As a member of UnitedHealthcare Community Plan, one of the first things to do is to pick a Primary Care Provider (PCP). Your PCP is your personal care doctor. A PCP can be a family or general practitioner, internist, pediatrician, or other type of provider. Your PCP is shown on your ID Card.
Your PCP will give or manage most of your care. Talk to your PCP about your health problems. Let your PCP know your medical history. Tell them about any specialists you are seeing. Follow all your PCP’s instructions. Get prior approval before getting services that require this. Each covered family member may pick a different PCP.
Part of good health is seeing your PCP for check-ups, even if you don’t feel sick. UnitedHealthcare Community Plan will send you a reminder of when to go for a check-up. When you don’t feel well, your PCP will help you. Be sure to call your PCP right away. Your PCP may refer you to a specialist. You can call our Member Services line, at 1-877-542-9238 (TTY: 711). We can help you find or change your PCP.
To find a PCP or a Specialist in our network, please visit these online directories for complete information, including names, addresses, specialties, new patient’s availability and languages spoken. If you would like us to provide you with a printed version at no cost, please call us, at 1-877-542-9238 (TTY: 711). Kansas Medicaid members residing in a Nursing Facility: You may stay in your current nursing home no matter which KanCare plan we picked or you choose.
Eastern Service Area (PDF 4.3 MB)
Middle Service Area (PDF 3.32 MB)
Western Service Area (PDF 2.38 MB)
Statewide Service Area (PDF 14.83 MB)
If you have an emergency, go to an Emergency Room (ER). If you need help getting to the ER fast, call 911. You do not need a referral from your PCP to use the ER. You should be seen within an hour to see the extent of your illness or injury. Call your PCP as soon as you can after getting emergency care.
After you get emergency care, the hospital must ask for approval within one hour for more care to keep you stable. If we do not respond in one hour or cannot be reached, or if we do not agree with the doctor on your care, we must let the doctor talk with our Medical Doctor. The doctor may continue the care until the Medical Doctor is reached or one of the guidelines is met. You may be treated in the ER, in a hospital room, or in another setting. This is called Post Stabilization Services.
What Is an Emergency?
Emergency means a condition with sudden symptoms so severe that lack of fast care could:
• Place the patient’s health in serious jeopardy;
• Seriously Impair bodily functions;
• Cause dysfunction of any body organ or part;
• Cause serious disfigurement; or
• In the case of a pregnant woman, jeopardize the health of a woman or her unborn child.
If you have an emergency, call 911 or go to the nearest ER.
Examples of Emergencies:
• Severe pain
• Severe or unusual bleeding
• A serious accident
• A suspected heart attack or stroke
Examples of What Is NOT usually an Emergency:
• Colds and flu
• Sore throats
• Bruises or minor cuts
At this link, you'll find answers to some of the questions and issues we've received.
The UnitedHealthcare Community Plan Preferred Drug List (PDL) is a list of covered prescription drugs, and drugs needing prior authorization for enrollees in KanCare. Prior authorization is when your doctor has to call us before giving you the prescription to see if we will cover it.
90 Day Maintenance Drug List (PDF 231.66 KB)
Quick Reference Guide for the State Preferred Drug List Policies
Direct Member Reimbursement (DMR) Form (PDF 43.33 KB)