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Primary Care
Your primary care provider (PCP) is a doctor or a nurse practitioner. When you are a member of Unison Health Plan, you pick a PCP for you and your family. Some PCP sites may have medical residents, nurse practitioners and physician assistants who will give you care under the supervision of your PCP. Please check with your PCP office.
Specialty Care
Unison also has a Special Needs Unit, or SNU, to help you better use Unison services. If you need extra help or have some difficult issues, you may have a special need. The SNU includes registered nurses and social workers. The SNU can help members use and learn about Unison services. The SNU can also help to make a specialist your PCP, if you qualify.
You may have a special need if you have:
- complicated medical problems (transplant)
- medical equipment like a wheelchair or cane
- mental health issues
- problems with drugs and alcohol
- problems with your sight or hearing
- problems getting to your doctor visits
- help with caring for foster children
These are only some special needs. There are many more. If you’re not sure if you have a special need, please call the SNU at 1.877.844.8844 and we’ll help you.
After-Hours Care
Sometimes, you may need your PCP when the office is closed. If you need urgent care, call your PCP’s office. They will give you directions on how to contact your PCP. Someone is there to help you 24 hours a day, 7 days a week. You should feel free to contact your PCP at any time regarding all of your medical needs. You may also contact our 24/7 Nurse Line at 1.866.915.0311. In emergency cases you may also go directly to the nearest emergency room.
Behavioral Health Services
Unison’s approach to providing behavioral health services accounts for all of a member’s family and medical needs. Unison thinks it’s important to coordinate care between the member, the member’s family, the behavioral health providers, the medical providers and Unison’s care managers.
- You may self-refer to any Unison-participating behavioral health provider for outpatient therapy services.
- When you call or go to the office to make an appointment, be sure to:
- Have your Unison Health Plan ID card number.
- Tell them you are a Unison Health Plan member.
- Tell them why you need an appointment.
- Bring your card for any other insurance you may have.
- How long should it take to see behavioral health provider?
Emergency: Immediately
Non-emergency: Within 6 hours
Urgent needs: Within 48 hours
Routine visits: Within 7 calendar days
If you have a behavioral health emergency or you need emergency transportation, contact your local emergency service or go get care at the nearest emergency facility. If you are treated, you must call Unison within 24 hours or as soon as possible. This number is listed on your Unison Health Plan ID card.
Members 17 years of age and under can have a total of 30 outpatient visits managed by Unison. All other treatment requests are managed through the Delaware Division of Child Mental Health Services (DCMHS). DCMHS can be reached by contacting the Intake Department at 1.302.633.2571 or 1.800.722.7710.
For additional information on behavioral health, including help making an appointment, please call 1.866.261.7692.
Out-of-Network Services
If Unison Health Plan does not have a specialist able to help you in your area, you have the right to get help from an out-of-network doctor. The out-of-network-doctor will need to call Unison to get an O.K. (prior authorization). Unison Health Plan will pay if you have the O.K. from Unison for services that need approval, as long as you are eligible at the time of service.
Out-of-Area Services
If you are traveling and have an emergency health need, Unison Health Plan will cover medically necessary services. Prior authorization is not needed for emergency room or hospital visits. The hospital will need to inform Unison about your treatment once you are stabilized. Non-emergency visits will need prior approval. If you are out of the area and need non-emergency services, call your PCP.
What To Do In An Emergency
An emergency condition is a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. If you are not sure if you are having an emergency, or if you would like to know more about medical conditions, please call the 24/7 Nurse Line at 1.866.915.0311.
Emergency services are needed to assess or stabilize an emergency condition. Emergency conditions have to meet the prudent layperson standard or occur during emergency ambulance transportation. You can get emergency services 24 hours a day, 7 days a week.
Some emergencies are:
- Heart attacks
- Severe chest pains
- Accidents
- Severe bleeding
- Major burns
- Loss of consciousness
- Serious breathing difficulties
- Spinal injuries
Colds and sore throats are not usually emergencies. If you are not sure if you are having an emergency, call your PCP or the 24/7 Nurse Line at 1.866.915.0311. If the office is closed, a message will tell you what to do next. Go to the nearest emergency room or 24 hour care center when you have an emergency. If you have an emergency or need emergency transportation, contact your local emergency service or go to the nearest emergency facility for help.
If you receive emergency treatment, you must call Unison within 24 hours, or as soon as possible. This number is listed on your Unison Health Plan ID card. You will need to call your PCP as soon as possible after the emergency is under control.
If you are outside the Unison Health Plan service area and have an emergency, go to the nearest emergency room or 24-hour care center. Call Unison within 24 hours, or as soon as possible.
Urgent Care
Urgent care is when you or a family member needs care or advice within 24 hours. If you or a family member needs urgent care, call your PCP and say why you need urgent care. Your PCP will see you or tell you what to do.
New Services and Treatments
We will review all new technologies that your doctor thinks would help you. Our medical directors, who consider new medical and scientific information, as well as governmental requirements, review these requests together. They will review any medically necessary treatment that is not experimental. We will notify you and your doctor of the decision. We will notify you as new procedures, services and devices are evaluated and approved as newly covered benefits. We will let you know in our quarterly member newsletter or a special mailing.