Where To Get Care

In order to have your health care services covered by your HAP CareSource plan, you must get them from an in-network provider. The only exceptions are:

  • In cases of emergency;
  • If you need medically necessary, covered emergency or urgent care services when traveling out of our service area; or
  • If you receive services in an in-network facility (like a hospital or outpatient facility) and you get services from an out of network provider.
  • When specifically authorized by HAP CareSource.

You can use our Find a Doctor/Provider search tool to find a network provider or care facility near you. Use the filters in the right column to find in network providers, facilities and pharmacies for your plan. You can search by specific criteria, like a provider’s specialty, foreign language, and more.

HAP CareSource wants you to be happy with your doctor and the network of providers we offer. If you have suggestions that would improve our network, we want to hear from you. Share your ideas with us on the Access Opportunity Form. This form also gives you a chance to tell us about your experience with a provider, like ease of scheduling appointments.

Your Primary Care Provider (PCP)

You must choose a PCP who is an in-network provider. They will treat you for most of your routine health care needs. Visit My CareSource to tell us who you choose for a provider, or to change your PCP. You may also call Member Services to let us know. This helps us ensure that your visits are billed at the PCP cost share level. You can find the most current list of network providers on our Find a Doctor/Provider tool.

Visiting your PCP is a great way to make the most of your health care benefits. It’s cost-effective and helps you get the most value for your money. Going to the same PCP every time helps them get to know you and your needs. With regular visits, your PCP can:

  • help you stay healthy,
  • manage long-term conditions,
  • spot problems before they become serious,
  • decide if you need to see specialists* or hospital admission for serious needs,
  • prescribe medication found on the HAP CareSource Formulary, and
  • send 90-day prescriptions through Express Scripts our mail order pharmacy.

Talk to your PCP’s office to find out more about your care options. They may offer telehealth visits or after-hours care. You are not required to get a referral from your PCP before you see many types of specialists.

Where to Get Care After Hours

You can get the care you need when you need it. If your doctor’s office is closed or you’re very sick or hurt, you have options. If it’s an emergency, call 911 or go to the nearest hospital or emergency department.

24-Hour Nurse Advice Line

The 24-Hour Nurse Advice Line gives you around-the-clock access to a caring and experienced staff of registered nurses. Call the toll-free number located on your member ID card, 24 hours a day, 7 days a week, 365 days a year. Our nurses can help you:

  • Decide when self-care, a doctor visit or the emergency room is appropriate
  • Understand a medical condition or recent diagnosis
  • Find out more about prescriptions or over-the-counter medicines

Telehealth

Your PCP may offer telehealth. This means you can talk to them by phone or computer from home. Talk to your PCP to see if it’s right for you. If your PCP doesn’t offer telehealth, you have other options.

Teladoc® is a telehealth service. It’s easy and safe to use 24/7. You can meet with a doctor anytime, anywhere. You and your family can get the care you need easily. Telehealth services include general medical and behavioral health visits.

GET MORE DETAILS ABOUT TELEHEALTH

Convenience Care Retail Clinics

These clinics are available when your PCP may not be available or convenient. You can find these clinics inside many local CVS® and Walmart® stores. Common care includes minor injuries, illness and immunizations. This is not an emergency service but can be used when you can’t get in to see your PCP quickly enough. You can find a Convenience Care Clinic near you by searching “clinics” in our Find a Doctor/Provider tool.

Urgent Care Clinics

Urgently needed care is care you get for a sudden illness, injury or condition that isn’t an emergency, but needs care right away.

If you need to get urgently needed care, you can:

  • Call your PCP for advice.
  • Call our 24-Hour Nurse Advice Line.
  • Go to a network urgent care center listed in our Find a Doctor/Provider tool.

After you go, always call your PCP to schedule follow-up care.

When you are temporarily outside the service area, you might not be able to get care from a network provider. In that case, our plan will cover urgently needed care you get from any provider within the United States or its territories.

Outpatient and Ambulatory Surgical Centers

You may need a test or surgery that can be performed at an outpatient center, also known as an ambulatory surgical center or ASC. Tests like colonoscopies, mammograms, and MRIs are done at these facilities at much lower costs to you. Simple procedures like knee replacements, shoulder surgeries and more are routinely done at ASCs every day.

You can save over 60% by having tests and procedures done at centers like these.  Navigate Learn more about outpatient centers and ASCs.

Emergency Services

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. Some examples include:

  • Severe chest pain.
  • Stroke symptoms like trouble speaking, numbness in face, arm and leg, or severe headache.
  • Loss of consciousness.
  • Major burns.
  • Uncontrolled bleeding.
  • Miscarriage/pregnancy with vaginal bleeding.

Emergency care is covered both in and out of our service area, within the United States. You do not have to contact HAP CareSource before you get emergency services. If you have an emergency, call 911 or go to the nearest emergency room (ER) or other appropriate setting.

Emergency Services are the most expensive out of pocket cost for members and should be used only when you have a true medical emergency. If you are unsure of whether you should get emergency care, please call your PCP or our 24-Hour Nurse Advice Line.

When You are Outside of our Service Area

If you receive emergency care from a provider who is not a network provider, or urgent care services outside the service area, you may need to submit the bill you receive to HAP CareSource with a claim form. You may download a claim form on the Forms page or call Member Services for a printed copy.

If you have additional questions about where to get care after hours or outside the service area, refer to your Member Handbook or Evidence of Coverage for your HAP CareSource plan.