Making and Breaking Appointments

Just call your PCP's office and make an appointment. With Capstone there are no co-payments or deductibles. Show your Capstone Membership ID Card at every medical appointment. If you do not let your provider know that you are a Capstone Member you could get a bill for the services.

Appointment Examples

There are 3 different types of doctor/dentist appointments that you may need:

  1. Same Day - You need to be seen today. Same day appointments are for when you have a condition that is not an emergency but need to be seen right away. Some examples are shortness of breath, infected tooth, high fever, earache.
  2. Urgent - You need to be seen within 1 to 3 days of your call. Some examples are sore throat, rash, constipation, mild nausea and vomiting, the flu or a cough that will not go away. For urgent appointments, you can expect to be seen by:
    • Your PCP within 2 days, or
    • A specialist or dentist within 3 days
  3. Routine - You can wait 3 to 5 weeks from the day you call to be seen. An example of a Routine Appointment is your annual check-up. For routine appointments, you can expect an appointment by:
    • Your PCP within 21 days,
    • A specialist within 30 days, or
    • A dentist within 45 days.

If you cannot get an appointment during these periods, please call Member Services.

Appointments with Specialists ~ Referrals & Prior Authorization

Please! Do not make an appointment with a specialist until you know that the referral has been approved. You may be responsible for the bill!

Your PCP may refer you to a specialist for care; however, he/she must make a referral through Capstone for the review and approval process for these services. If approved, Capstone will cover the services. This is the prior authorization process.

Capstone will only approve services that are medically necessary and/or emergent. Referrals will only be allowed to health care professionals who are registered with AHCCCS and have an AHCCCS Provider ID number.

Canceling Appointments

If you must cancel an appointment, let your PCP know as soon as you can that you will not make it. Try to do this within 24 hours. This will give the doctor time for another patient. Re-schedule your appointment at a time that is good for you both.

Capstone Health Plan