Member Services: 1-844-243-5187 (TTY use 711) Available 8am - 7pm Monday - Friday | Language Assistance

Choosing a Primary Care Provider (PCP)


If you have Medicare, please contact the number on your Medicare ID card for information about your PCP.
One of the first things you will need to do when you enroll in our plan is choose a PCP. This can be a doctor, nurse practitioner, or a physician assistant. You will see your PCP for regular check-ups, shots (immunizations), or when you are sick. Your PCP will also help you get care from other providers or specialists. This is called a referral. You can choose your PCP by calling Member Services.
You can choose a different PCP for each family member or you can choose one PCP for the entire family. If you do not choose a PCP, we will assign a PCP for you and your family.
You can change your PCP at any time. To change your PCP, call Member Services.

Choosing a PCP for Your Child


You can pick a PCP for your baby before your baby is born. We can help you with this by calling Member Services. If you do not pick a doctor by the time your baby is born, we will pick one for you. If you want to change your baby’s doctor, call us.
It is important that you select a PCP for your child to make sure they get their child health check-ups each year. Child health check-ups are for children 0 – 20 years old. These visits are regular check-ups that help you and your child’s PCP know what is going on with your child and how they are growing. Your child may also receive shots (immunizations) at these visits. These visits can help find problems and keep your child healthy. 
You can take your child to a pediatrician, family practice provider, or other health care provider.
You do not need a referral for child health check-ups.
There is no charge for child health check-ups.

Urgent Care


Urgent Care is not Emergency Care. Urgent Care is needed when you have an injury or illness that must be treated within 48 hours. Your health or life are not usually in danger, but you cannot wait to see your PCP or it is after your PCP’s office has closed.
If you need Urgent Care after office hours and you cannot reach your PCP, you can call our 24-hour Nurse Advice Line at 1-844-865-7922 or TTY: 711 or your urgent care center.
You may also find the closest participating urgent care center to you by calling Member Services at 1-844-243-5187 or going to www.miamichildrenshealthplan.com/providerdirectory.

If you would like to talk to your PCP’s office, the phone number is on the front of your ID card. Your PCP will have a doctor who monitors and returns calls also known as being “on call.” This doctor will call you back and tell you what to do. If you go to an urgent care center be sure to call your PCP the next day to ensure you get the follow up care you need.

Hospital Care


If you need to go to the hospital for an appointment, surgery or overnight stay, your PCP will set it up. We must approve services in the hospital before you go, except for emergencies. We will not pay for hospital services unless we approve them ahead of time or it is an emergency.
If you have a case manager, they will work with you and your provider to coordinate services when you go home from the hospital.

Emergency Care

A medical emergency is when you are so sick or hurt, that your life or health is in danger if you do not get medical help right away. Some examples are:

  • Broken bones
  • Bleeding that will not stop
  • You are pregnant, in labor and/or bleeding
  • Trouble breathing
  • Suddenly unable to see, move, or talk

Emergency services are services that you get when you are very ill or injured. These services try to keep you alive or to keep you from getting worse. They are usually delivered in an emergency room.

If your condition is severe, call 911 or go to the closest emergency facility right away. You can go to any hospital or emergency facility.

If you are not sure if it is an emergency, call your Primary Care Doctor (PCP). Your PCP will tell you what to do.

The hospital or facility you go to for emergency care does not need to be part of the Miami Children's Health Plan provider network, or in our service area. You also do not need to get approval ahead of time to get emergency care or for the services that you receive in an emergency room to treat your condition.

If you have an emergency when you are away from home, get the medical care you need. Be sure to call Member Services when you are able and let us know.
 

Filling Prescriptions

We cover a full range of prescription medications. We have a list of drugs that we cover. This list is called our Formulary. You can find the list here or by calling Member Services.

We cover brand name and generic drugs. Generic drugs have the same ingredients as brand name drugs, but they are often cheaper than brand name drugs. They work the same. Sometimes, we may need to approve using a brand name drug before your prescription is filled.

We have pharmacies in our provider network. You can fill your prescription at any pharmacy that is in our provider network. Make sure to bring your Plan ID card with you to the pharmacy.

The list of covered drugs may change from time to time, but we will let you know if anything changes.
 

Behavioral Health Services

There are times when you may need to speak to a therapist or counselor if you are having any of the following feelings or problems:

  • Always feeling sad
  • Not wanting to do the things that you used to enjoy
  • Feeling worthless
  • Having trouble sleeping
  • Not feeling like eating
  • Alcohol or drug abuse
  • Trouble in your marriage
  • Parenting concerns

We cover many different types of behavioral health services that can help with issues you may be facing. You can call a behavioral health provider for an appointment. You can get help finding a behavioral health provider by:

  • Calling 1-888-710-2313 or TTY 711
  • Looking at our provider directory
  • Searching for a provider 


Someone is there to help you 24 hours a day, 7 days a week.

You do not need a referral from your PCP for behavioral health services.

If you are thinking about hurting yourself or someone else, call 911.

You can also go to the nearest emergency room or crisis stabilization center, even if it is out of our service area. Once you are in a safe place, call your PCP if you can. Follow up with your provider within 24-48 hours. If you get emergency care outside of the service area, we will make plans to transfer you to a hospital or provider that is in our plan’s network once you are stable.