Selecting a Primary Care Provider (PCP)
It is important for you to have a main doctor. This is called your Primary Care Provider (PCP). PCPs are physicians, nurse practitioners, and physician assistants who manage your overall healthcare needs. They provide services such as annual exams, routine immunizations (vaccines), and treatment for illnesses and injuries. PCPs include family practice doctors, general practitioners, internists, and pediatricians. If you need help, your Empower Care Coordinator can help you find a PCP in your area.
To select or change your PCP, you can call Empower Customer Service at 866-261-1286 or contact your Care Coordinator directly. Members that have both Medicare and Medicaid can keep their existing Medicare PCP if desired.
Access to Care
When you need care, call your Care Coordinator first. You can reach Care Coordination 24/7. If you need Care Coordination between 5 p.m. and 8 a.m., please call 866-261-1286. Your Care Coordinator will help you manage all of your health services. If you think you need to see a specialist or another provider, talk with your PCP. Your PCP can help you decide if you need to see another provider. You do not need a referral from your PCP to access services.
It is very important that you keep all appointments you make for doctor visits, lab tests, or X-rays. Please call your PCP at least one day ahead of time if you cannot keep an appointment.
If you need help in making an appointment, please contact your Care Coordinator directly or Empower Customer Service at 866-261-1286, TTY: 888-479-6532.
Reaching Your PCP After Hours
PCPs have 24-hour answering services or they have a telephone recording. The answering services or recording will instruct you on how to receive care after regular office hours.
Urgent care is for a health issue that need care right away but is not life threatening. Urgent care is not emergency care. You will require a prior approval from Empower if you go to an Urgent Care clinic not in Empower’s network. Some examples of urgent care are:
- Minor Cuts and scrapes
- Ear ache
An emergency medical condition is very serious. It could even be life threatening. An emergency is sudden, serious and puts you at risk for harm. You could have severe pain, injury or illness. It can happen when your body is not working as it should. If you have an emergency call 9-1-1 immediately.
Examples of Emergencies
- Chest pains
- Severe bleeding
- Difficulty breathing
- Broken bones
What you Can Do in Case of an Emergency
- Go to the nearest Emergency Department; you can use any hospital or other setting to get emergency services
- Call 9-1-1
- Call ambulance if no 9-1-1 service is in the area
- No authorizations are needed in emergencies
- No referral is needed
- Prior authorization is not needed, but as soon as your condition is stable you should call your Care Coordinator to assist in arranging follow-up care
Empower covers all medically necessary Medicaid services. We cover the services at no cost to you. Some services require prior authorization from Empower. Your healthcare provider will submit any needed prior authorizations. You do not need to contact us about this. Empower will not deny services due to moral or religious issues.
Covered services include:
- Adult developmental day treatment services
- Advanced nurse practitioners and registered nurse practitioner services
- Ambulatory surgical center services
- Audiologist services
- Burn therapy
- Chiropractor services
- Critical access hospital
- Early and periodic screening and diagnosis of individuals under 21 years of age and treatment of conditions found
- End-stage renal disease facility services
- Emergency services
- Eye prostheses
- Factor 8 injections
- Family Planning Services
- Federally qualified health center services
- Hearing aid dealer services
- Hearing aids, accessories, and repairs
- Home Health services
- Medical supplies, equipment, and appliances suitable for use in the home
- Durable medical equipment (DME)
- Augmentative communication devices
- Specialized wheelchairs
- Diapers/under pads
- Physical therapy, occupational therapy, or speech pathology and audiology services provided by a home health agency
- Hospice care
- Inpatient hospital services
- Intellectual disability services in an intermediate care facility (other than in an Institution for Mental Diseases)
- Laboratory services
- Maternity clinic services (limited to services before and after childbirth)
- Mentally retarded care in intermediate care facilities
- Nurse anesthetist services
- Nurse-midwife services
- Obstetric-gynecologic and gerontological nurse practitioner services
- Occupational therapy
- Optical lab services
- Optometrist services
- Orthotic appliances
- Outpatient hospital services
- Outpatient surgical procedures
- Pacemakers and internal surgical prostheses
- Pediatric or family nurse practitioners’ services
- Personal care
- Pregnancy care, extended services
- Prescription drugs
- Private duty nursing
- Psychiatric inpatient services for individuals under age 21
- Psychologist services
- Podiatrist services
- Physical therapy and related services
- Physician services
- Radiation therapy
- Rehabilitative Services – Outpatient behavioral health services; Tier 1 services
- Rehabilitative hospital services – Extended
- Respiratory care services
- Rural health clinic services
- Speech therapy
- Tobacco cessation counseling
- X-ray services
Early and Periodic Screening, Diagnosis and Treatment (EPSDT)
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) is a federally mandated Medicaid program developed to ensure that the Medicaid population younger than the age of 21 is monitored for preventable and treatable conditions which, if undetected, could result in serious medical conditions and/or costly medical care. Empower will track the progress of all members younger than the age of 21 and perform outreach as needed to encourage members to obtain EPSDT health screens according to the American Academy of Pediatrics Guidelines for screening intervals. Once a condition is detected, treatment may be considered under EPSDT Special/Expanded Services if it is not a current covered benefit under Medicaid, if medical necessity is proven. EPSDT preventive health screens that result in any treatment recommendations must be monitored to ensure follow up has occurred.
Family Planning Services
Empower has a network of Family Planning providers where you can get family planning services. We cover the cost of contraceptives, including birth control devices and the fitting or insertion of the device (such as IUDs and implants). You can get services from any qualified family planning provider. S/he does not have to be a network provider. You do not need a referral from your PCP and you do not have to get permission from Empower to get these services.
A provider network is a list of health care providers that the PASSE contracted with to provide health care to members. Empower members are encouraged to receive care from providers and hospitals that are in network with Empower. You must have prior approval from Empower to visit out-of-network providers. The only exceptions are for treatment of emergencies and for family planning services.
Empower has many providers. For help finding an in-network provider call 866-261-0286, TTY: 888-479-6532. Members can also look for providers on the Empower website at www.getempowerhealth.com.