Where to Go for Care | Ambetter from Sunshine Health


Where to Go for Care

Choose the care option that’s right for you.

Being an Ambetter Health member means getting the care you need, when you need it. But every situation is different. Are you sick? Injured? Do you need a checkup? Be prepared for any medical situation by taking a look at the care options available to you:

   Your Primary Care Provider (PCP)

Your primary care provider is your main doctor — the one you see for regular checkups. If your condition isn’t life-threatening, calling your PCP should be your first choice. Use our online Ambetter Guide tool to find an in-network provider in your area.

Visit or call your PCP if you need:

  • Your annual wellness checkup & vaccinations
  • Advice about your overall health
  • Help with medical problems such as cold, the flu and fevers
  • Treatments for an ongoing health issue like asthma or diabetes

Learn how to use the Ambetter Guide** with this step-by-step instructional video. The Ambetter Guide is a useful online tool that helps you find in-network providers, urgent care clinics, pharmacies, and more. 

   Virtual 24/7 Care*

Virtual 24/7 Care offers convenient, 24-hour access to in-network healthcare providers for non-emergency health issues. You can get medical advice, a diagnosis or a prescription by phone or video. Use Virtual 24/7 Care anytime or schedule an appointment wherever and whenever you need it. Set up your Virtual 24/7 Care account at Teladoc.com/Ambetter

Contact Virtual 24/7 Care for illnesses such as:

  • Sinus problems and allergies
  • Upper respiratory infections
  • Cold, the flu and fevers
  • Rash and skin problems

   24/7 Nurse Advice Line

Talk to a registered nurse any time of the day or night with this free service. The 24/7 Nurse Advice Line provides quick, reliable advice for medical situations that aren’t life-threatening. Call the 24/7 Nurse Advice Line if you need:

  • Help caring for a sick child
  • Answers to questions about your health 
  • To determine whether you should see a doctor immediately

   Urgent Care

If you can’t wait for an appointment to see your PCP, an urgent care center offers fast, hands-on care for health conditions or injuries that require immediate attention. Be sure to visit an in-network urgent care center to avoid paying out-of-pocket costs.* Use our online Ambetter Guide tool to find an in-network urgent care facility in your area.Use urgent care for medical issues such as:

  • Sprains
  • Ear infections
  • High fevers
  • Flu symptoms with vomiting
  • X-rays and stitches*

Always refer to your Schedule of Benefits to make sure you understand the costs you may be responsible for if you choose a provider or service outside of our network.
 

   Emergency Room (ER)

Go to the emergency room or call 911 if your condition is life-threatening. If you have a serious accident or illness, the ER may save your life. But if your situation isn’t life-threatening, you may receive more prompt care through one of the other options available to you. Plus, visiting the ER may increase your out-of-pocket costs significantly.

CALL 911 or get to an ER if you experience:

  • Shortness of breath, asthma
  • Chest pains
  • Bleeding that won’t stop
  • Severe cuts or burns
  • Poisoning

   988 Suicide and Crisis Lifeline

The 988 Lifeline provides confidential help for mental health, drug use, or suicidal concerns when you need it quickly. To connect:  

988 can help you or a family member if you are thinking about suicide or have anxiety, depression or concerns about alcohol or drug use. It can also help for thoughts of hurting yourself or others.  

What’s the difference between in-network and out-of-network?

In-Network means the doctor, pharmacy or facility is included in the Ambetter network. You should always try to use in-network services and providers.

Out-of-Network means the doctor, pharmacy or facility is not included in the Ambetter network — and isn’t covered by your health plan. You’ll likely pay more for those out-of-network services and providers.   

    Always have your member ID card with you when you receive medical care. 

*Cost sharing may apply when using Virtual 24/7 Care. Virtual 24/7 cost share does not apply to HSA plans until the deductible is met and is only applicable when used through the Virtual 24/7 program. Ambetter Health does not provide medical care. Medical care is provided by individual providers which are independent contractors and not agents of Ambetter Health.

**Ambetter Health is underwritten by Celtic Insurance Company, Centene Venture Company Florida, and Sunshine State Health Plan, Inc. Centene Venture Company Florida, and Sunshine State Health Plan, Inc are Qualified Health Plan issuers in the Florida Health Insurance Marketplace. Celtic Insurance Company is a Health Plan issuer in the Florida market. This is a solicitation for insurance. ©2024 Celtic Insurance Company, Centene Venture Company Florida and Sunshine State Health Plan, Inc., AmbetterHealth.com. If you, or someone you’re helping, have questions about Ambetter Health, and are not proficient in English, you have the right to get help and information in your language at no cost and in a timely manner. If you, or someone you’re helping, have an auditory and/or visual condition that impedes communication, you have the right to receive auxiliary aids and services at no cost and in a timely manner. To receive translation or auxiliary services, please contact Member Services at 1-877-687-1169 (Relay Florida 1-800-955-8770). For more information on your right to receive an Ambetter Health plan free of discrimination, or your right to receive language, auditory and/or visual assistance services, please visit AmbetterHealth.com and scroll to the bottom of the page.