(More information appears later in this section.). Pelvic exam 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. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. In addition, some of the ConnectiCare plans include Part D, prescription drug coverage. Really good service. Preferred Provider Organization Questions? 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. ConnectiCare, in compliance with advance directives regulations, must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care. 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). This includes information about our financial condition, and how our Plan compares to other health plans. You can sometimes get advance directive forms from organizations that give people information about Medicare. It is important to sign this form and keep a copy at home. MRI/MRA (all examinations) Coverage for skilled nursing facility (SNF) admissions with preauthorization. Question 5. PPM/10.16 Overview of Plans Overview of products We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Health Plan Satisfaction (CAHPS) survey and implement quality improvement activities when opportunities are identified. Any personal information that you give us when you enroll in this plan is protected. ConnectiCare will communicate to your patients how they may select a new PCP. Pleasant and provided correct information in a timely manner. Some plans may have deductible requirements. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Monitoring includes member satisfaction with physicians. I called in with several medical bills to go over and their staff was extremely helpful. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. Portal Training for Provider Groups Customer Service at 800-337-4973 Accessing PHCS Savility PHCS Savility is available to insurers and benefit plan administrators meeting certain benefit design ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 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. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. PHCS Health Insurance - Health Insurance Providers Coverage for medical emergencies without preauthorization. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. 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. (SeeOther Benefit Information). Members can print temporary ID cards by visiting the secure portion of our member website. Circumstances beyond our control such as complete or partial destruction of facilities, war, or riot. Letting us know if you have any questions, concerns, problems, or suggestions. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? Question 2. Some plans may have deductible and coinsurance requirements. 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. Incorrect Email or Password - MultiPlan It is not medical advice and should not be substituted for regular consultation with your health care provider. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. What to do if you think you have been treated unfairly or your rights are not being respected? Dominion Tower 999 Waterside Suite 2600 Norfolk, VA 23510. 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. Check with our Customer Service Team to find out if your plan accesses Health Coaching. 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. PHCS is the leading PPO provider network and the largest in the nation. United Faith Ministries, Inc. is a 501(c)(3) nonprofit corporation, dba Unite Health Share Ministries or UHSM Health Share, that facilitates member-to-member sharing of medical bills. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. For preauthorization of the following radiological services, call 877-607-2363 or request online atradmd.com/. New Century Health - Medical Oncology Policies, Provider resource: 2020 changes to Medicare Advantage plans, Dual special needs plan member information available through provider website, Reminders about caring for our Medicare Advantage members, Changes to claims payment for Medicare Advantage inpatient stays, Update on Medicare Beneficiary Identifiers (MBIs), Clinical Review Prior Authorization Request Form. Your right to know your treatment options and participate in decisions about your health care Please Note: When searching for providers, the results presented are for reference only; as participating physicians, hospitals, and/or healthcare providers may have changed since the online directory was last updated. If you have not signed an advance directive form, the hospital has forms available and will ask if you want to sign one. Renal dialysis services for members temporarily outside the service area. You can sometimes get advance directive forms from organizations that give people information about Medicare. What services are available to me that could save me money? ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Just like we shop for everything else! Timely access means that you can get appointments and services within a reasonable amount of time. Please review the member's ID card to confirm the appropriate phone number. If you make a complaint, we must treat you fairly (i.e., not retaliate against you) because you made a complaint. 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. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. 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. providers - IBA TPA Regardless of where you get this form, keep in mind that it is a legal document. Multiplan or PHCS | Mental Health Coverage | Zencare Zencare Nuclear cardiology 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. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. If so, they will follow up to recruit the provider. Make recommendations regarding our members rights and responsibilities policies. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. Documents called a "living will" and "power of attorney for health care" are examples of advance directives. Your Registration Code is the Alternate ID number on your ID card plus a suffix of 01 for the subscriber, 02, 03, 04, 05, etc for spouse and/or dependents. HPI | Provider Resources | Patient Benefits & Eligibility The member loses entitlement to Medicare Parts A and/or B. You should consider having a lawyer help you prepare it. Benefits Administration and Member Support for The Health Depot Association is provided byPremier Health Solutions. Your right to the privacy of your medical records and personal health information. Visit Performance Health HealthworksWellness Portal. Colorectal screening (age restrictions apply) When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. Box 340308, Hartford, CT 06134-0308, 860-509-8000, TTY: 860-509-7191. (SeeOther Benefit Information). Box 450978 Westlake, OH 44145. It is critical that the members eligibility be checked at each visit. 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. We believe there is no such thing as a standard cost management approach. part 91; other laws applicable to recipients of federal funds; and all other applicable laws and rules, are required by applicable laws or regulations. ConnectiCare's policies must show evidence of respecting the implementation of their rights, including a clear and precise statement of limitation if ConnectiCare and its network of participating providers cannot implement an advance directive as a matter of conscience. Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. Eligibility Claims Eligibility Fields marked with * are required. Register for an account For No Surprises Act First time visitor? You have 24/7 access to all of the tools needed to answer your questions, whenever it's convenient for you. Go to the Client Portal > Provider directories Create a customized listing of facilities and/or practitioners participating in the network services offered by MultiPlan. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. You can easily: Verify member eligibility status; . Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. Long Term Care Insurance. Note: Some services require preauthorization. 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. We request your cooperation in investigating and resolving these complaints. Examples of qualifying medical conditions can be found below. ThriveHealth STM - Health Depot Association For concerns or problems related to your Medicare rights and protections described in this section, you may call our Member Services. Describe the range or medical conditions or procedures affected by the conscience objection; Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. 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. MedAvant Answer 2. Payors > MultiPlan Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Actual copayment information and other benefit information will vary. ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. If you are a primary care provider (PCP), you may also check your most recentMembership by PCPreport. ConnectiCare enrolls individual members into the ConnectiCare plan. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. How to get more information about your rights Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. Questions regarding the confidentiality of member information may be directed to Provider Services at 877-224-8230. precertification on certain services. All oral medication requests must go through members' pharmacy benefits. Your right to see plan providers, get covered services, and get your prescriptions filled within a reasonable period of time You have the right to timely access to your providers and to see specialists when care from a specialist is needed. The rental and/or purchase of CPAP and BI-PAP machines must be done through our preferred vendors. Best of all, it's free- no downloads required or software to install. Members are required to see participating providers, except in emergencies. 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.
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