Where to Get Care

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You or your child chose or were assigned to MDwise. Your or your child’s MDwise doctor is called a Primary Medical Provider (PMP). PMPs can be one of five types of doctors:
  • Family Practice doctor.
  • General Practice doctor.
  • Internal Medicine doctor–for adults only.
  • OB/GYN doctor–for women only.
  • Pediatric doctor–for children only.

For information on changing your doctor, Hoosier Healthwise members see page 44-45. HIP members see page 28.

Some PMPs work with other trained health care professionals. These include:
  • Nurse Practitioners.
  • Physician Assistants.
  • Medical Residents.

These providers can provide the health care services your doctor does. They can take medical histories, complete physicals, order lab tests and give you health education. If you would like to learn more about these providers, or would like to see one of these providers at your doctor’s office, please call MDwise customer service.

Your MDwise Doctor Will Handle All of Your Health Care


This includes:

  • Giving check-ups and immunizations (shots).
  • Giving routine care.
  • Writing prescriptions.
  • Referring you to specialists or other providers.
  • Admitting you to the hospital.

You should call your doctor whenever you need care.

calendar-icon.pngTIP: New MDwise members should call to make an appointment with their doctor right away. Make an appointment with your new doctor in the first 60 days. You should make an appointment even if you are not sick. You can ask to have a physical exam and talk to your doctor about any other preventive care that you need. This is also a good way to get to know your new doctor so they can take better care of you—before an emergency happens!

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calendar-icon.pngAs a MDwise member, you must get most health care through your assigned doctor. This way, the doctor can organize all health care services. This helps you be as healthy as possible.

Always call your doctor when you need medical care. The doctor has someone who can help you 24 hours a day. If you get sick after hours, call your doctor’s regular office number. If you hear a message, listen for instructions on what to do.

Sometimes, the doctor may want you to get care from other providers. When this happens, the doctor will give you a written okay. This will let you go to another doctor or to a hospital or lab.

This written okay is called a referral. Your doctor will give you a referral to visit another MDwise doctor. If we do not have the doctor you need in the MDwise network, or the doctor you need is not within 60 miles of your home, then we will find you a doctor outside of MDwise who can help you. Please note that there are some specialty providers that may be within 90 miles of your home.

If you are a HIP member and want to get care from a Federally Qualified Health Center (FQHC) or a Rural Health Center (RHC), MDwise will help you find a center within your area, even if the center is not in the MDwise network.

You or your child may need to go to the hospital at some time. The doctor will set this up for you. You should not go to the hospital without your doctor’s okay. This is very important. Otherwise, MDwise may not cover your hospital care. If you have a true emergency, you do not have to call your or your child’s doctor. Just go to the nearest hospital for immediate care.

Choosing a Hospital

The doctor only treats patients at a certain hospital. You should only use the hospital that your doctor uses. Ask your doctor first! Examples of when you or your child should use your doctor’s hospital:
  • When you are having a baby.
  • When you have planned surgery.
  • When your doctor wants to admit you for other reasons.

For HIP Members: If you call the MDwise NURSEon-call service before going to the emergency room, you may not have to pay a copay for the visit. You can reach the NURSEon-call 24 hours a day by calling MDwise customer service. Choose option #1 and then option #4.

TIP: Ask your doctor which hospital to use before you need it. Always use that hospital, unless it is a true emergency. Then, just go to the closest hospital right away.

You get the best care when you go to your in-network MDwise doctor. Your doctor can organize all your health care services and knows you best. This means:
  1. You will be healthier.
  2. Your doctor will have your records.
  3. Your doctor will know you and your family's health history.
  4. You will have less paperwork to fill out.

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What Do I Do If There Is An Emergency?

You should call your doctor whenever you have questions or need care. This is the best way to help your doctor take care of you and your children. However, if it is an emergency, do not wait to call your doctor first!

Call 911 or go straight to the nearest hospital emergency room. You can read more about emergency care on pages 8–9.

What Do I Do When I Am Far From Home?

If you are far away from home, you should still call your doctor if you need care. They can help you get routine or urgent health care.

If you cannot afford the long distance call to your doctor, we can help. You can call MDwise free of charge. We will help you reach your doctor.

phone-icon.pngTIP: Your doctor should be available 24 hours a day! You should always be able to reach your doctor or your doctor’s after-hours number. It is okay to call, even late at night, if you have an emergency or urgent health care needs.

