Types of Care

There are different types of care that you may receive.  These include the following:

Routine Care

Routine care is the regular care you get from your PCP, such as checkups, to help keep you healthy.  You can call your PCP to make an appointment for routine care.  West Virginia Family Health Plan (WVFH) will try to give you a PCP with an office no more than 30 minutes from your home.  The hospital you go to for basic care should be no more than 45 minutes from your home.

Urgent Care

A medical condition is urgent if it is not an emergency but should have medical care within 48 hours.  Call your PCP if you have an urgent medical condition.  If you cannot reach your PCP:

  • Call our Member Services number at 855-412-8001; the TTY number is 711 or 1-800-982-8771.
  • Call the 24-hour nurse help line.

The registered nurses (RNs) at the Nurse Line can answer your health care questions and help you make good health care decisions.  If you need emergency health care, call 911 right away.  The Nurse Line is not meant to replace the medical advice of your doctor.  Please always ask your doctor for medical advice.

Poststabilization or Follow-up Care

This is the care to keep your condition stable after emergency medical care.  You will be covered for follow-up care even if the provider is not part of our network, as long as:

  • You get the care after an emergency medical condition.
  • The care you get helps to maintain your stabilized condition.
  • The care you get helps to improve your condition.

After-Hours Care

You can reach your PCP 24 hours a day at the number on your WVFH member ID card.  After normal business hours, leave your name and phone number with the answering service.  Either your PCP or an on-call doctor will call you back.  You also can call the 24-hour nurse help line.

Out-of-Area Care

You never know when or where you will get sick or injured.  That is why we ask that you to carry your WVFH member ID card with you at all times.  We can still help if you get sick when you are outside of our service area.

If you are outside of our service area, and your problem is not an emergency or you are not sure if it is, call one of these right away:

  • Your PCP (Your PCP’s phone number is listed on your member ID card).
  • Member Services at 855-412-8001; the TTY number is 711 or 1-800-982-8771.
  • The 24-hour nurse help line.

If you think you have an emergency, call 911 or go to the nearest emergency room.  We cover emergencies anywhere in the United States.  You are not covered for services received outside the United States.

PLEASE NOTE:  Do not use an emergency room for routine care.  We do not cover emergency room visits for routine care, whether the visits are made inside or outside our service area.

Pregnancy Care

We have a special program for pregnant women.  This program provides education and support to help you have a healthy pregnancy.

You should try to remain with us throughout your pregnancy to get the most of this program.  Specially trained care managers can answer your questions or concerns about your pregnancy.  The care managers can also help with community service referrals.  You will also receive information on pregnancy and baby care in the mail.  If you would like more information about the Prenatal Program, call our Care Management department at 855-412-8004, Monday to Friday, 8:30 a.m. to 4:30 p.m.

Here are some helpful tips for your pregnancy:

  • Keep all of your prenatal appointments.  If you miss an appointment, call your doctor to reschedule.  Do not wait until your next visit.

  • Take the prenatal vitamins prescribed by your doctor.  Prenatal vitamins are an important part of your prenatal care for both the health of you and your baby.  There are many prenatal vitamins available that we pay for.

  • Avoid alcohol, illegal drugs and smoking.  Second-hand smoke can harm you and your unborn child.  Get help to quit smoking by calling the West Virginia Tobacco QuitLine.

  • Never take any medicines without checking with your doctor first.  This includes prescription medications and over the counter medications like aspirin, Tylenol and cough syrup.

  • Eat at least 3 meals a day and choose healthy foods like fruit, meat, milk, vegetables, breads and cereals.

  • Avoid foods like coffee, soda pop, fast foods, candy and doughnuts.

  • Drink at least 6 to 8 glasses of water every day.  Juice and milk are also healthy choices.

  • Keep your teeth and gums healthy by brushing and flossing daily.  Gum infections can increase the risk of preterm labor.

  • Wear your seat belt when you are in a car.  The lap portion should be low under your belly and touching your thighs.

Specialist Care

Your PCP may send you to a specialist for special care or treatment.  Your PCP will work with you to choose the specialist to give you the care you need.  Your PCP’s office can help you make the appointment. 

PLEASE NOTE: Your PCP must send an approval to the specialist before he or she can give you care.  Tell your PCP and the specialist as much as you can about your health, so that all of you can decide what is best.

Call our Member Services at 855-412-8001, Monday to Friday, 8 a.m. to 8 p.m; the TTY number is 711 or 1-800-982-8771 to let us know about seeing the same specialist each time without an approval first.  Our Utilization Management nurses may approve a number of visits with the same specialist without your PCP setting up each visit.  We will try to find you a specialist with an office no more than 30 minutes from your home.