Selecting a Primary Care Provider

When choosing a PCP, consider your special needs. Your PCP may be chosen from the following:

• Family Practice
• General practice
• Internal Medicine
• Pediatrics

Please refer to this Provider Directory for a complete listing. You must select a PCP for each member of your family. This relationship between you and your PCP is very important. Your PCP understands your health care needs. Your PCP is the best person to:

• Coordinate routine or unexpected care
• Oversee preventive care

Your PCP is the best person to determine when you need:

• Tests
• Treatment hospitalization
• Surgery
• The services of a specialist

Female Self Referrals

All female members are allowed to self-refer to certified nurse midwives (CNMs), obstetricians and gynecologists on Buckeye Community Health Plan’s provider panel. In addition, female members are also allowed to self-refer to women’s health specialists on the Buckeye Community Health Plan panel for routine and preventative health care services if their PCP is not a women’s health specialist. For a list of women’s health specialists on Buckeye Community Health Plan’s panel, please call (866) 246-4358 or TTY (800) 750-0750).

What To Do In An Emergency

Emergency services are services for a medical problem that you think is so serious that it must be treated right away by a doctor. We cover care for emergencies both in and out of the county where you live.

Some examples of when emergency services are needed include:

• Miscarriage/pregnancy with vaginal bleeding
• Chest pain
• Loss of consciousness
• Seizures or convulsions
• Sudden shortness of breath or difficulty breathing
• Poisoning
• Broken arm or leg

You do not have to contact Buckeye for approval before you get emergency services. If you have an emergency, call 911 or go to the NEAREST emergency room (ER). If you are not sure whether you need to go to the emergency room, call your PCP or Buckeye’s NurseWise at (866) 246-4358, option 7, TTY at (800) 750-0750). Your PCP or Buckeye’s NurseWise representative can talk to you about your medical problem and give you advice on what you should do.

Remember, if you need emergency services:

• Go to the nearest hospital emergency room, or other appropriate setting.
• Be sure to tell them that you are a member of Buckeye and show them your ID card.
• If the provider that is treating you for an emergency takes care of your emergency but thinks that you need other medical care to treat the problem that caused your emergency, the provider must call Buckeye.
• Call your Buckeye PCP (or ask the hospital to call your PCP) as soon as possible. This lets your PCP know the care you received. Your PCP can then take over coordination of your care. Your PCP must arrange follow-up care within the service area with participating providers.
• If the hospital has you stay, please make sure that Buckeye is called within 24-hours.

Follow-up care must be arranged by your PCP, within the service area with participating providers. If you are unable to return to the service area for follow-up care, after an out of service area emergency, you must contact your PCP for instructions or call Member Services, toll-free at (866) 246-4358.

Transportation

Buckeye offers up to 15 round-trip visits (30 one-way trips) per member per 12-month period to covered healthcare/dental appointments, WIC appointments, and redetermination appointments with your CDJFS caseworker. Members can call TMS directly 48 hours (two business days) in advance at (866) 531-0615 to schedule transportation.