Primary Care Provider (PCP). Your PCP must be in the INTotal Health network. Your PCP will get to know you and your health history and be able to help you get quality care. Your PCP will give you all of the basic health services you need. He or she will also send you to other providers or hospitals when you need special care. Your PCP or other provider will make hospital arrangements for you if you need to be hospitalized. 
 
When you enrolled in INTotal Health, you should have chosen a PCP. If you did not, we chose one for you. We chose one whose office is near to the address you gave the state when you applied for Medicaid. This PCP’s name and phone number are on your INTotal Health ID card. If we assigned a PCP to you, you can still choose a different one whenever want. Just look at the Provider Directory here on our website to choose the PCP you prefer. Then call us or contact us via this website to let us know the PCP you prefer.
 
We can also help you choose a different PCP. Call Member Services for help at 1.855.323.5588. If you already have a PCP you like, look in the Provider Directory on this website to see if that PCP is in our network. If so, you can tell us you want to keep that PCP. Family members do not have to have the same PCP. PCPs can be any of the following as long as they are in the INTotal Health network:
 
• General practice practitioners
• Family practice practitioners
• Internists
• Pediatricians
• Specialists who provide primary care (obstetrician/gynecologists)
• Federally Qualified Health Centers, Rural Health Clinics, or other health clinics
• Other providers approved by the Department
• Any member who is identified as an Indian may receive healthcare services from a participating Indian Health Provider.

Specialist

Your PCP can take care of most of your healthcare needs, but you may also need care from other kinds of providers. INTotal Health offers services from many different kinds of providers that provide other medically needed care. These providers are called specialists because they have training in a special area of medicine.

Some examples of specialist include:

• Allergists (allergy specialists)
• Dermatologists (skin specialists)
• Cardiologists (heart specialists)
• Podiatrists (foot specialists)

Your PCP may refer you to a specialist in our network if your PCP cannot give you the care you need. Even though a referral is not required by INTotal Health for you to see a specialist, it is a good idea to get a referral from your PCP. A referral form tells you and the specialist what kind of healthcare you need. Be sure to take the referral form with you when you go to the specialist.

If you have an emergency, you should call 911 or go to the nearest hospital emergency room right away. If you want advice, call your Primary Care Provider (PCP) or our 24-hour Nurse HelpLine at 1.855.323.5588. The most important thing is to get medical care as soon as possible. You should be able to see a provider immediately for emergency care.

Behavioral Health (Mental Health) Services

Sometimes the stress of handling the many responsibilities of a job, home and family can lead to depression, anxiety, marriage and family problems, parenting problems, and alcohol and drug abuse. If you or a family member is having these kinds of problems, INTotal Health has providers in its network who can help. You can also call INTotal Health Member Services for help. You can also get the name of a provider who will see you if you need one. All services and treatments are strictly confidential. You do not need a referral from your PCP to get these services.
 
Mental health services are covered, including:
• Inpatient mental healthcare
• Outpatient mental healthcare services, including group, individual and family therapy
• Temporary detention orders (unless the member is between age 21 and 64 and is admitted to a freestanding psychiatric facility)