When you have a health question or concern, knowing which care option to choose can help you save time and money. From $0 virtual consults to urgent care, you can choose from a quality network of healthcare providers with coverage from Blue Shield of California or Blue Shield of California Promise Health Care Plan.
Here’s how to find the most cost-effective care when you need it, where you need it.1
Primary doctor
The best place to start when you need care is with your primary care provider, also known as your primary care physician (PCP) or Physician of Choice (POC). This is your main healthcare provider for routine medical needs.
Your primary care provider can treat common medical conditions. They can provide preventive care, annual physicals or wellness visits. They can also provide referrals to a specialist if needed.
Specialists
From cardiology to gynecology, you have access to a wide range of medical specialists.
Use our Find a doctor tool to find a specialist to help you with your specific healthcare needs.
Note: PPO members do not need a referral to see a specialist. HMO members should check their Evidence of Coverage or Certificate of Insurance first.
Mental health care
Whether you’re feeling stressed or need a specialist, we’re here to help.
If you’re in crisis or have suicidal thoughts, seek help right away. Please call 911 or go to the nearest emergency room. You can call, text, or chat with the 988 Suicide & Crisis Lifeline at 988.
Standards for Timely Access to Care
You are entitled to timely access to care. We ask providers to meet these wait time standards.
Telehealth1,6
Telehealth advice and virtual care options let you speak with medical professionals via phone or video.
Common uses for virtual care include non-emergency conditions. For example, respiratory infections, cold and flu, allergies, and joint pain.
NurseHelp 24/7℠ or Nurse Advice Line
You can call toll-free or use the online chat to speak with a registered nurse, anytime at no extra cost. They can give you advice on how to treat minor illnesses and injuries at home. They can also help you decide if you should see a doctor for treatment.2
Medi-Cal members: Talk to a nurse
All other members: Talk to a nurse
Teladoc3
Board-certified, licensed doctors are available 24/7 in all 50 U.S. states. Speak to doctors by phone or video who can treat non-emergency medical issues and may prescribe medications.
In-person care
While many people are choosing virtual care options, we understand that sometimes you may need – or prefer – to see a doctor in person.
That’s why we offer access to in-person options beyond your primary provider. These can be used for both simple and more complex needs.
Urgent care
Walk-in, non-emergency care when your primary care provider is not available. Available to all members.5
Ambulatory surgery centers (ASCs)
ASCs – also known as outpatient surgery centers – are healthcare facilities that can perform procedures normally done in a hospital setting. These are surgeries that are same-day and do not need an overnight stay. ASCs can be used for a range of procedures. This includes general surgery, urology, neurology, and more.
CVS MinuteClinic1
A CVS MinuteClinic® is a walk-in health care at CVS retail locations. These are for non-emergency conditions and immunizations. This service is available to PPO members only. It has the same cost as an office visit after your deductible has been met.
Emergency care:
Emergency room
For serious, life-threatening conditions or disabling conditions or injuries, such as trauma, stroke, or heart attack, always go straight to the emergency room or call 911. This is available to all members.
In-home care1
You can get urgent care in the comfort of your own home. Common conditions that can be treated at home include viral infections, flu, and migraines.
Urgent Care at Home1
Members with a PPO plan and all Medi-Cal plan members can get urgent medical care at home for the same out-of-pocket cost as a visit to an in-network urgent care center. Available seven days a week from 8 a.m. to 10 p.m. in Riverside, Orange, Los Angeles, and San Diego counties for members 3-months-old and older.
1Some of the services listed above may not be covered by your medical plan. For more information and complete details on benefits, covered services, or exclusions, please refer to your Evidence of Coverage (EOC) or Certificate of Insurance (COI) or call the customer care number on your Blue Shield member ID card.
2NurseHelp 24/7 is a service mark of Blue Shield of California. NurseHelp 24/7 is a healthcare advice line. Nurses do not provide medical services for treatment or diagnosis.
3Teladoc does not replace the primary care provider. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA-controlled substances, non-therapeutic drugs, and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
4Limitations apply. Refer to your prescription drug coverage for any out-of-pocket costs. If you do not have prescription drug coverage, you are responsible for the cost of the prescription drug.
5If you are a Trio HMO member who needs to visit an urgent care center, you may be required to call your doctor’s office each time you seek care. HMOs may require your doctor’s office to provide authorization before you go to the urgent care center. You must receive care at an urgent care center that is affiliated with your doctor’s medical group or IPA, or your plan may not cover the services received.
6Your network providers may offer telehealth and in-office services. Contact your primary care provider, treating specialist, facility, or other health professional to learn whether telehealth is an option. Network telehealth and in-person services are subject to the same timely access to care standards. If your plan has out-of-network benefits, they are subject to your plan’s cost-sharing obligations and balance billing protections.
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