Visits to your doctors
AmeriHealth Caritas Delaware is committed to maintaining an adequate network of primary care providers (PCPs) and specialists to meet the needs of our members. AmeriHealth Caritas Delaware has established appointment availability standards for providers in our network. Each year, AmeriHealth Caritas Delaware assesses our members’ access to provider appointments to be sure our members get the care they need.
If you have an emergency, you should always call 911 for an ambulance or go directly to the nearest hospital emergency room (ER). An emergency medical condition is a medical problem so serious that you must seek care right away to avoid severe harm.
If you need care, but are not sure if it is an emergency, call your PCP or behavioral health specialist first. If you cannot reach your PCP or behavioral health specialist, call the AmeriHealth Caritas Delaware 24/7 Nurse Call Line at 1-844-897-5021. Your PCP or the 24/7 Nurse Call Line will help you find the best care available for you at that time.
AmeriHealth Caritas Delaware’s appointment availability standards are shown in the tables below.
| Primary care provider (PCP) appointment availability standards | ||
|---|---|---|
| Emergency | Same day | Examples of emergency conditions are: high temperature, persistent vomiting or diarrhea, or symptoms which are of sudden or severe onset but which do not require emergency room services. |
| Urgent care | Within two calendar days | Examples of urgent care: persistent rash, recurring high-grade temperature, and nonspecific pain or fever. |
| Routine care | Within three weeks | Examples of routine care: well-child exams, routine physical exams, and minor illnesses or injuries. |
Urgent care centers
Urgent care centers provide urgent and non-life-threatening emergent care. For an urgent care provider near you, visit Find a provider on the website.
Going to an urgent care center does not replace care provided by your PCP. If you go to an urgent care center or the ER, be sure to call your PCP the next day to make an appointment. Your PCP must schedule an appointment for you within two calendar days of your request for an urgent care appointment.
| Specialist appointment availability standards | |
|---|---|
| Emergency
|
Immediately Emergency care is available 24 hours a day, seven days a week. |
| Urgent care | Within two calendar days |
| Routine care | Within three weeks |
| Pregnancy care (OB/GYN) appointment availability standards (after learning of pregnancy) | ||
|---|---|---|
| First trimester | First three months of pregnancy | Within three weeks |
| Second trimester | Second three months of pregnancy | Within seven calendar days |
| Third trimester | Last three months of pregnancy | Within three calendar days |
| High-risk pregnancy | N/A | Within three calendar days of identification of high risk |
| Behavioral health appointment availability standards | |
|---|---|
| Emergency (life-threatening) | Immediately (within 60 minutes) |
| Non-life-threatening emergency | Within six hours |
| Nonemergency access | Within three weeks |
| Initial Assessment (Initial visit for routine care) | Within seven calendar days |
| Routine outpatient services (with nonprescribing clinician) | Within seven calendar days |
| Follow-up to inpatient care (members seen in an ER or behavioral health crisis provider) | Within seven calendar days of discharge |
| Nonemergency outpatient services | Within three weeks |
Telehealth Services (telemedicine) helps you get physical and behavioral health services from your home. Telehealth visits may be offered by your provider.
For more information on telehealth, visit the Getting Care section of the member website via:
https://www.amerihealthcaritasde.com/member/eng/getting-care/telehealth.aspx
If you need help making your appointment, please call AmeriHealth Caritas Delaware Member Services at:
- Diamond State Health Plan: 1-844-211-0966 (TTY 1-855-349-6281).
- Diamond State Health Plan-Plus: 1-855-777-6617 (TTY 1-855-362-5769).
After-hours care from your PCP
AmeriHealth Caritas Delaware members have access to quality, comprehensive health care services 24 hours a day, seven days a week. PCPs must have either an answering machine or an answering service for members after hours for nonemergent issues. The answering service must forward calls to the PCP or on-call provider, or instruct the member that the provider will contact the member within 30 minutes.
Providers who use answering machines for after-hours services must meet the following requirements:
- The answering machine must provide the member with a process for reaching a provider after hours.
- The after-hours coverage must be accessible using the medical office’s daytime telephone number.
For emergent issues, both the answering service and after-hours answering machine must direct the member to call 911 or go to the nearest emergency room.