Getting Care

Wherever you live in Southwest Florida, expert quality care through the Vivida Health network is always close by. From routine family care to major emergencies and everything in between, our caring local doctors and nurses are ready to give the medical help you and your family need.

Our network and coverage include the following services. Click on the section titles or the + below to learn more.

Your first stop for non-emergency care is your Primary Care Physician (“PCP”). You will see your PCP for regular check-ups, physicals, and shots (immunizations). These services are called preventative care and are free as part of your Vivida Health plan. Your PCP is the first person to call when you are sick and will also help you get care from other providers and specialists. This service is called a referral.

Your PCP helps you and your family by giving you tools and tips to stay active and live a healthy life.

Choosing a Primary Care Provider

One of the first things you will need to do when you enroll in our plan is choose a Primary Care Physician or PCP. This can be a doctor, nurse practitioner, or a physician assistant. Choose your PCP by calling Member Services at 844-243-5131 (TTY: 711), from Monday to Friday, 8 am to 7 pm.

You can choose a different PCP for each family member or you can choose one PCP for the entire family. If you do not pick a PCP, we will choose one for you and your family.

Find a PCP near you.

You can change your PCP at any time by calling Member Services at 844-243-5131 (TTY: 711), from Monday to Friday, 8 am to 7 pm.

If you have Medicare, please call the number on your Medicare ID card for information about your PCP.

 

Choosing a PCP for Your Child

We can help you pick a PCP for your child, even before they are born. This can be a pediatrician, family practice provider, or other health care provider. If you would like help, call Member Services at 844-243-5131 (TTY: 711), from Monday to Friday, 8 am to 7 pm. If you do not choose a PCP by the time your baby is born, we will pick one for you. If you want to change your baby’s doctor, call us.

It is important that you select a PCP for your child to make sure they get their Child Health Check-ups each year. Child Health Check-ups are for kids 0–20 years old and do not cost you anything. These visits help you and your PCP keep your child healthy and spot any problems early. Your child may also receive shots at these visits.

You do not need a referral for Child Health Check-ups.

Find a PCP near you.

Sometimes, you may need to see a doctor other than your PCP for medical problems like special conditions, injuries, or illnesses. Talk to your PCP first. Your PCP will refer you to a specialist. A specialist is a doctor who works in one health care area.

If you have a Case Manager, make sure you tell them about your referrals. They will work with the specialist to get you care.

Some services require approval before your visit. Your PCP will submit a prior-authorization request for you. See our Prior Authorizations page for more information.

If you want to check prices before picking a specialist, you can use the Florida Health Price Finder to help you compare costs.

You have the right to get a second opinion about your care. This means talking to a different provider to see what they think about certain services or treatments. This may help you feel confident about your care decisions. There is no cost to you to get a second opinion.

Any Vivida Health provider can give you a second opinion. Your PCP, Case Manager, or Member Services can help find someone qualified. If you are unable to find a Vivida Health provider, we can even help find someone who is not in our network. But we must approve the provider before you see them.

Emergency Care is for when you are so sick or hurt that it puts your life and health in danger if you not treated right away.
Some examples are:

  • Broken bones
  • Bleeding you can’t stop
  • Pregnancy labor and/or bleeding
  • Trouble breathing
  • Suddenly unable to see, move, or talk
  • Very ill or injured

If your condition is severe, call 911 or go to the closest emergency facility right away. You can go to any hospital or emergency facility. If you are not sure if it is an emergency, call your PCP. Your PCP will tell you what to do.

The hospital or facility does not need to be part of our provider network or in our service area. You also do not need to get approval ahead of time to get emergency care or for the services that you receive in an emergency room to treat your condition. If you have an emergency when you are away from home, get the medical care you need.

Once you are safe and healthy, please call Member Services to let us know that you had emergency care.

Urgent Care is needed when you have an injury or illness that must be treated within 48 hours. Your health or life are not usually in danger, but you cannot wait to see your PCP or it is after your PCP’s office has closed. Urgent Care is not Emergency Care. You may need to go to Urgent Care for:

  • Cuts that need stitches
  • Severe rashes or allergic reactions
  • Suspected fractures and small broken bones

Urgent Care centers are open 24 hours a day, 7 days a week. Prior authorizations are not required.

If you need Urgent Care after office hours and you cannot reach your PCP, you can call our 24-hour Nurse Advice Line at 844-865-7920 or you can go to a participating Urgent Care center. You may also find the closest Urgent Care center to you by calling Member Services at 844-243-5131 (TTY: 711).

If you would like to talk to your PCP’s office, call the phone number on the front of your ID card. Your PCP will have a doctor who monitors and returns calls also known as being “on call.” This doctor will call you back and tell you what to do. If you go to an Urgent Care center be sure to call your PCP the next day to ensure you get the follow up care you need.

If you need to go to the hospital for an appointment, surgery, or overnight stay, your PCP will set it up. If you have a Case Manager, they will work with you and your provider to coordinate services when you go home from the hospital.

Vivida Health must approve services in the hospital before you go, except for emergencies. We will not pay for hospital services unless we approve them ahead of time or it is an emergency. For more information regarding prior approvals, see Specialist Care, Referrals, and Prior Authorizations (see above).

There are times when you may need to speak to a therapist or counselor if you are having any of the following feelings or problems:

Always feeling sad
Not wanting to do the things that you used to enjoy
Feeling worthless
Having trouble sleeping
Not feeling like eating
Alcohol or drug abuse
Trouble in your marriage
Parenting concerns

We cover many different types of behavioral health services that can help with issues you may be facing. You can call a behavioral health provider for an appointment. You can get help finding a behavioral health provider by:

Calling: 844-243-5131 or TTY 711
Search our Provider Directory

Someone is ready to help you 24 hours a day, 7 days a week. NO prior approval is required to get behavioral health services.

If you are thinking about hurting yourself or someone else, call 911. You can also go to the nearest emergency room or crisis stabilization center, even if it is out of our service area. Once you are in a safe place, call your PCP if you can. Follow up with your provider within 24-48 hours. If you get emergency care outside of the service area, we will make plans to transfer you to a hospital or provider that is in our plan’s network once you are stable.