They should be informed of any health care needs that require follow-up, as well as self-care training. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Land or air ambulance/medical transportation that is not due to an emergency requires pre-authorization. Members receive in-network level of benefits when they see participating providers. You must pay for services that arent covered. You may want to give copies to close friends or family members as well. Use our online Provider Portal or call 1-800-950-7040. Box 340308 If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Please note that your benefits and out of pocket expenses may vary when using PHCS providers. Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Answer 1. However, the majority of PHCS plans offer members . If you have any questions please review your formulary website or call Member Services. New members may use a copy of the enrollment form as a temporary identification card until they receive their ID card. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. I really appreciate the service I received from UHSM. If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. You should consider having a lawyer help you prepare it. plan. Please note: The benefit information provided is not a comprehensive list and is subject to change. Coverage is provided for temporomandibular joint (TMJ) surgery or orthognathic procedures with preauthorization, when medical necessity is established. The member loses entitlement to Medicare Parts A and/or B. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. Members pay a copayment cost-share for most covered health services at the time the services are rendered. Please check the privacy statement of the website where this link takes you. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. While you may contact us by telephone, you will be asked to place your concerns in writing. That goes for you, our providers, as much as it does for our members. PCP name and telephone number The Evidence of Coverage (EOC) will instruct them to call their PCP. That goes for you, our providers, as much as it does for our members. We also cover additional benefits beyond Original Medicare alone. In these cases, you must request an initial decision called an organization determination or a coverage determination. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. ConnectiCare members will receive an identification (ID) card when they enroll in the plan. ConnectiCare will communicate to your patients how they may select a new PCP. To verify or determine patient eligibility, call 1-800-222-APWU (2798). Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. Emergency care is covered. (SeeOther Benefit Information). The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. View sample member ID cards forcopayandhigh-deductibleplans for details. If authorization is not obtained, payment for the service may be denied. To get this information, call Member Services. If you have questions or concerns about your rights and protections, please call Member Services. Regardless of where you get this form, keep in mind that it is a legal document. Hartford, CT 06134-0308 Your plan does require ThriveHealth STM - Health Depot Association This includes the right to stop taking your medication. To begin the precertification process, your provider(s) should contact Your right to the privacy of your medical records and personal health information. You have the right to timely access to your prescriptions at any network pharmacy. Stress echocardiograms (214) 436 8882 You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. The sample ID cards are for demonstration only. How do I know if I qualify for PHCS insurance? In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Physicians may make referrals to participating specialists without entering them into the telephonic referral system. Provider Portal UHSM is NOT an insurance company nor is the membership offered through an insurance company. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. Your providers must explain things in a way that you can understand. 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. Initial mental health consultation Oops, there was an error sending your message. (SeeOther Benefit Information). Provider. Be treated with respect and recognition of your dignity and right to privacy. TTY users should call 877-486-2048. 410 Capitol Avenue We request your cooperation in investigating and resolving these complaints. For example, you have the right to look at medical records held at the plan, and to get a copy of your records. Answer 3. allergenic extracts (or RAST allergen specific testing); 2.) MultiPlan - Delivering affordability, efficiency and fairness to the US ConnectiCare will also notify members of the change thirty (30) days prior to the effective date of the change, or as soon as possible after we become aware of the change. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. The following are samples of each type of ID card that ConnectiCare issues to members. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. PHCS is the leading PPO provider network and the largest in the nation. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. Just like we shop for everything else! ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. Covered at participating urgent care providers. It is important to note that not all of the Sutter Health network . Keep scheduled appointments or give sufficient advance notice of cancellation. TTY users should call 877-486-2048. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. A new web site will open up in a new window. You should consider having a lawyer help you prepare it. Pleasant and provided correct information in a timely manner. ConnectiCare takes all complaints from members seriously. The bill of service for these members must be submitted to Medicaid for reimbursement. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. In addition, information is protected by information systems security, and authentication and authorization procedures, such as but not limited to: password-protected files; storage, data disposal, and reuse of media and devices; and transmission and physical security requirements using company-protected equipment including access to devices and media that contain individual-level data. If so, they will follow up to recruit the provider. Product and plan details are outlined in the product and coverage section on this page. If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. Answer 2. Blue Cross Providers: 800 . UHSM is excellent, friendly, and very competent. SeeMedical Management. 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. ConnectiCare involuntary disenrollment Reference the below Performance Health Open Negotiation Notice for details on the process your provider must follow for disputing the allowable rate used on your claim. We are equally committed to you, our PHCS PPO Network, and your overall satisfaction. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. PHCS PPO Network - Health Depot Association Benefits - Penn Medicine Princeton Health You have the right to get information from us about our plan. Go > (More information appears later in this section.). 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. We believe there is no such thing as a standard cost management approach. To get this information, call Member Services. Visit Performance Health HealthworksWellness Portal. UHSM is a different kind of healthcare, called health sharing. Benefit Type* Subscriber SSN or Card ID* Subscriber Group #* Patient First Name Patient Gender* Male Female Patient Date of Birth* Provider TIN or SSN*(used in billing) ConnectiCare, in coordination with participating providers, will maintain and monitor the network of participating providers to ensure that members have adequate access to PCPs, specialists, hospitals, and other health care providers, and that through the network of providers their care needs may be met. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. You have the right to make a complaint if you have concerns or problems related to your coverage or care. No specialist-to-specialist referrals permitted, except OB/GYNs may make referrals. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. Eligibility and Referral Line For Medicaid managed Members are encouraged to actively participate in decision-making with regard to managing their health care. All participating providers agree to certify that all information submitted to ConnectiCare is accurate, complete, truthful, and shall comply with applicable CMS standards. Actual copayment information and other benefit information will vary. You will now leave the AvMed web site once you click the "I agree" button. Its affordable, alternative health care. your current benefits ID card upon arrival at your appointment. Remember, it is your choice whether you want to fill out an advance directive (including whether you want to sign one if you are in the hospital). You can sometimes get advance directive forms from organizations that give people information about Medicare. MRI/MRA (all examinations) Optional Life Insurance *. Your right to use advance directives (such as a living will or a power of attorney) While we strive to keep this list up to date, it's always best to check with your health plan to determine the specific details of your coverage, including benefit designs and Sutter provider participation in your provider network. All oral medication requests must go through members' pharmacy benefits. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Members have an in-network deductible for some covered services before coverage for the benefits will apply. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. All genetic testing requires preauthorization, with the exception of the following: Routine chromosomal analysis (e.g., peripheral blood, tissue culture, chorionic villous sampling, amniocentesis) - CPT 83890 - 83914, billed withModifier 8A or ICD-9 diagnosis codes V77.6 or V83.81, DNA testing for cystic fibrosis - CPT 88271 - 88275; 88291, billed withModifier 2A - 2Z or ICD-9 codes V10.6x or V10.7x, FISH (fluorescent in situ hybridization) for the diagnosis of lymphoma or leukemia - CPT 88230 - 88269; 88280 - 88289; 88291; 88299. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Register for an account For No Surprises Act First time visitor? You may also call the Office for Civil Rights at 800-368-1019 or TTY:800-537-7697, or your local Office for Civil Rights. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. . 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. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407.