About Getting Care

 

Q. How do I make an appointment?

A. To make an appointment, call your primary care provider (PCP). Be sure to request an interpreter if needed. If you are a new member, please let your provider know when you make your first appointment.

Q. What should I do if I am sick or my child is sick?

A. When you are sick, call your PCP. If your child is sick, call your child's PCP. The PCP can often treat small problems faster than the emergency room. Plus, most PCPs offer after-hours medical advice by phone.

Members can also call Community Health Plan's free Nurse Advice Line 24 hours a day, 7 days a week, toll free 1-866-418-1002 (voice) or TTY 1-866-418-1006 (for speech or hearing impaired).

If you think you are too sick or your child is too sick to wait, go to the nearest emergency room. You or someone you know must notify your PCP of your emergency room visit by the next business day or as soon as your health allows.

Q. What should I do in an emergency?

A. If you think you have an emergency, call 911 or your local police department or go to the nearest hospital. If you have questions about what is considered an emergency, please talk to your PCP.

You do not need a referral from your PCP for an emergency room visit. However, you or someone you know must call your PCP within 24 hours after your emergency room visit or as soon as your medical condition allows. Tell your PCP what happened and make a follow-up appointment if necessary.

Q: How do I get care after clinic hours?

A: If you cannot reach your PCP, and you think you are too sick or your child is too sick to wait, go to the nearest emergency room. You or someone you know should tell your PCP about your emergency room visit by the next business day or as soon as your health allows.

To get care after clinic hours:

  1. Call your primary care clinic. PCPs are required to offer after-hours medical advice by phone.
  2. If the clinic or your PCP is not available, call the Nurse Advice Line toll free at 1-866-418-1002 (voice) or 1-866-418-1006 (TTY for speech or hearing impaired). The nurses can help you when you have questions about health concerns or need health information.
  3. If your symptoms are severe or if your PCP cannot see you right away, ask your PCP if you can go to an urgent care center, where they can treat you that same day. Urgent care is covered only if you get an authorization from your PCP.
  4. If you cannot reach your PCP and you think you are too sick to wait, go to the nearest emergency room.

Q. What if I become ill or injured when I am far away from home?

A. Community Health Plan Basic Health and Healthy Options enrollees are covered for emergency care and medications necessary for emergency treatment when they are out of their service area in Washington State or in other places. Disability Lifeline (GA-U) members are covered when outside of their service area in Washington State only.

If you have an emergency while you are traveling, go directly to the nearest hospital emergency room. Remember that you or someone you know must call your primary care provider (PCP) within 24 hours of your emergency or as soon as is medically reasonable. Your follow-up care is covered if it is medically necessary and cannot wait until you return home, although it must first be authorized by Community Health Plan.

If you need a 30-day supply of a regular prescription before you go on vacation, please consult with your PCP before you leave. If you need more than a 30-day supply, please call the Community Health Plan customer service team at 1-800-440-1561 or email us at customercare@chpw.org. If you are hearing or speech impaired, please call TTY 1-866-816-2479 (toll free) or local 206-613-8875.

Non-emergency, out-of-state prescriptions are not covered by your plan.