District Cares Program - How to Obtain Medical Care

primary-careYour Primary Care Physician - A Primary Care Physician (PCP) is a doctor who takes care of your basic health care needs. Your Primary Care Physician will manage and coordinate your health care needs. You will see your PCP for physical exams, immunizations, health screenings, preventive care, and referrals for other medical services.

When you need medical care or medical services, always call your Primary Care Physician first. The telephone number is printed on your membership card. It is important that your doctor has a way to contact you when you are requesting or receiving care. If you do not have a telephone, please try to provide the telephone number of a person who can get in contact with you.

The Health Care District will not pay for any service, supply, or care that requires a referral if the referral was not first obtained from your participating provider, except for emergency care.

Assignment of Your Primary Care Physician - When you are enrolled as a member, you will be assigned a Primary Care Physician (doctor). Although you will be assigned to one Primary Care Physician, you may not always see or speak to that same doctor when you receive care. In addition to your primary care physician, you may receive some health care services from people who work in your physician’s office, such as other doctors, physician assistants and nurse practitioners.

medical-recordsMedical Records - You may request copies of your medical records. You may be asked to make your request in writing and you may be billed a fee to cover the cost of the copies.

Making or Canceling Appointments - Call as far in advance as possible to make an appointment. Inform your doctor that you are a Health Care District member and you need an appointment. If you need to cancel an appointment, you must give your doctor at least 24 hours notice. If you fail to keep your appointment, you are at risk of losing your eligibility.

Care after Regular Office Hours - If you are sick or injured after regular office hours, please call your Primary Care Physician. The telephone number is listed on the front of your membership card.

Referrals - If you need the care of a specialist or other service, contact your Primary Care Physician.

The following specialists do not require a referral from your Primary Care Physician as long as they are participating providers with the Health Care District. For a list of these providers, please see your provider directory or contact Customer Services at (866) 930-0035.

  • Dermatology
  • Endocrinology
  • Gastroenterology
  • Hematology
  • Infectious Disease
  • Nephrology
  • Neurology
  • OB/GYN and Family Planning
  • Oncology
  • Optometry (One (1) visit every 365-days, regardless of service provided)
  • Otolaryngology (ENT)
  • Perinatology
  • Podiatry
  • Pulmonology
  • Rheumatology
  • Therapy (physical, occupational and speech) *combined limit of 30 treatments per calendar year.

Note: The specialist may refer you for additional services or you may be referred back to your PCP.

Participating Providers - The Health Care District has contracted with physicians, hospitals, facilities and other medical providers to render services to you. Only those doctors, hospitals, and other providers who are part of the Health Care District program network can be paid for the care and services that you receive. Only these providers are eligible for reimbursement from the Health Care District. You may be responsible for payment for services received by non-contracted providers, facilities, and those services not approved by the Health Care District.

Out of Area Use - The Health Care District does not cover services rendered outside of Palm Beach County unless authorized by the Health Care District.

Emergency Care Services - Emergency care services do not require a referral from your Primary Care Physician if you receive services at a licensed, participating emergency facility.

Emergency Care is a medical emergency is a sudden, severe, and unexpected onset of illness or bodily injury, which would endanger the person’s life or health if immediate medical or surgical care were not received. Some examples are heart attack, strokes, and difficulty in breathing, poisoning, excessive bleeding, unconsciousness or anything that could endanger your life or health if not treated immediately.

It is important that you let your Primary Care Physician know that you were treated for an emergency. All follow-up and continuing care must be provided or arranged by your Primary Care Physician.

You will have six (6) emergency room visits per calendar year

  • This applies to adults 21 years of age and older
  • This does not apply to pregnant women
  • If the emergency room visit results in an inpatient admission, it will not count towards the limit as these services are billed as inpatient.

Emergency Care Within the Service Area - In case of a medical emergency, seek care at the nearest licensed emergency facility.

Out of Area Use - The Health Care District does not cover emergency care services rendered

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