Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. Member satisfaction with ConnectiCare is very important. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Reminding the patient to notify ConnectiCare; and Describe the range or medical conditions or procedures affected by the conscience objection; Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Prior Authorizations are for professional and institutional services only. How to get more information about your rights Regardless of where you get this form, keep in mind that it is a legal document. In addition, the following guidelines apply: The following are covered preventive care services: Please note there are designated frequencies and age limitations. We will make sure that unauthorized people dont see or change your records. part 84; the Americans with Disabilities Act; the Age Discrimination Act of 1975, as implemented by regulations at 45 C.F.R. New members may use a copy of their enrollment form. There are federal and state laws that protect the privacy of your medical records and personal health information. Your Explanation of Payment (EOP) will specify member responsibility. Information is protected as outlined in ConnectiCare's policies. Copyright 2022 Unite Health Share Ministries. ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. Your right to get information about your prescription drugs, Part C medical care or services, and costs (SeeOther Benefit Information). For emergency care received outside the U.S. there is a $100,000 limit. You can easily: Verify member eligibility status; . 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. For non-portal inquiries, please call 1-800-950-7040. After the Plan deductible is met, benefits will be covered according to the Plan. 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. Broker benefits Get in touch. Colorectal screening (age restrictions apply) With discounts averaging 42% for physicians and specialiststhe types of services most typically used with these plansHealth Depot members get more value for their benefit dollars. Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. You should consider having a lawyer help you prepare it. Answer 4. As of January 1, 2023, the Transparency in Coverage Rule mandates member access to a healthcare price comparison tool. 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. 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. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. If you have any questions please review your formulary website or call Member Services. You have the right to be treated with dignity, respect, and fairness at all times. Mail Paper HCFAs or UBs: Medi-Share UHSM is always eager and ready to assist. All oral medication requests must go through members' pharmacy benefits. Best of all, it's free- no downloads required or software to install. SeeMedical Management. Be treated with respect and recognition of your dignity and right to privacy. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. Since you have Medicare, you have certain rights to help protect you. No referrals needed for network specialists. To determine copayment requirement, call ConnectiCare's Eligibility & Referral Line at 800-562-6834. Prostate cancer screening (age restrictions apply) We must tell you in writing why we will not pay for a drug, and how you can file an appeal to ask us to change this decision. Your right to get information in other formats The plan cannot and will not disenroll a member because of the amount or cost of services used. While you may contact us by telephone, you will be asked to place your concerns in writing. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. How to manage the front desk when they ask who you are insured with? I really appreciate the service I received from UHSM. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. What does Transition of Care and Continuity of Care mean? PCPs:Advise your patients to contact ConnectiCare's Member Services at 860-674-5757 or 800-251-7722 to designate a new PCP, even if your practice is being assumed by another physician. Some plans cover preventive dental services: Receive information about us, our services, our participating providers, and "Members Rights and Responsibilities.". Any information provided on this Website is for informational purposes only. How do I contact PHCS? ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Hartford, CT 06134-0308 drug, biological or venom sensitivity. I called in with several medical bills to go over and their staff was extremely helpful. Once you have completed the Registration form you will be emailed a link to confirm your Registration. 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). Choose "Click here if you do not have an account" for self-registration options. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. 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). If you have any questions regarding a member's eligibility, call Provider Services at 877-224-8230. Identify the state legal authority permitting such objection; New users to the Provider Portal can create an account by selecting the Provider Access Link on the portal login page. 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. Documents called a "living will" and "power of attorney for health care" are examples of advance directives. Our goal is to be the best healthcare sharing program on the planet and to provide. Requests may be made by either the physician or the member. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. Coverage for medical emergencies without preauthorization. Members have an in-network deductible for some covered services. If authorization is not obtained, payment for the service may be denied. ConnectiCare takes all complaints from members seriously. For guidance in the prohibition of balance billing of QMBs, please refer to thisMedicare Learning Network document. After the deductible is met, benefits will be covered according to the Plan. Please check the privacy statement of the website where this link takes you. 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. Members must reside in the service area. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. ConnectiCare cannot reverse CMS' determination. Some applicable copayments 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. Answer 2. 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. It is important to note that not all of the Sutter Health network . PCP name and telephone number 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. You have the right to get information from us about our plan. 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. 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. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. The right to know how information about race, language, ethnicity, gender orientation, and sexual identity are collected and used. ConnectiCare members are entitled to an initial assessment of their health care status within ninety (90) days of enrollment in the Plan. Performance Health at If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. 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. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. Bone mass measurement Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. 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). Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. (SeeOther Benefit Information). This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. Regardless of where you get this form, keep in mind that it is a legal document. It is important to sign this form and keep a copy at home. The Evidence of Coverage (EOC) will instruct them to call their PCP. You may also use the ConnectiCare Eligibility and Referral Line. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. If you need more information, please call our Member Services. 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. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. What services are available to me that could save me money? Simplifying the benefits experience, so you can focus on patient care. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. 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. ConnectiCare also makes available to members printable, temporary ID cards via our website. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Although not a provider of health insurance, PHCS is a provider of PPO (Preferred Provider Organization) networks. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. Submit a Coverage Information Form. However, ConnectiCare must terminate members for the following: The member has a change of address outside the service area. Question 3. The provider must agree to accept network rates for the defined period of time. See preauthorization list for DME that requires pre-authorization. Glaucoma screening To get this information, call Member Services. This feature is meant to assist members who need additional copies of their ID card. You can sometimes get advance directive forms from organizations that give people information about Medicare. You have the right to go to a womens health specialist (such as a gynecologist) without a referral. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). Your right to get information about our network pharmacies and/or providers Members are required to see participating providers, except in emergencies. Your right to get information about our plan, plan providers, drugs, health care coverage, and costs. Access to any Medicare-approved doctor or hospital in the United States. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. The member provides fraudulent information on the application or permits abuse of an enrollment card. We hope that our members are satisfied and decide to stay with ConnectiCare; however, should you learn that a member plans to disenroll, you may avoid payment delays by: 1. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). Members receive in-network level of benefits when they see participating providers. If you are calling to verify your patient's benefits*, please have a copy We have partnered with TALON to bring you access to MyMedicalShopper; which provides you the ability to shop for healthcare services based on price, quality, and location. PHCS is a large health insurance company with a wide range of plan types, therefore the amount of coverage ranges. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. (800) 557-5471. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. To get any of this information, call Member Services. 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. MRI/MRA (all examinations) UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. Get coverage information. This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans.
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