info@healthdepotassociation.com, Copyright © 2023 Health Depot Association, All Rights Reserved, Supplemental Accident and/or Critical Illness, Follow the prompts to enter your search criteria. Your right to use advance directives (such as a living will or a power of attorney) You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. To find a participating provider outside of Oklahoma, follow the steps listed below. ConnectiCare requires all of its participating practitioners and providers to treat member medical records and other protected health information as confidential and to assure that the use, maintenance, and disclosure of such protected health information complies with all applicable state and federal laws governing the security and privacy of medical records and other protected health information. We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. Notifying providers when seeking care (unless it is an emergency) that you are enrolled in our plan and you must present your plan enrollment card to the provider. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. We also cover additional benefits beyond Original Medicare alone. For non-portal inquiries, please call 1-800-950-7040 . Popular Questions. You should consider having a lawyer help you prepare it. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. After the deductible is met, benefits will be covered according to the Plan. Ask to see the member's ConnectiCare member identification (ID) card. Question 2. Members have an in-network deductible for some covered services before coverage for the benefits will apply. Our plan must have individuals and translation services available to answer questions from non-English speaking beneficiaries, and must provide information about our benefits that is accessible and appropriate for persons eligible for Medicare because of disability. ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only) Specialists:Provide continuity and coordination of care by sending a written report to the member's PCP regarding any treatment or consultation provided to the member. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. What can you doif you think you have been treated unfairly or your rights arent being respected? Answer 5. Remember you will only need your registration code this one time to set up your account. If authorization is not obtained, payment for the service may be denied. For non-portal inquiries, please call 1-800-950-7040. Member race, language, ethnicity, gender orientation, and sexual identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits), and cannot be disclosed to unauthorized users. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. UHSM is NOT an insurance company nor is the membership offered through an insurance company. Routine hearing tests covered up to 1 every year, Routine eye exams covered up to 1 every year, Discounts are available on lenses, contacts and frames. Claims or Benefits questions will not be answered here. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions UHSM Health Share and WeShare All rights reserved. Member Services can also help if you need to file a complaint about access (such as wheel chair access). I called in with several medical bills to go over and their staff was extremely helpful. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Broker benefits Get in touch. Since you have Medicare, you have certain rights to help protect you. Colorectal screening (age restrictions apply) Provide, to the extent possible, information providers need to render care. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. To verify eligibility for services, request to see the member's current ID card. This line is available twenty-four (24) hours a day, seven days a week. Providers are also reminded that dual eligible members who are designated as Qualified Medicare Beneficiaries (QMB or QMB+) cannot be billed for any Medicare cost-share. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. Any personal information that you give us when you enroll in this plan is protected. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. We request your cooperation in investigating and resolving these complaints. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. They should be informed of any health care needs that require follow-up, as well as self-care training. (SeeOther Benefit Information). The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. The Evidence of Coverage (EOC) will instruct them to call their PCP. High Deductible Health Plan (Health Savings Account [HSA] Compatible). UHSM is not insurance. This includes, but is not limited to, an enrollee's medical condition (including mental as well as physical illness), claims experience, receipt of health care, medical history, genetic information, evidence of insurability (including conditions arising out of acts of domestic violence), disability or on any other basis otherwise prohibited by state or federal law. Your right to get information about your prescription drugs, Part C medical care or services, and costs We believe there is no such thing as a standard cost management approach. Make recommendations regarding our members rights and responsibilities policies. Members are required to see participating providers, except in emergencies. PHCS Health Insurance - Health Insurance Providers Your right to get information about your drug coverage and costs Provider. Influenza and pneumococcal vaccinations When you complete the form, MultiPlan will contact yournominee to determine whether the provider is interested in joining. Your rights include knowing about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. There are federal and state laws that protect the privacy of your medical records and personal health information. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. Your plan does require Customer Service at 800-337-4973 ConnectiCare takes all complaints from members seriously. The temporary card is a valid form of ConnectiCare member identification. Solutions. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. When performed out-of-network, these procedures do require preauthorization. To get this information, call Member Services. You have the right to an explanation from us about any prescription drugs or Part C medical care or service not covered by our plan. You may also use the ConnectiCare Eligibility and Referral Line. ConnectiCare will disclose to the Centers of Medicare & Medicaid Services (CMS) all information that is necessary to evaluate and administer our Medicare Advantage plans, and to establish and facilitate a process for current and prospective members to exercise choice in obtaining Medicare services. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. ConnectiCare cannot reverse CMS' determination. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. Requests may be made by either the physician or the member. If you have any concerns about your health, please contact your health care provider's office. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. Continuity of Care allows members the option to apply to receive services at in-network coverage levels for specified medical and behavioral conditions, from their current health care provider if the provider is or is soon to be out-of-network. Answer 3. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. A PHCS logo on your health insurance card tells both you and yourprovider that a PHCS discount applies. If you know ahead of time that you are going to be hospitalized, and you have signed an advance directive, take a copy with you to the hospital. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. You can also get free help and information from CHOICES - your SHIP. Additional term life coverage can be elected in increments of $10,000 to a maximum of $500,000 or 5 times your salary, whichever is less; paid for through payroll deductions. Referrals must be signed in to ConnectiCaresProvider Connection. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. No referrals needed for network specialists. If you have questions or concerns about your rights and protections, please call Member Services. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. It is important to note that not all of the Sutter Health network . To get any of this information, call Member Services. All oral medication requests must go through members' pharmacy benefits. Can be provided safely by persons who are not medically skilled, with a reasonable amount of instruction, including, but not limited to, supervision in taking medication, homemaking, supervision of the patient who is unsafe to be left alone, and maintenance of bladder catheters, tracheotomies, colostomies/ileostomies and intravenous infusions (such as TPN) and oral or nasal suctioning. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. MRI/MRA (all examinations) 2. All requests to initiate or extend a mental health or substance abuse authorization should be directed to our Behavioral Health Program at 800-349-5365.
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