Take Charge of Your Health

One of the first things you will need to do when your child enrolls in our plan is choose a primary care provider, or PCP. This can be a doctor, nurse practitioner, or a physician assistant. Your child will see his or her PCP for regular check-ups, shots (immunizations), or when your child is sick. Your child’s PCP will also help your child get care from other providers or specialists. This is called a referral. You can choose your child’s 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 your child. You can change your child’s PCP at any time. To change your child’s PCP, call Member Services at 1-855-463-4100.

Call your PCP office to schedule a visit, even if your child doesn’t need immediate medical care.

See your child’s PCP if your child needs:

• Help with colds, flus and fevers
• Care for ongoing health issues like asthma or diabetes
• A Well Child Visit
• Vaccinations
• General advice about your overall health

Tips for Making the Most out of Your Doctor’s Visit:

• If you don’t understand something, ask questions until you understand
• Encourage your child, if able, to talk about any health issues or symptoms
• Ask about next steps and schedule a follow-up appointment if needed

Need Help?

If you would like help finding a new primary care provider, call Member Services at 1-855-463-4100, or use our Find a Provider Tool. 

When is it Time to Switch to a PCP from a Pediatrician?

Getting care that is right for your age and your health is important.

When your kids are young, they see a pediatrician. This is a doctor who knows all about kids’ health. But when they grow up, their health needs change. That is when it is time to move to a doctor who knows about adult health. Your doctor and your health plan can help you and your child make this change. If you need help finding a new doctor, talk with your doctor or call Member Services at 1-855-463-4100.

Appointment Standards

Sunshine Health is committed to providing quality and timely care for our members. The following appointment standards outline the timeframes you should expect to get an appointment from your child's PCP, specialist or behavioral health provider.

PCP Appointment Type

• Urgent Care: Within 48 hours for service that does not require prior authorization and within 96 hours for services that do require prior authorization
• Regular and Routine Well Exam: Within 30 days
• After Hours Care: PCPs must offer after hours appointments

Specialist Appointment Type

• New Patient Appointment: Within 60 days of request with appropriate referral
• Routine Prenatal Exams: Within four weeks until week 32, every two weeks until week 36 and every week thereafter until delivery
• Oncology (New Patient Appointment): Within 30 days of request
• Follow Up After Physical Health Admission: Within seven days of discharge from the hospital

Behavioral Health Appointment Type

• Non-life Threatening Emergency: Within six hours
• Urgent Access: Within 48 hours
• Initial Visit for Routine Care: Within 10 business days
• Follow Up for Routine Care: Within 30 calendar days
• Follow Up After Behavioral Health Hospital Admission: Within seven calendar days
• After Hours: Your BH provider must have a call receiving service that is answered by a live person