Mental Health and Substance Use Services for Adult Members
A PCP is your main doctor, nurse practitioner or physician assistant who takes care of your medical needs. Your PCP will make sure you get regular checkups. They will write prescriptions for medicines and supplies you need. Your PCP may also refer you to other providers if needed.
It is important you have a good relationship with your PCP. Your PCP needs to know your medical history to be able to provide you with the best care. You need to take part in decisions about your healthcare. Together, you and your PCP will make the right decisions to keep you healthy.
Upon joining Driscoll Health Plan, we will assign you to a PCP. You can call Member Services if you would like to choose another PCP.
In special circumstances, you may choose a specialist as a PCP. You may also choose a clinic as the PCP. This can be a Federally Qualified Health Center (FQHC) or a Rural Health Clinic (RHC). To learn more, call Member Services.
STAR Kids dual-eligible members are not required to have a PCP. If you are dual-eligible (you get Medicare and Medicaid), your ID card will not have PCP information. Your card will show Long Term Services and Supports.
Your PCP can help you decide if your child needs to see a specialist. Your child’s doctor will make a referral for services, if needed. There are some exceptions to referral requirements, especially for MDCP members. You may also share your referral questions with your Service Coordinator.
To search for providers and specialists in the DHP network, visit Find a Provider. Driscoll Member Services can provide assistance with finding a provider. You can also request a printed version of the provider directory at no cost to you. Please call 1-877-324-7543.
A specialist is a doctor for certain types of healthcare like cardiology (heart health), orthopedics (bones and joints) or gynecology (women’s health).
A referral is a request from your PCP for you to see another doctor. Your PCP can help you decide if your child needs to see a specialist. Your child’s doctor will make a referral for services, if needed. There are some exceptions to referral requirements, especially for MDCP members. You may also share your referral questions with your Service Coordinator.
To see any Medicaid Physician Specialist (in-network or out-of-network), your PCP will need to follow DHP’s authorization and referral rules when asking for a referral to another provider.
All requests for services will be reviewed. Requests that are determined to be medically necessary and meet clinical criteria will be approved and given an authorization number. Requests that fail to meet clinical criteria will be referred to the Medical Director for review.
DHP Members have the right to make a self-referral for certain services. A referral is NOT needed for the following services:
A provider, member, or someone acting on behalf of a member, may file a complaint by calling Member Services. A member advocate is available to help with filing the complaint. For more information on member complaints, visit our File a Complaint page.
Member Complaints & AppealsAppeals are processed in two separate and distinct departments dependent upon the categorization of appeals.
For members: If you need assistance with appealing denied services, visit the Member Complaints, Appeals, and State Fair Hearing page.
For providers: If you need assistance with Provider and Administrative Claims Appeals processed by the Claims Department, visit our Providers page.
