Use Your Coverage | Washington Healthplanfinder

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Use Your Coverage

Body

The Appointment

Before You Make Your First Appointment

If you are a Washington Apple Health client you most likely have “managed care,” which means Washington Apple Health pays a health plan a monthly premium for your coverage, which include preventive, primary, specialty, and other health services. Clients in managed care must see only providers who are in their plan's provider network, unless prior authorized or to treat urgent or emergent care.

All Washington Apple Health plans cover the same basic services, but they have some differences in the way they provide services. Each health plan has its own network of providers, hospitals, and pharmacies. Please verify with the health plan that the providers you prefer are in the plan’s network.

Contact your Washington Apple Health managed care plan to find a doctor or find more information about the plan.

 Amerigroup (AMG)  1-800-600-4441
 Community Health Plan of Washington (CHPW)  1-800-440-1561
 Coordinated Care of Washington (CCW)  1-877-644-4613
 Molina Healthcare of Washington, Inc. (MHW)  1-800-869-7165
 United Healthcare Community Plan (UHC)  1-877-542-8997

 

Make Your First Appointment

Once you're enrolled in a health plan, you'll need to choose a primary care provider (sometimes called a PCP). Your primary care provider might be a doctor, a nurse practitioner, a physician assistant, or a naturopath. Sometimes it’s not just one person— it can be a clinic with several kinds of providers.

Review your health plan for details on using your coverage.

 

Why a Primary Care Provider is Important

Your primary care provider is the main health care professional you see, whether you are sick or getting preventive care. If you need special care that your primary care provider can’t give, they'll refer you to a specialist.

Even if you aren’t sick now, it’s important to choose a primary care provider and to schedule your first appointment. Your primary care provider will help you prevent future health problems and do routine screenings for certain diseases.

 

How to Choose Your Primary Care Provider

You can ask for a male or female primary care provider. You can also ask for a provider who speaks your language, specializes in your disability, or understands your culture.

You can ask for a specific provider, as long as they're in your health plan’s network.

If the provider you want is not in your health plan’s network, ask the provider which health plan they work with. If the other health plan is available where you live, you may be able to change to that health plan.

Your primary care provider should be someone you feel comfortable with. If you aren’t happy with them for any reason, you can choose another provider.

To choose a different primary care provider, follow the directions sent to you by your health plan, call your health plan’s customer service phone number, or visit your health plan’s website.

 

Make an Appointment

You must have an appointment to see a provider. Once you have selected a primary care provider, call their office to make an appointment.

Check the information your health plan sent you to see how to make your first appointment. You should be able to find the provider’s office contact information through your health plan’s website. Or call your health plan’s customer service line and ask for the phone number to make an appointment.

If you have immediate health concerns or needs, you should be able to see your primary care provider within a few days. Even if you don’t have immediate health concerns, make an appointment for a general check-up (also called a wellness check). It takes longer to get an appointment for a general check-up, so don’t put it off.

 

If You Need an Interpreter

If you don’t speak English, professional interpreters are available in many languages, including sign language, at no cost to you. When you make an appointment, let the receptionist know if you need an interpreter. The interpreter can go to the provider’s office or be on the phone during your appointment.

It’s better to use a professional interpreter than to bring a family member or friend to interpret for you. Professional interpreters are trained to understand health care terms and will help you and your provider understand each other.

 

If You have Disabilities

If you have a speech or hearing disability, difficulty communicating, or a mobility impairment, be sure to tell the receptionist about it when you make the appointment. The receptionist will help you make any necessary arrangements.

 

Getting Help with Transportation

If you have no way to get to your health care appointment, you may be eligible for help with transportation. The appointment must be for services allowed by your current health plan. For Washington Apple Health clients, a regional broker contracted by the Health Care Authority will arrange the most appropriate transportation for you. For information on how to request non-emergency medical transportation, visit transportation services.

 

Get Ready for Your Appointment

Make a list of the things you want to talk about with your primary care provider. Your provider can go over the most important things at your first visit.

Take a list of all your prescription medications with you, including vitamins, herbal supplements, and other over-the-counter medications, even aspirin.

Write down any allergies you have to medications, foods, or environmental allergens, such as pollen.

Bring previous medical records, including vaccination or immunization records, if you have them.

 

Go to Your Appointment

Take someone with you. Feel free to take along a family member or friend. That person can help you find your way around or just help you feel more comfortable. Sometimes it’s good to have someone else to listen to what your primary care provider tells you.

Plan to arrive at the provider’s office 15 minutes before your appointment. Check in with the receptionist and fill out any forms given to you. You will need to show your health plan ID card and/or Plan Card for Washington Apple Health (also called a ProviderOne card). You will be asked to show a photo ID, such as a driver’s license.

Parents can stay with their children during the exam. Preteen and teenage kids may see their primary care provider without a parent present. Discuss this with your kids and their primary care provider.

For details about benefits and services for children covered by your health plan, review your health plan information.

 

Meet Your Primary Care Provider

Your primary care provider will check out your overall health and talk to you about any health-related problems. Ask your provider for written instructions on any health topics discussed during your visit. It’s okay to ask your provider to repeat anything you don’t understand.

Ask if your current medications are covered by your health plan. If they aren’t, your provider may be able to select a medication that is covered. Tell your primary care provider about any problems you may have with your medications. If you have any questions about your medications, ask your provider before you leave the office.

Your primary care provider might order tests. It usually takes a few days to get the results. Ask how long it will take and make sure your provider knows how to contact you. To get tests done, you might need to go to a different room or a different building. Your primary care provider or an assistant should tell you what you need to know. If you’re not sure, ask for directions.

If you need your primary care provider to fill out and sign special forms for you, please allow extra time for that. It is helpful to fill out the form with information that you know about, such as name and address, before you give it to the provider. This helps the provider fill out the form more quickly. Ask the receptionist or the assistant about the best way to get your forms filled out and how long it will take.

 

Seeing a Doctor Right Away

If You Need Urgent Care

You may have an injury or illness that is not an emergency but needs urgent care. Contact your plan to find urgent care facilities in your plan’s network. You can also call your health plan’s 24-hour nurse helpline for advice.

If you have a sudden or severe health problem that you think is an emergency, call 911 or go to the nearest emergency room.
As soon as possible afterward, call your health plan and let them know that you had an emergency and where you received care.

Only go to the hospital emergency room if it’s an emergency. Do not go to the emergency room for routine care. The emergency room is only for serious emergencies.

 

Other Useful Information

Getting Prescriptions Filled

You don’t have to pay for prescriptions that are covered by your health plan. If you don’t know how to fill prescriptions, such as which pharmacies to use, contact your health plan for more information.

 

Seeing a Specialist

Do not make an appointment with a specialist until you talk to your primary care provider or your health plan. To see a specialist you need to get “prior approval,” also called a “referral,” from your primary care provider. It’s important to follow your health plan’s procedure.

 

Be sure to check with your health plan for further details on using your coverage.