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Getting Medical Care

You have many different healthcare needs.

These needs will come up at different times for different reasons. There are several ways for you to get healthcare, including these:

The following sections offer helpful details of when to use each place of care. In case of an emergency, call 9-1-1.

When you need care, call your Primary Care Provider (PCP) first. Your PCP helps you manage your health services. Need to see another doctor or a specialist? Talk with your PCP. Note: You do not need a referral from your PCP for mental health or substance abuse treatment.

  • Women: In addition to your PCP, you can see a women’s healthcare provider without a referral. For example, you can see an OB/ GYN doctor or a nurse midwife.
  • Children: Pediatricians can be a child’s PCP.

Specialists are doctors who focus on a specific area of medicine. Some doctors focus just on the heart, skin, or bones. Your PCP may refer you to see a specialist if needed. In some cases, a specialist may be assigned as your PCP due to a chronic condition. You do not need a referral to see a specialist, but it’s a good idea to see your PCP first.

Need mental health services? We don’t require a referral if you see a CountyCare provider. Contact any of our mental health providers – the Behavioral Consortium at 312-864-8200. Select 4 for member options, then 1 for behavioral health. Click here to see a list of behavioral health providers.

When you need care sooner than a routine PCP visit, that’s called urgent care. Urgent care, however, is not emergency care. If you need urgent care, call your PCP or our 24-hour nurse advice line at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

Examples of urgent care needs:

  • Most broken bones
  • Minor cuts
  • Sprains
  • Bruises
  • Non-severe bleeding
  • Most drug reactions
  • Minor burns

Emergency care is when you need help right away due to an injury or sudden illness. Emergency care does not require prior authorization or PCP referral.

WHEN SHOULD YOU GO TO THE EMERGENCY ROOM?

If your emergency is sudden or life-threatening, you should call 9-1-1 and go to the emergency room. Examples of emergencies that are sudden or life-threatening:

  • Choking
  • Trouble breathing
  • Suspected poisoning
  • Serious broken bones that break the skin
  • Suspected heart attack
  • Suspected stroke
  • Severe burns
  • Sexual assault
  • Severe or unusual bleeding
  • Sudden loss of vision, speech, or mobility
  • Neck or back injuries
  • Loss of consciousness or fainting
  • Prolonged or repeated seizures
  • Convulsions
  • Unconsciousness
  • Severe pain
  • Health problem that puts pregnant woman or unborn child at risk
  • Immediate fear that you may hurt yourself or someone else

Everyone has questions about their health. If you do and cannot reach your PCP by phone or by having them paged after hours, call our nurse advice line at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).

Here’s what the nurse advice line can give you:

  • Over-the-phone medical advice from registered nurses
  • Around-the-clock help – The line is open 24 hours a day, 7 days a week
  • Help deciding where to go for care

Common nurse advice line health topics:

  • Advice on minor injuries
  • Questions about glucose and insulin
  • Ways to address pressure sores and open wounds
  • Ways to deal with asthma
  • Information about medicine doses
  • Information about headaches
  • Answers to questions about pregnancy and baby issues

  

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