Initial mental health consultation Any treatment for which there is insufficient evidence of therapeutic value for the use for which it is being prescribed is also not covered. UHSM is always eager and ready to assist. SISCO's provider portal allows you to submit claims, check status, see benefits breakdowns, and get support, anytime. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. Stress echocardiograms If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. (800) 557-5471. Choice - Broad access to nearly 4,400 hospitals, 79,000 ancillaries and more than 700,000 healthcareprofessionals. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. Monitoring includes member satisfaction with physicians. Describe the range or medical conditions or procedures affected by the conscience objection; The following information was provided by the Connecticut Office of Attorney General for the Department of Public Health and Addiction Services and the Department of Social Services. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. However, the majority of PHCS plans offer members . PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. To verify or determine patient eligibility, call 1-800-222-APWU (2798). Please review our formulary website or call Member Services for more information. Referrals must be signed in ConnectiCares referral system viaProvider Connection. If you have signed an advance directive, and you believe that a doctor or hospital hasnt followed the instructions in it, you may file a complaint with: Connecticut Department of Health 410 Capitol Avenue, P.O. Submit a Coverage Information Form. A sample of the ConnectiCare ID cards appear below. Eligibility, Benefits & Claims Assistance, If you dont see the network listed on your ID card please contact our Customer Service at, Please be sure to verify your providers network access with your provider's office directly prior to receiving services. You have the right to get your questions answered. On a customer service rating I would give her 5 golden stars for the assistance I received. Note: Some plans may vary. To get any of this information, call Member Services. The member loses entitlement to Medicare Parts A and/or B. All oral medication requests must go through members' pharmacy benefits. For emergency care received outside the U.S. there is a $100,000 limit. You have the right under law to have a written/binding advance coverage determination made for the service, even if you obtain this service from a provider not affiliated with our organization. To get any of this information, call Member Services. You and your administrative staff can quickly and easily access member eligibility and claims status information anytime, on demand. If you think you have been treated unfairly or your rights have not been respected, you may call Member Services or: If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, you can call the Office for Civil Rights at 800-368-1019 or TTY 800-537-7697, or call your local Office for Civil Rights. To request a continuation of an authorization forhome health careorIV therapyfax 860-409-2437, All infertility services that are subject to the mandate must be preauthorized, including: a) injectible infertility drugs for the purpose of ovulation induction, b) intrauterine insemination with or without the use of oral or injected medications for ovulation induction, and c) all ART procedures. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. Emergency care is covered. your current benefits ID card upon arrival at your appointment. Examples of qualifying medical conditions can be found below. UHSM is excellent, friendly, and very competent. 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. 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. Out of network benefits will apply when receiving care from non-participating providers. PET scans If you have signed an advance directive, and you believe that a doctor or hospital hasnt followed the instructions in it, you may file a complaint with: Connecticut Department of Health Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. To verify benefits and eligibility - (phone) 800-828-3407, To inquire about an existing authorization -800-562-6833, To request a continuation of authorization for home health care or IV therapy (seeForms, to obtain a copy of the applicable form) - fax 860-409-2437. 410 Capitol Avenue Note: These procedures are covered procedures, but do not require preauthorization in network. Medicare providers under their ConnectiCare contract are required to see all ConnectiCare VIP Medicare Plan members including those who are dual eligible for Medicare and Medicaid. What to do if you think you have been treated unfairly or your rights are not being respected? It is important to sign this form and keep a copy at home. Go > 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. Copyright 2022 Unite Health Share Ministries. ConnectiCare takes all complaints from members seriously. If you refuse treatment, you accept responsibility for what happens as a result of your refusing treatment. Wondering how member-to-member health sharing works in a Christian medical health share program? They are used to assess health care disparities, design intervention programs, and design and direct outreach materials, and they inform health care practitioners and providers about individuals needs. Nutritionist and social worker visit For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. If you need assistance with the shopping tool or with obtaining pricing please contact our Customer Service Team at 877-585-8480, View the video below for additional information on the MyMedicalShopper pricing tool:. If there are unusual and extraordinary circumstances, or the enrollees PCP is unavailable or inaccessible, the enrollee may seek urgent care treatment at the nearest facility. ConnectiCare will communicate to your patients how they may select a new PCP. If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. Letting us know if you have additional health insurance coverage. We believe there is no such thing as a standard cost management approach. If you have any questions please review your formulary website or call Member Services. Influenza and pneumococcal vaccinations Call Automated Phone Specialists between 8 a.m. and 4:30 p.m. (CST) Monday through Fridays at 800-650-6497. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Member Services can also help if you need to file a complaint about access (such as wheel chair access). 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. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Once submitted, ConnectiCare will verify the eligibility of the member with the Centers for Medicare & Medicaid Services (CMS) as they are the sole arbiter of eligibility for Medicare. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Contact us. If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. There are different types of advance directives and different names for them. 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. Identify the state legal authority permitting such objection; Contact the pre-notification line at 866-317-5273. The member provides fraudulent information on the application or permits abuse of an enrollment card. (SeeOther Benefit Information). The plan contract is terminated. ConnectiCare also makes available to members printable, temporary ID cards via our website. abnormal MRI; and 2.) In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. To get any of this information, call Member Services. Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. These members may have a different copayment and/or benefit package. For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. Information is protected as stated in ConnectiCares policies. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time Participate with practitioners in decision-making regarding your health care. Click Here to go to the PHCS / Multiplan Provider Search. Members have an in-network deductible for some covered services before coverage for the benefits will apply. In addition, MultiPlan is not liable for the payment of services under plans. The provider must agree to accept network rates for the defined period of time. Renal dialysis services for members temporarily outside the service area. Regardless of where you get this form, keep in mind that it is a legal document. Life Insurance *. MultiPlan uses technology-enabled provider network, negotiation, claim pricing and payment accuracy services as building blocks for medical payors to customize the healthcare cost management programs that work best for them. For Medicaid managed Following is the statement in its entirety. You must apply for Continuity of Care within 30 days of your health care providers termination date (this is the date your provider is leaving the network) using the request form below. Covered at participating urgent care providers. SeeAutomated and Online Featuresfor additional information. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. It is generally available between 7 a.m. and 9:30 p.m., Monday through Friday, and from 7 a.m. to 2 p.m. on Saturday. Please check the privacy statement of the website where this link takes you. No out-of-network coverage unless preauthorized in writing by ConnectiCare. Note: Some services require preauthorization. Documents called "living will" and "power of attorney for health care" are examples of advance directives. Prior Authorizations are for professional and institutional services only. This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Coverage for skilled nursing facility (SNF) admissions with preauthorization. Balance Bill defense is available for all members with a Reference Based Pricing Plan. We are required to provide you with a notice that tells about these rights and explains how we protect the privacy of your health information. 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. Below are the additional benefits covered by ConnectiCare. Initial chiropractic assessment If you have questions or concerns about your rights and protections, please call Member Services. If you have any concerns about your health, please contact your health care provider's office. These services are covered under the Option Plan nationwide. PHCS is the leading PPO provider network and the largest in the nation. If authorization is not obtained, payment for the service may be denied. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. The Evidence of Coverage (EOC) will instruct them to call their PCP. Members must meet an in-network Plan deductible that applies to most covered health services, including prescription drug coverage, before coverage of those benefits apply. Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Provider. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Visit our other websites for Medicaid and Medicare Advantage. Register for an account For No Surprises Act First time visitor? Yes, PHCS provides coverage for therapy services. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. A complete list of Sutter Health Hospitals and Medical Groups accepting this health plan. Remember you will only need your registration code this one time to set up your account. ConnectiCare must provide written information to those individuals, including their rights under the law of the State to make decisions concerning their medical care, such as the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. Question 2. They should be informed of any health care needs that require follow-up, as well as self-care training. You must pay for services that arent covered. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. Your plan does require If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. 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. Giving your doctor and other providers the information they need to care for you, and following the treatment plans and instructions that you and your doctors agree upon. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. Refuse treatment and to receive information regarding the consequences of such action. The plan cannot and will not disenroll a member because of the amount or cost of services used. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. Any information provided on this Website is for informational purposes only. Nuclear cardiology Since you have Medicare, you have certain rights to help protect you. 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. Member eligibility Medicaid managed care and Medicare Advantage plan effective dates Note: MultiPlan does not have access to payment records and does not make determinations with respect to ben-efits or eligibility. We request your cooperation in investigating and resolving these complaints. You have the right to find out from us how we pay our doctors. You have the right to make a complaint if you have concerns or problems related to your coverage or care. It includes services and supplies furnished to a member who has a medical condition that is chronic or non-acute and which, at our discretion, either: Are furnished primarily to assist the patient in maintaining activities of daily living, whether or not the member is disabled, including, but not limited to, bathing, dressing, walking, eating, toileting and maintaining personal hygiene or. 1-1/2 times your annual salary paid to your beneficiary in the event of your death. 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. You also have the right to receive an explanation from us about any utilization-management requirements, such as step therapy or prior authorization, which may apply to your plan. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Use our online Provider Portal or call 1-800-950-7040. You may want to give copies to close friends or family members as well. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Actual copayment information and other benefit information will vary. Regardless of where you get this form, keep in mind that it is a legal document. ConnectiCare offers both employer-sponsored plans and individual insurance plans. It is important to note that not all of the Sutter Health network . You have the right to refuse treatment. ConnectiCare provides each member with a statement of member rights and responsibilities. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Members are no longer eligible for coverage after their 40th birthday. You have the right to an explanation from us about any bills you may get for services not covered by our plan. ConnectiCare cannot reverse CMS' determination. If you need help with communication, such as help from a language interpreter, please call Medicare Member Services.
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