Tips for using a Managed Care Health Plan

ID Card

Carry your AmeriHealth Mercy ID Card and Pennsylvania ACCESS card at all times.

1. If you lose your AmeriHealth Mercy ID card, please call Member Services at 1-888-991-7200.
2. If you lose your Pennsylvania ACCESS card, please call your caseworker at your local County Assistance Office.

Primary Care Practitioner (PCP)

You and your family will receive most of your health care from your PCP.

1. Call Member Services at 1-888-991-7200 to select or change your Primary Care Practitioner (PCP) for any reason
2. When you make an appointment with your PCP, it is VERY important to keep your appointment and to be on time.
3. If you cannot keep your appointment, call the PCP’s office to cancel or reschedule the appointment. Call at least 24 hours before your appointment.
4. Call your PCP’s office any time you think you need health care.  If the PCP’s office is closed, leave your name and number.  Your PCP will return your call if you need immediate assistance.

Special Needs

If you or your child have special medical conditions that require coordination with other services, call Member Services at 1-888-991-7200 and ask for the Special Needs Unit.

Emergency Care

An emergency is a health problem that is life threatening or one that will seriously affect your health if not treated immediately.

1. If you have an emergency, go to the nearest Emergency Room, or call 911 if you cannot get to the Emergency Room on your own.
2. You do not need approval from AmeriHealth Mercy to receive care in an emergency. The Emergency Room staff will contact AmeriHealth Mercy about your emergency.
3. If you have an emergency away from home, follow the same guidelines.  Go to the nearest Emergency Room.
4. If you are not sure you have an emergency, always call your PCP first.  He or she can help you decide if you need to go to the Emergency Room.

Urgent Care

Urgent Care treats a health problem that is serious but not an emergency. It requires attention from a doctor but not in the Emergency Room.  Examples of Urgent Care are:

If you need Urgent Care, call your Primary Care Practitioner. Your PCP should see you within 24 hours or help you decide if you need to go to the Emergency Room.

Self-Referrals

As a member of AmeriHealth Mercy Health Plan, you can arrange these services with a participating provider without calling your PCP first. Some of these services are:

• Prenatal (pregnancy) Visits
• First Visit with Chiropractor
• Eye Exam once every year
• Dental Exam every 6 months
• GYN Exam once every year

Routine family planning services are provided through AmeriHealth First Call 1-800-541-4560 for more information on clinic locations.

PCP Referral to a Specialist

Your PCP provides most of your health care services.  If you have a special health problem, your PCP may send you to a special doctor.  This doctor is called a Specialist and is trained in the type of health care you need.  In most situations, your PCP must give you a referral to see a specialist. Referrals are usually good for unlimited visits in a 90-day period.  Your doctor can help choose a Specialist and make an appointment.  Specialists include:

• Heart Doctor (Cardiologist)
• Ear, Nose and Throat Doctor (Otolaryngologist)
• Skin Doctor (Dermatologist)
• Doctor for blood problems (Hematologist)
• Foot Doctor (Podiatrist)
• Surgeon

If you need this translated into another language, please call Member Services at 1-888-991-7200. Si usted necesita que esto sea traducido a otro idioma, por favor llame al Servicio para Miembros al 1-888-991-7200.

For members with a hearing impairment, please call the TTY Line at 1-888-987-5704.

Member Services
1-888-991-7200
TTY: 1-888-987-5704