Your child’s primary care
physician
Think of your child’s primary care physician (PCP) as a health care manager. If your child is
sick, needs a checkup or if you have a question, call your
child’s PCP first.
It is important
that you get to know your child’s PCP right away. It also is
important to tell the PCP as much as you can about your child’s
health. It is not a good idea to wait until your child is sick
to have your first visit with the PCP.
When your child
needs medical care, call the PCP’s office to make an
appointment.
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Have your
child’s member ID card handy.
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Be ready to
describe the problem or reason for the visit.
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If your child
needs medical help the same day, call the PCP as early in the
day as possible.
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Call at least
24 hours in advance to cancel if you cannot keep your
appointment.
Changing your PCP
Your relationship with your child's doctor is very important. If you
decide the PCP you chose does not meet your child's needs, you
may choose another doctor.
The names,
addresses and telephone numbers of the PCPs in Texas Children’s
Health Plan can be found in the
CHIP provider directory.
For a current directory or for help choosing a new PCP, call
Member Services toll free at 1-866-959-6555. We will be glad to
help.
You can change
your child’s PCP up to four times a year. Primary care
physician changes are effective the day following your request
for a change. A new ID card will be mailed to you with the new
PCP’s name and telephone number.
If you choose
to go to a doctor who is not your child’s PCP, you may have to
pay for the care. Always call Member Services to change your
child’s PCP before making an appointment with another doctor.
If your child’s PCP leaves Texas Children’s Health Plan
If your child’s
PCP decides to end his or her participation with Texas
Children’s Health Plan, we will notify you within 15 days of
finding out about the doctor’s decision. You may choose another
PCP. Call Member Services toll free at 1-866-959-6555. A Member
Services representative will help you make the change.
Referrals and specialty care
The PCP is the only doctor your child needs for most health care. If your
child has a special condition, your PCP may have your child see
another doctor. This is called a referral. Your child’s PCP will
refer you to an in-network specialist or another doctor who is
contracted with Texas Children’s Health Plan. The PCP will make
sure your child is seeing the right specialist for his or
her condition. Your child’s PCP will discuss the need for more
treatment or hospital care with the specialist.
Remember, the
specialist should only give services requested by your child's
PCP on the referral form. The specialist should only give
services covered by your child’s health plan.
If you visit a
specialist without being referred, you may have to pay the
specialist for the services. Except in an emergency, always
check with your child’s PCP before you go anywhere else for
care.
Services that do not need a referral
There are certain types of services that your child can receive without a
referral:
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In-network
obstetrical/gynecological (OB/GYN) care, including routine
exams, pap smears, and prenatal and postpartum care. This
includes delivery of a baby.
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Emergency
care
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Behavioral
health and substance abuse care
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Vision
care
The OB/GYN
must be a doctor in Texas Children’s Health Plan’s network. You
may choose any OB/GYN listed in the
CHIP provider directory. You can also call Member Services for the names of
participating OB/GYNs toll free at 1-866-959-6555.
The
behavioral (mental) health and substance abuse provider must be
in Texas Children’s Health Plan’s network. You may choose any
behavioral health provider listed in the
CHIP provider directory. You can also call Member Services at 1-866-959-6555 for
the names of participating providers.
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