Take Charge of Your Child's Health
It’s important to have a good relationship with your child's primary care provider (PCP) and to visit the doctor at least once a year, even when your child is feeling well. During an annual checkup, the doctor can check your child's overall health and recommend any needed annual screenings or tests based on health needs. The provider can also help manage any chronic conditions your child may have to help him or her achieve the best health.
Call your child's PCP office to schedule a visit if your child doesn't need immediate medical care.
See a PCP if your child needs:
- Help with colds, flus and fevers
- Care for ongoing health issues like asthma or diabetes
- An annual wellness exam
- Vaccinations
- General advice about your overall health
Tips for Making the Most out of a Doctor’s Visit:
- Be honest. Don’t minimize symptoms or feelings.
- If you don’t understand something, ask questions until you understand.
- Don’t be embarrassed to talk about your child's health issues or symptoms. The doctor is there to help.
- Ask about next steps and schedule a follow-up appointment, if needed.
If you would like help finding a new primary care provider for your child, please call their care manager or Member Services at 1-866-799-5321 (TYY 1-800-955-8770), 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 child's age and 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 child's doctor and CMS 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 1-866-799-5321 (TYY 1-800-955-8770).
Appointment Standards
Children's Medical Services Health Plan is committed to providing members and their families with the resources that they need to get the best care possible. The following appointment standards outline the timeframes one should expect to get an appointment from a PCP, specialist or behavioral health provider.
| PCP Appointment Type | Access Standard |
|---|---|
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 | ACCESS STANDARD |
|---|---|
| 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 | ACCESS STANDARD |
|---|---|
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 |