Your CountyCare Member Handbook has information on how to use your health plan.
This is your CountyCare identification (ID) card. Don’t forget to bring it to your appointments or to pick up your medicine!
A primary care provider (PCP) is a doctor who helps you with your everyday health needs. Your PCP is the first person you go to when you feel sick or need a checkup. They will provide care, answer your questions and give you information to stay healthy.
As a CountyCare member, you have to have a PCP. Their name and contact information are printed on your CountyCare member ID card. If you do not have your member ID card or do not know who your PCP is, log into the Member Portal or call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
As a CountyCare member, you will be assigned a PCP. Their name and contact information are printed on your CountyCare member ID card. If you want to change your PCP, call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY), submit a PCP change request form or make the change through the Member Portal.
If you ask for a new PCP, you can start seeing them on the first day of the next month. You will receive a new member ID card in the mail. You can see your PCP before you get your new card.
CountyCare has a “network” of doctors, specialists, dentists and other health care professionals (“providers”) who take care of our members. “In-network” providers agree to accept payment from CountyCare for your care.
We have thousands of health care providers in our network. To look for one, use the Find a Provider tool or call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
CountyCare members must get care at in-network offices and providers. You must have approval from CountyCare if you go to an out-of-network provider. You do not need approval for emergency rooms, family planning services, school dental care and state-operated hospitals. To ask for approval (also called “prior authorization”), tell your provider to visit our For Providers page.
Your primary care provider (PCP) might suggest that you see a specialist. A “specialist” is a provider who focuses on one type of care. For example, they might be a cardiologist (heart doctor), oncologist (cancer doctor) or obstetrician/gynecologist (women’s health doctor). You do not need a referral if your provider is in our network.
It’s important to CountyCare that you see your provider as soon as they are available. You might have to plan ahead to see a provider for non-emergency care. You should be able to get an appointment within the timeframes below. For dental and vision appointment wait times, click here.
Routine visits (checkups, school exams, vaccinations): within five weeks
Non-urgent visits (new illnesses or injuries that do not need care right away): within three weeks
Urgent care visits (new illnesses or injuries that need care right away but are not life-threatening): within 24 hours
Emergency visits (life-threatening illnesses or injuries): immediately, 24 hours a day, seven days a week
Initial prenatal (pregnancy) visits: 1st trimester: two weeks / 2nd trimester: one wee / 3rd trimester: three days
If you have a health problem that needs care right away, you should go to an urgent care center or emergency room. Here are some tips for helping you decide where to go.
CountyCare covers your prescriptions (medications that your provider asks an in-network pharmacy to give you) at no cost to you. Some medications may require a prior authorization.
All Medicaid plans have a “preferred drug list” for members. Providers are encouraged to prescribe medications from this list. If your provider asks for it, they can visit our For Providers page.
If you receive a bill for your health care, do not pay it. Call the phone number on the bill and give them the information on the back of your CountyCare member ID card. If you have any problems, call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
You can get a new card by ordering it in the Member Portal or calling Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). It will be mailed to you at no cost. You can also print a temporary ID card in the Member Portal.
If you travel outside of Illinois and need emergency care for a life-threatening illness or injury, health care providers can treat you. They will send your bill to CountyCare. Emergency services are covered only if these services are provided in the United States.
If you need immediate or routine (non-emergency) care while you are away from home, you must get approval from CountyCare to go to a different provider. Call Member Services for more information at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
Sometimes, you might need to get pre-approval (“prior authorization”) before receiving certain types of care or medication. Your provider or a pharmacist will submit any needed prior authorizations. If your provider has questions, they can visit our For Providers page or call Provider Services at 312-864-8200 / 855-444-1661.
Every CountyCare member can receive help from a care coordinator. A “care coordinator” is not a doctor but still supports your health care needs. They can answer questions about your treatment, set up transportation to doctor’s offices and help you manage your health. They also can help you understand your CountyCare benefits.
You can fill out the Referral to Care Coordination form to talk to a care coordinator. After you finish it, they will contact you.
We want you to be happy with the care you get from CountyCare and your providers. If you are not happy, you can file a grievance or appeal.
A “grievance” is a complaint about your care, the services you receive or the place you receive care. For example, your provider or a CountyCare staff member might have misunderstood you. You can file a grievance in writing or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). For more information on how to do this, click here.
You might want to file an “appeal” if you don’t agree with a decision CountyCare made about your care. For example, CountyCare might not have approved the care your provider asked for. In these cases, you will receive an Adverse Benefit Determination letter in the mail explaining the decision. You have 60 days after the date on the letter to file an appeal. You can do this in writing or by calling CountyCare Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY). For more information, click here.
You should always keep your home address and phone number up to date with CountyCare and the Illinois Department of Healthcare and Family Services (HFS). You can change these with CountyCare by logging into the Member Portal or by calling Member Services at 312-864-8200/ 855-444-1661 (toll-free) / 711 (TDD/TYY).
To change your contact information with HFS, click here.
Every year, the State of Illinois checks to make sure you are still eligible to receive Medicaid services. This is called “redetermination.” You must go through this process to keep your health plan.
Visit our Redetermination page to learn more. You can also go to a redetermination event to get in-person help with renewing your plan. Click here for a calendar of events.
Check the CountyCare Member Handbook to see if it has the answer to your question. If you still need to talk to someone at CountyCare, you can call Member Services at 312-864-8200 / 855-444-1661 (toll-free) / 711 (TDD/TTY).
CountyCare has a secure member portal (website) where you can
Emergency Services: | 911 |
Member and Provider Services: | 312-864-8200 855-444-1661 (toll-free) 711 (TDD/TTY) |
24 Hour Nurse Advice Line: | 312-864-8200 |