Where to go for care

There are many options for care, so it’s important for members to understand when to utilize each care option. For example, scheduling an appointment with your Primary Care Provider (PCP) and going to the emergency room are two very different care experiences in terms of necessity, care received, and cost.

 

Click on the types of care listed below to learn more about their purpose and when to use them.

A Primary Care Provider (PCP) is a healthcare service provider who practices general medicine and treats people with common medical problems. Usually, a PCP is a trusted and long-term provider who you see at least annually and manages your general care. A PCP can be a general medicine/family practitioner, pediatrician, obstetrician/gynecologist, a nurse practitioner, physician’s assistant, and more! We encourage members to develop a relationship with a PCP because they are meant to be your healthcare guide, advocate, and educator as someone who knows you and your health history. It’s great to go to your PCP for:

 

  • Scheduled care
  • Routine care and routine medications
  • Annual check-up/preventive wellness visit
  • Common medical problems

.
Most providers offer scheduled Telehealth/Virtual Visits – a convenient option to use when traveling outside of your service area. Use the button above to find out more.

Urgent care is healthcare that can be received on a walk-in basis when there is an urgent or “acute” healthcare need that cannot wait for a scheduled visit. Urgent care is great for health concerns such as: sprains/strains, small cuts that may require stitches, flu-like symptoms, fever (without a rash), sore throat or cough, and minor infections like a urinary tract infection. For example, if you fall and cut your arm and need stitches, urgent care is a great place to go! However, if you fall and suffer head trauma, the emergency room would be a better option.

 

  • Unscheduled, same day care
  • Non-life threatening, acute medical concerns
  • Non-routine care or medications

Emergency care is received in a hospital’s emergency department for serious and life-threatening illness or medical emergencies. Emergency care is an important feature of healthcare but should only be used when absolutely necessary. It is important to utilize emergency care when you or someone else is experiencing life-threatening illness or injury such as: bleeding uncontrollably, severe head trauma, severe bone break, convulsions or seizures, moderate to severe burns, symptoms of a heart attack or stroke, or a very high persistent fever. A good rule of thumb for emergency care is to consider whether the medical concern is life-threatening. Emergency care can be very expensive, especially when used in inappropriate circumstances.

.

  • Unscheduled, immediate care
  • Serious and life-threatening medical attention

.

We understand that during an emergency, you will not always be able to go to an in-network emergency room. Because of this, CGHC will cover out-of-network expenses for serious emergency care up to the maximum allowed amount. This will lessen any out-of-pocket expense to you if you happen to be at an out-of-network facility. But remember, it will ALWAYS be most cost-effective to go to an in-network emergency room whenever possible.

A specialist is a provider who is specialized in a certain type of medicine/care. Some examples would include: cardiologist, dermatologist, endocrinologist, an infectious disease specialist, and many more. Many people with chronic illness see a specialist for specialized healthcare treatment, outside of the scope of a PCP. At CGHC, members do not need a referral to see a specialist.

 

  • Scheduled care
  • Treatment or examinations for a specialized health ailment
  • Exploratory care
  • Chronic care treatment (i.e., heart disease, cancers, diabetes)

.

Most providers offer scheduled Telehealth/Virtual Visits – a convenient option to use when traveling outside of your service area. Use the button above to find out more.

Telehealth is the use of telephone/virtual technology for healthcare when you and your provider are not physically together. Many times, members can understand how their service will be billed based on whether or not their visit was scheduled.


Unscheduled Visit:
 you did not schedule this visit ahead of time, and you utilized virtual services on-demand.

 

  • Not scheduled ahead of time with a specific provider
  • Generally, treated like a Quick Care, Fast Care, or “On Demand” visit
  • Typically less expensive than a scheduled telehealth visit

.

An E-visit differs from simply sending your doctor a message. The goal is to diagnose and provide a plan for care.


Scheduled Visit:
 you scheduled this visit ahead of time and chose the provider for this visit

 

  • Scheduled ahead of time with a specific provider
  • Generally, treated like a Primary Care Provider (PCP) or Specialist visit
  • Typically billed like an in-person visit with your provider, and more expensive than an unscheduled telehealth visit

.

Our provider partners each offer their own telehealth (virtual healthcare visit) options:

Aurora Health Care: https://www.advocateaurorahealth.org/virtual-visits

    • Unscheduled visit: Quick Care Video Visit and E-Visit
    • Scheduled visit: Video Visit (scheduled with your provider)

.
Bellin Health
: https://www.bellin.org/appointments-registration/mybellinhealth/virtual-visits

    • Unscheduled visit: E-visit
    • Scheduled visit: Video Visit (scheduled with your provider)

.
ThedaCare
: https://www.thedacare.org/Medical-Team/evisits.aspx

    • Unscheduled visit: E-Visit
    • Scheduled visit: Video Visit (scheduled with your provider)

Virtuwell.com is our 24/7/365 online clinic available to all members. The first 10 Virtuwell visits are free to most members, except members with an HSA plan, who pay the deductible/coinsurance billed amount (due to federal regulations). Virtuwell is easy to use and accessible from anywhere you have Wi-Fi! All you need to do is complete the online survey about your symptoms, and you will get a response from a board-certified Nurse Practitioner within the hour. The Nurse Practitioner can diagnose and even prescribe medications if necessary!

 

  • Unscheduled care
  • Virtual (done through the app or website)
  • Non-life threatening, acute medical concerns
  • Great to use if you are outside of the service area

Did you know?

 

Because all CGHC plans have an Exclusive Provider Organization (EPO) network, members do not need a referral to see a specialist! That means, if your PCP is not specialized to treat you for a specific health concern, you can see any in-network specialist at any time.

CGHC Promo Video