Answers to common questions

SoonerCare is a government program that provides no-cost or low-cost health care for millions of Americans. Adults and children who qualify meet certain state guidelines. Eligibility is based on your total family income and household size. Once you apply, the Oklahoma Health Care Authority reviews your enrollment in SoonerCare. If you’re approved for SoonerCare, you can choose us or another SoonerSelect health plan as your plan.

Questions about eligibility? You can contact SoonerCare directly for help at 1-800-987-7767.

SoonerCare

Learn more about what’s covered

Find out if you qualify

If you’re approved for SoonerCare, you can choose us as your SoonerSelect health plan.
 

Learn about choosing our plan

Some members must renew every year. You can find out if you need to renew.

Learn how to renew

We want you to be happy with the care you get. So if you’re ever unhappy with your health plan or a provider, you can file a grievance. Or you can file an appeal if we deny, delay or change a service. If you don’t agree with the decision on your appeal, you can ask for a state fair hearing.

Grievances and appeals

Tell us. You have the right to report anyone you believe is committing fraud or abuse.

Fraud and abuse

You’ll find your health plan summary and benefits info in your member handbook or on your Member Portal or Aetna Better Health app.

Learn more about your Member Portal and app

We’re here for you at 1-844-365-4385 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

You can also use the Contact us page to get in touch. Or log in to your Member Portal or Aetna Better Health app. 

Learn more about your Member Portal and app

You have some options if you lose your member ID card. First, log in to your Member Portal or Aetna Better Health app. There, you can:

• Ask us to mail you a new ID card
• Find the electronic version of your ID card — as long as you have your smartphone, you’ll always have your ID card with you for health care visits

Or call us at 1-844-365-4385 (TTY: 711). We’re here for you 24 hours a day, 7 days a week.

Learn more about your Member Portal and app

Your PCP is a medical provider who will manage your health care. They’re the doctor, nurse, physician assistant or clinic that provides your main health care. They’ll help you get all the covered services you need.

Find a provider

You can change your PCP through your Member Portal or Aetna Better Health app. You can also call Member Services at 1-844-365-4385 (TTY: 711). This is the number on your ID card.

You can also learn more about choosing a PCP.

Learn more about your Member Portal and app

Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.

Learn more about your Member Portal and app

Specialists are providers who treat specific conditions. Your PCP might refer you to a specialist in our network. Or they may recommend you see one. Need help finding a specialist? You can call us at 1-844-365-4385 (TTY: 711).

Find a specialist

You can use our online search tool to find providers for the health care services you need. 

Find a provider

Whether it’s day or night, your PCP or on-call provider can tell you what to do. If they’re not in the office, leave a message. They’ll return your call. Your provider must see you within 24 hours if you need urgent care.

If you're having an emergency, call 911 or go to the closest hospital.

You’ll only need emergency care if you think your health is in serious danger. Emergencies may include:

• Severe pain
• Serious injury
• Sudden illness
• Illness that is quickly getting much worse
• Heavy bleeding that doesn’t stop, especially if you’re pregnant

If it’s not an emergency, but you need medical advice, call us at 1-844-365-4385 (TTY: 711). Then, choose the option for the 24-Hour Nurse Line. A nurse can help you decide if you need to go to the ER or urgent care.

Check out some of these articles to learn more about getting the right care at the right time:

• Is it an emergency?

• Where to go for quick medical care

Find a hospital

If you have no way to get to the hospital during an emergency, call 911. We cover ambulance rides on the ground in a medical emergency. 

Need a ride to your doctor visits? You can get help with rides to medical services we cover. We cover rides for your nonemergency medical needs. You can get a ride for visits to your:

• Provider
• Dental provider
• Pharmacy
• Behavioral health appointments
  

Rides

If you’re away from home and have an emergency, go to the closest hospital or call 911. The hospital doesn’t have to be in our network for coverage and care.

You can use the provider search tool to find a hospital. Or you can call us at 1-844-365-4385 (TTY: 711) for help. 

Find a hospital

Pregnant women need special care. You’ll want to see a provider within three weeks of a positive pregnancy test (home or lab). We can help with pregnancy care. Just call us as soon as you can at 1-844-365-4385 (TTY: 711).

You can also visit our health and wellness library to learn more about pregnancy, women’s health and other topics to help keep you healthy.

Pregnancy care

You’ll want to make sure your baby has medical coverage. If you don’t have insurance when your baby is born, enroll them in SoonerCare. You can do so by contacting the Oklahoma Health Care Authority.  

If you have questions or need help, just call us at 1-844-365-4385 (TTY: 711).