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Call for an Appointment

You should always call before visiting the doctor’s office. When you call, the doctor’s staff will schedule a time for you or your child to see the doctor as soon as possible.

Before You Call

When you or your child need health care, call the doctor right away. When you call, you can also ask to talk to a nurse if you have medical questions.

Before you call, be sure that you:
  • Have your MDwise member ID card handy.
  • Are ready to explain what is wrong.
  • Have a phone number where the doctor can call you later (this can be a family member or friend’s number if needed).
  • Have a pen and paper ready to write down any instructions.

Schedule Your Appointment

Once you call your doctor, this is the longest you should have to wait to get an appointment:
  • Within 1 month for a child’s first appointment.
  • Within 1 day for urgent care (like a fever or earache).
  • Within 3 days for non-urgent care (like ongoing knee pain).
  • Within 3 months for an annual physical exam.
  • Pregnant women can see a doctor quicker. In the first six months of pregnancy, you should not have to wait more than one month for an appointment.

It is very important to keep your doctor appointments. This helps your doctor take better care of you and your children.

Getting Ready for Your Doctor’s Appointment

Here are some tips for getting ready for your doctor appointment:
  • Write down your questions.
  • Write down a list of the medications you take or bring your medications with you.
  • Never be afraid to ask questions. The doctor wants you to understand all your treatment decisions.
  • If this is you or your child’s first appointment with a doctor, plan to arrive early. The doctor’s office may have paperwork for you to fill out before you see the doctor.
  • Take your MDwise member ID card with you to your appointment.

In the Waiting Room

You will have the shortest wait in the waiting room if you make an appointment first. Your wait time should be under one hour. Sometimes it may take longer if your doctor has unplanned emergencies.

right-arrow-icon.pngTIP: Always call at least 24 hours before your appointment if you have to cancel it. The doctor’s office will set up a new appointment for you. Calling will also let the doctor’s office know they can give your appointment time to someone else.

Please call MDwise customer service at 1-800-356-1204 if you have problems with waiting times or making an appointment.

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person-heartbeat-icon.pngNo one likes to spend hours in an emergency room. You can avoid the ER by getting preventive care. This way, you or your child can get health care before the problem gets too bad.

Hoosier Healthwise Members

For Package A members, MDwise will cover emergency care 24 hours a day, 7 days a week. If you have a true emergency, go to the closest hospital or call 911 right away. Package C members will have to pay for ER visits if it is not a true emergency. If your child needs urgent care but it is not an emergency, you should call your child’s doctor instead of going to the ER.

Healthy Indiana Plan Members

Healthy Indiana Plan members may pay a copay when going to the emergency room for a condition or symptom that is not emergent. The copay amount may vary. The copay amounts are available on myMDwise. Don’t forget that your doctor is available to help you even after hours. You can also call the NURSEon-call line to get help deciding whether you should go to the emergency room. See page 50 for more information about NURSEon-call.

Three Kinds of Care

There are different kinds of health care: preventive care, urgent/sick care and emergency care. This chart shows you what to do when you need each kind of care. If you have questions, always ask your doctor for advice.


When to Go to the Emergency Room

  • You should not use the ER for anything but true emergencies.
  • If you are not sure if it is an emergency, call your doctor for advice.
  • Your doctor has someone who can help 24 hours a day, 7 days a week. If you hear a recorded message when you call, listen carefully for instructions. Have a pencil or pen and paper ready when you call.

Emergency Room Visits Are Covered

MDwise will cover emergency care 24 hours a day, 7 days a week. If you or your child has a true emergency, go to the closest hospital or call 911 right away. MDwise will cover your emergency care even if:
  • You are far away from home.
  • You cannot get to your doctor’s regular hospital.

Post-stabilization services in the emergency room are also covered. The emergency room doctor will stabilize the condition that you or your child went to the ER for. If the doctor decides that more testing or services are needed, they can contact MDwise to get approval for more tests or services. This happens only after you are stable and are no longer in immediate danger.

Out-of-Area Care

If you are far away from home, you can still get health care. Before getting care, you must call your doctor. You can also call MDwise customer service for help. If you have a true emergency, do not call first. Go straight to the nearest hospital.

After Hours Care

You can call your doctor's regular office number even after hours. If you hear a message, listen for instructions on what to do.

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