ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. Your Explanation of Payment (EOP) will specify member responsibility. PHCS is the leading PPO provider network and the largest in the nation. If you are calling to verify your patient's benefits*, please have a copy If you do, please call Member Services. UHSM Providers - PHCS PPO Network abnormal MRI; and 2.) Three simple steps and a couple minutes of your time is all it takes to obtain preauthorization from UHSM. Members pay a copayment as cost-share for most covered health services at the time services are rendered. Your right to get information about our network pharmacies and/or providers UHSM is a different kind of healthcare, called health sharing. HPI | Provider Resources | Patient Benefits & Eligibility ConnectiCare offers both employer-sponsored plans and individual insurance plans. Nuclear cardiology Note: Presentation of a member ID card is not a guarantee of a member's eligibility. Simplifying the benefits experience, so you can focus on patient care. Answer 5. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? We believe there is no such thing as a standard cost management approach. Reminding the patient to notify ConnectiCare; and There are federal and state laws that protect the privacy of your medical records and personal health information. ConnectiCare cannot reverse CMS' determination. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections It is critical that the members eligibility be checked at each visit. ConnectiCare reserves the right to terminate coverage for members who repeatedly fail to make the required copayments, coinsurance or deductibles, subject to the terms outlined in the applicableMember Agreement, Evidence of Coverage, or other governing contract. 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. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. The following is a description of all plan types offered by ConnectiCare, Inc. and its affiliates. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! A sample of the ConnectiCare ID cards appear below. You should consider having a lawyer help you prepare it. The Evidence of Coverage (EOC) will instruct them to call their PCP. Once your account has been created you will only need your login and password. This system requires that you have a touch-tone phone and know your ConnectiCare provider ID number, as well as the member's identification number, to verify eligibility. You will now leave the AvMed web site once you click the "I agree" button. The member loses entitlement to Medicare Parts A and/or B. 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. 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 your questions answered. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. Answer 3. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. 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. 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. ConnectiCare encourages members to actively participate in decision making with regard to managing their health care. If you need more information, please call our Member Services. 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). Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. 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. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. Portal Training for Provider Groups ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Your right to use advance directives (such as a living will or a power of attorney) To get this information, call Member Services. P.O. I really appreciate the service I received from UHSM. You can also get free help and information from CHOICES - your SHIP. Not condition the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an advance directive. ConnectiCare members may directly access care through self-referral to a participating clinician for covered services and certain Medicare-covered services at designated frequencies and ages, including: Annual routine eye exam (Prime and Custom Plans only) No referrals needed for network specialists. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. In addition, MultiPlan is not liable for the payment of services under plans. What can you doif you think you have been treated unfairly or your rights arent being respected? ConnectiCare also makes available to members printable, temporary ID cards via our website. Notify ConnectiCare within twenty-four (24) hours after an emergency admission at 888-261-2273. This means the PHCS Savility network offers the same quality for which PHCS Network has been recognized since 2001. Go > Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. 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. Members have an in-network deductible for some covered services. PET scans Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. Timely access means that you can get appointments and services within a reasonable amount of time. Claims or Benefits questions will not be answered here. You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. A new web site will open up in a new window. 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. Best of all, it's free- no downloads required or software to install. UHSM medical sharing eligibility extends to qualifying costs at the more than 1.2 million doctors, hospitals, and specialists in this network. 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. 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. Medicare and Medicaid eligible members designated as Qualified Medicare Beneficiary. Influenza and pneumococcal vaccinations From www.myperformancehlth.com, go to My Plan, Web Access Login, Register & Enroll, Select Member, Complete the Registration form. Your right to get information about our plan Lifetime maximums apply to certain services. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. Browse the list to see where your plan is accepted. Really good service. The member engages in disruptive behavior. Covered according to Massachusetts state mandate. Answer 4. When in the service area, members are expected to seek routine services, except for certain self-referred services, from their PCP. The plan cannot and will not disenroll a member because of the amount or cost of services used. Refractions are not covered by ConnectiCare Medicare Advantage plans. Solutions. Treatment Programs we offer and in which you may participate. What insurance carrier is PHCS? - InsuredAndMore.com Please check the privacy statement of the website where this link takes you. We also cover additional benefits beyond Original Medicare alone. They are collected via enrollment information, self-disclosure, and the member portal. PHCS PPO Network - WeShare Healthcare To get any of this information, call Member Services. Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. Members are encouraged to actively participate in decision-making with regard to managing their health care. drug, biological or venom sensitivity. You have the right to get information from us about our plan. 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 Payors > MultiPlan If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. We must investigate and try to resolve all complaints. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. ConnectiCare will communicate to your patients how they may select a new PCP. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. (SeeOther Benefit Information). The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. Always confirm network participation and provide your UHSM Member ID card prior to scheduling an appointment and before services are rendered. Documents called "living will" and "power of attorney for health care" are examples of advance directives. Your rights include knowing about all of the treatment options that are recommended for your condition, no matter what they cost or whether they are covered by our plan. You have the right to make a complaint if you have concerns or problems related to your coverage or care. 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. This video explains it. Members have the responsibility to: Members rights and our obligations are limited to our ability to make a good faith effort in regard to: Each time a member receives services, you should confirm eligibility. Some plans may have deductible requirements. (800) 557-5471. 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 must tell you in writing why we will not pay for or approve a prescription drug or Part C medical care or service, and how you can file an appeal to ask us to change this decision. Provider Portal Eligibility inquiry Claims inquiry. First, try the Eligibility and Referral Line, If unable to verify, then call Provider Services, (You must participate with Medavant to utilize services). Note: Some services require preauthorization. Actual copayment information and other benefit information will vary. If you have questions or concerns about your rights and protections, please call Member Services. All oral medication requests must go through members' pharmacy benefits. If you dont know the member's ID number, contact Provider Services during regular business hours to verify eligibility and benefits. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). A 3-day covered hospital stay is not required prior to being admitted. You have the right to be told about any risks involved in your care. You may also use the ConnectiCare Eligibility and Referral Line. 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. Member satisfaction information is updated and posted annually and is made available on our website atconnecticare.com. Copyright 2022 Unite Health Share Ministries. Your right to get information in other formats Your right to get information about your drug coverage and costs You have the right to get full information from your providers when you go for medical care, and the right to participate fully in decisions about your health care. 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. 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. PDF PHCS Savility - MultiPlan Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date.