When you have a condition, you’ll work with your health care provider to set up a treatment plan. The plan will likely include certain steps, like:
 

• Taking medication
• Making lifestyle changes, like eating and exercise
•  Finding emotional support

Some conditions can benefit from disease management, like:

• Asthma 
• Chronic obstructive pulmonary disease (COPD) 
• Diabetes 
• Heart failure 
• Coronary artery disease (CAD) 
• Depression

Do you have one of these conditions? If yes, you may be able to get help from a care manager. You can learn more on our page about disease management. Or call us at 1-844-365-4385 (TTY: 711).

Disease management

A PDL is a list of covered medications. In Oklahoma, the list comes from Oklahoma Health Care Authority. These medications treat a variety of conditions. You can learn more on our Pharmacy benefits page.

Pharmacy benefits

You can ask your provider to:
 

• Give you a similar medication that is preferred on the list
• Get prior authorization (PA) to cover this medication if they think it’s necessary to treat your medical condition

First, your provider will contact us. Then, our pharmacy staff will review the info your provider gave us. Finally, we’ll make a decision.

Some health care services and supplies need approval before you can get them. The Oklahoma Health Care Authority Drug Utilization Board follows nationally recognized guidelines to make these decisions. Before providing a service, your provider must check the list. It may change from time to time. You can learn more about PA.

Prior authorization

You don’t need a referral to see in-network providers for routine and preventive health care services.

You do need PA for some health care services and supplies before you get them. The Oklahoma Health Care Authority Drug Utilization Board uses nationally recognized guidelines to make PA decisions about care your provider suggests.

Your provider must check to see if your service requires PA before they provide it. You can learn more about PA.

Prior authorization

The Oklahoma Health Care Authority Drug Utilization Board sets quantity limits for different reasons. Some medications have a maximum limit or dose for safety reasons. The Oklahoma Health Care Authority Drug Utilization Board sets the limits based on proven standards of care, such as the U.S. Food and Drug Administration (FDA) guidelines. In some cases, we make exceptions. Have your provider contact us. We’ll review the info from your provider and make a decision. You can learn more about pharmacy benefits.

Pharmacy benefits

These types of medications aren’t covered on the PDL:
 

• Cosmetic
• Hair growth
• Infertility or erectile dysfunction
• Experimental or investigational 
• Weight loss/weight gain
• Nutritional supplements
• Cough and cold medications

Staying active is one of the best things you can do for your health. It can:
 

• Give you more energy
• Help you feel better 
• Prevent some health problems that go along with aging 

Some physical activity is better than none at all. But check with your doctor before you start — just to be sure it’s safe. Want to learn more about staying active?  

Learn more about exercise 

You can learn more about health goals, info and coaching.

Health coaching

You’re not alone. During the COVID-19 pandemic, many people have felt more stress and anxiety than ever. They need more help than usual coping with everyday pressures. Things like job loss, child care issues and other challenges are very real.

Did you know that stress can affect your health? It’s common during times of stress to pick up some unhealthy habits. Don’t be too hard on yourself. It’s not always easy, but you can learn ways to:

• Eat healthy
• Exercise regularly
• Start other healthy habits
   

Learn more about healthy habits:

• Healthy living resources
• 4 ways to take care of physical and mental well-being during unsettled times
• Staying mentally healthy in tough times

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. Or you can find this info on your Member Portal or Aetna Better Health app.

Learn more about your Member Portal and app

It may not be easy, but you can stop using nicotine — whether it’s smoking, vaping, chewing or another form. Let’s quit together.
 

Oklahoma Tobacco Settlement Endowment Trust (TSET)
 

TSET is a state trust that aims to prevent cancer and cardiovascular disease. These are leading causes of death in Oklahoma. The trust awards grants to:
 

• Schools
• Communities
• State agencies
• Other partners

Through these grants, TSET: 

• Funds research and other opportunities  
• Addresses our state’s most pressing public health issues 
• Works to improve the health of people who live in Oklahoma
• Creates healthier places for all Oklahomans to live, work, learn and play 
   

Find more support

You can also learn more about quitting from the:

• Oklahoma Tobacco Helpline: 1-800-QUIT-NOW (1-800-784-8669)
• American Cancer Society’s guide to quitting smoking
• Great American Smokeout® event
• Centers for Disease Control and Prevention
   

Your PCP can give you more personal help and treatment. Be sure you know who your PCP is and make an appointment today. Your ID card will have your PCP’s name and phone number. You can also find this info on your Member Portal or Aetna Better Health app.

Learn more about your Member Portal and app