After the deductible has been met, coinsurance will apply to the covered benefits. How do I contact PHCS? Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). TTY users should call 877-486-2048, or visit www.medicare.govto view or download the publication Your Medicare Rights & Protections. Under Search Tools, select find a Medicare Publication. If you have any questions whether our plan will pay for a service, including inpatient hospital services, and including services obtained from providers not affiliated with our plan, you have the right under law to have a written/binding advance coverage determination made for the service. From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. 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. For Medicaid managed Click Here to go to the PHCS / Multiplan Provider Search. This video explains it. No referrals needed for network specialists. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. See the preauthorization section for a listing of DME that requires preauthorization. Covered at participating urgent care providers. Be sure to ask your doctors and other providers if you have any questions and have them explain your treatment in a way you can understand. Please review our formulary website or call Member Services for more information. 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. If you need assistance If you encounter issues when scheduling appointments with PHCS Network providers, call us at 866-685-7427. Choose "Click here if you do not have an account" for self-registration options. Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design Customer Service at 800-337-4973 By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother process and overall cost savings. Members with End Stage Renal Disease (ESRD) will not qualify, except if they are currently covered by a ConnectiCare benefit plan through an employer or self pay (a commercial member). 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. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. You must pay for services that arent covered. Best of all, it's free- no downloads required or software to install. We must investigate and try to resolve all complaints. MRI/MRA (all examinations) If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). 410 Capitol Avenue Monitoring includes member satisfaction with physicians. Members receive out-of-network level of benefits when they see non-participating providers. A new web site will open up in a new window. Some plans may have a copayment requirement for radiology services. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). Some applicable copayments First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). The member engages in disruptive behavior. 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. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. Your right to get information about our plan and our network pharmacies You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. There are exceptions allowed or required by law, such as release of health information to government agencies that are checking on quality of care. 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. Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. This includes information about our financial condition and about our network pharmacies. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. On a customer service rating I would give her 5 golden stars for the assistance I received. If you have any other kind of concern or problem related to your Medicare rights and protections described in this section, you can also get help from CHOICES. Please call Member Services if you have any questions. Below are the additional benefits covered by ConnectiCare. Member Services can also help if you need to file a complaint about access (such as wheel chair access). Since you have Medicare, you have certain rights to help protect you. Simply call (888) 371-7427 Monday through Friday from 8 a.m.to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for LimitedBenefit plans. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Home health services are coordinated by ConnectiCare's Health Services: To verify benefits and eligibility - (phone) 800-828-3407 For non-portal inquiries, please call 1-800-950-7040. 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. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). All oral medication requests must go through members' pharmacy benefits. 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. PHCS is the leading PPO provider network and the largest in the nation. Supporting evidence, which may be required includes: 1.) Please review the member's ID card to confirm the appropriate phone number. Note: Some services require preauthorization. plan. You can also visit www.medicare.gov on the Web to view or download the publication Your Medicare Rights & Protections. Under Search Tools, select Find a Medicare Publication. Or, call 1-800-MEDICARE (800-633-4227). Timely access means that you can get appointments and services within a reasonable amount of time. There are federal and state laws that protect the privacy of your medical records and personal health information. The plan will release your information, including your prescription drug event data, to Medicare, which may release it for research and other purposes that follow all applicable Federal statutes and regulations. Understand their health problems and participate in developing mutually agreed upon treatment goals to the degree possible. Provider Portal Eligibility inquiry Claims inquiry. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! A voluntary termination initiated by a practitioner should be communicated to ConnectiCare verbally or in writing, in accordance with the terms set forth in the contract, but no less than sixty (60) days before the effective date. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. TTY users should call 877-486-2048. SeeAutomated and Online Featuresfor additional information. 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). These members may have a different copayment and/or benefit package. CT scans (all diagnostic exams) It is important to sign this form and keep a copy at home. However, the majority of PHCS plans offer members . Prior Authorizations are for professional and institutional services only. Your right to use advance directives (such as a living will or a power of attorney) Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. 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. Your right to get information in other formats Call us and tell us you would like a decision if the service or item will be covered. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. Reminding the patient to notify ConnectiCare; and (214) 436 8882 We will make sure that unauthorized people dont see or change your records. When performed out of network, these procedures do require preauthorization. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (medical coverage) and may offer extra benefits too. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. Visit our other websites for Medicaid and Medicare Advantage. You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and figure out whether the changes are appropriate). Your right to get information about your drug coverage and costs You may want to give copies to close friends or family members as well. How to manage the front desk when they ask who you are insured with? Just like we shop for everything else! Your right to get information about our network pharmacies and/or providers Please note that your benefits and out of pocket expenses may vary when using PHCS providers. 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. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. You are now leavinga ConnectiCare website. Pelvic exam You have the right to an explanation from us about any bills you may get for services not covered by our plan. To begin the precertification process, your provider(s) should contact Devices can include but not be limited to diskettes, CDs, tapes, mobile applications, portable drives, desktops, laptops, secure portals, and hardware. 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. Members are encouraged to actively participate in decision-making with regard to managing their health care. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Members are no longer eligible for coverage after their 40th birthday. Your Explanation of Payment (EOP) will specify member responsibility. Make recommendations regarding our members rights and responsibilities policies. After the Plan deductible is met, benefits will be covered according to the Plan. provider must already be participating in PHCS Network, which is certified for credentialing by NCQA. Regardless of where you get this form, keep in mind that it is a legal document. Members are required to see participating providers, except in emergencies. Keep scheduled appointments or give sufficient advance notice of cancellation. 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. Its affordable, alternative health care. Members must reside in the service area. You have the right to be told about any risks involved in your care. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. 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. To verify or determine patient eligibility, call 1-800-222-APWU (2798). PHCS is the leading PPO provider network and the largest in the nation. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. CommunityCare Life and Health Insurance Company provides an in-network level of benefits for services delivered outside of Oklahoma through a national PPO network, PHCS. To get this information, call Member Services. Your responsibilities as a member of our plan. Members receive in-network level of benefits when they see participating providers. Renal dialysis services for members temporarily outside the service area. Note: To ensure accurate billing for plans with deductibles, bill ConnectiCare prior to taking any payment from members. All routine laboratory services must be obtained from participating laboratories. Visit Performance Health HealthworksWellness Portal. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. To pre-notify or to check member or service eligibility, use our provider portal. Note: Presentation of a member ID card is not a guarantee of a member's eligibility. I'm a Broker. The plan cannot and will not disenroll a member because of the amount or cost of services used. If you do, please call Member Services. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. 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. Nuclear cardiology We request your cooperation in investigating and resolving these complaints. View sample member ID cards forcopayandhigh-deductibleplans for details. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review.
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