Your Responsibilities as a Member
Your responsibilities include:
- Know when you should go to the emergency room.
- Call your doctor first for non-emergency medical care.
- Learn and follow Driscoll Health Plan’s (DHP) rules and Medicaid rules.
- Choose a doctor quickly.
- Keep scheduled doctor visits.
- Cancel doctor visits ahead of time when you can’t keep them.
Your Primary Care Provider or another doctor is available by phone 24 hours a day, 7 days a week.
Emergency Medical Care is provided for Emergency Medical Conditions and Emergency Behavioral Health Conditions.
Emergency Medical Condition means: A medical condition manifesting itself by acute symptoms of recent onset and sufficient severity (including severe pain), such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical care could result in:
- placing the patient’s health in serious jeopardy;
- serious impairment to bodily functions;
- serious dysfunction of any bodily organ or part;
- serious disfigurement; or
- in the case of a pregnant women, serious jeopardy to the health of a woman or her unborn child.
Emergency Behavioral Health Condition means: Any condition, without regard to the nature or cause of the condition, which in the opinion of a prudent layperson, possessing average knowledge of medicine and health:
- requires immediate intervention or medical attention without which the Member would present an immediate danger to themselves or others; or
- which renders the Member incapable of controlling, knowing, or understanding the consequences of their actions.
How soon can I expect to be seen?
Emergency care is there for you 24 hours a day, 7 days a week.
Are Emergency Dental Services Covered?
DHP covers limited emergency dental services for the following:
- Dislocated jaw.
- Traumatic damage to teeth and supporting structures.
- Removal of cysts.
- Treatment of oral abscess of tooth or gum origin.
- Treatment and devices for craniofacial anomalies.
- Drugs for any of the above conditions.
DHP also covers dental services your child gets in a hospital or ambulatory surgical center including other services your child might need, like anesthesia.
The Member Handbook tells you about emergency care. Call DHP, Case Management Department at 1-877-222-2759 if you have any questions or comments.
We hope this information makes it easier for you to contact your PCP, after-hours clinic or an urgent care clinic in your area. If you have questions or need help changing your PCP, please call us at 1-877-DCHP-KIDS (1-877-324-7543). We are available Monday – Friday, 8am–5pm.
Thank you for choosing Driscoll Health Plan!