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 get any of this information, call Member Services. You have the right to timely access to your providers and to see specialists when care from a specialist is needed. Examples of covered medical conditions can be found below. 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. Reminding the patient to notify ConnectiCare; and ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. Question 2. PDF PHCS Network Bringing Greater Choice and Savings to the Employees To find a participating provider outside of Oklahoma, follow the steps listed below. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. If a complaint about you or your office staff is received, ConnectiCare will contact you and request information relating to the complaint. Prostate cancer screening (age restrictions apply) 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). Regardless of where you get this form, keep in mind that it is a legal document. While other insurance companies and TPAs make you go through numerous frustrating prompts and then hold for an extensive period, our approach is to take the call as soon as possible so that you can move on with your day. 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. A complaint can be called a grievance, an organization determination, or a coverage determination depending on the situation. Follow the plans and instructions for care that they have agreed on with practitioners. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). You may want to give copies to close friends or family members as well. Additional term life coverage can be elected in increments of $10,000 to a maximum of $500,000 or 5 times your salary, whichever is less; paid for through payroll deductions. You have the right to get your questions answered. 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. Your responsibilities as a member of our plan. No out-of-network coverage unless preauthorized in writing by ConnectiCare. Discounts on frames, lenses, and contact lenses: 25% discount for items costing $250 or less; 30% discount for items over $250. You may also search online at www.multiplan.com: Click on the Search for a Doctor or Facility button Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. 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. 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. You may want to give copies to close friends or family members as well. How do I contact PHCS? 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. The PHCS Network is designed to be used with limited benefit plans that offer a higher level of coverage. You will be contacted by Insurance Benefit Administrators regarding final pricing for the claims submitted in the weeks following submission. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. We are a caring community dedicated to keeping our members healthy, happy, and in control of their well-being. Member race, language, ethnicity, gender orientation, and sexual identity cannot be used to perform underwriting, rate setting, and benefit determinations (specifically denial of coverage and benefits), and cannot be disclosed to unauthorized users. UHSM Health Share and WeShare All rights reserved. Savings - Negotiated discounts that result in significant cost savings when you visit in-network providers,helping to maximize your benefits. I called in with several medical bills to go over and their staff was extremely helpful. The ID card lists the following information: ConnectiCare member ID number Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). This arrangement will be allowed until the safe transfer of care to a participating provider and/or facility can be arranged. PHC's Member Services Department is available Monday - Friday, 8 a.m. - 5 p.m. You can call us at 800 863-4155. 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) Blue Cross Providers: 800 . Note: Some plans may vary. 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. If you are relocating out of ConnectiCare's network or retiring, please notify your patients at least ten (10) days in advance, in writing, in addition to notifying ConnectiCare and, if applicable, your contracted PHO/IPA in writing sixty (60) days in advance. Visit www.uhsm.com/preauth Download and print the PDF form Fax the preauth form to (888) 317-9602 GET PREAUTH FORM member-to-member health sharing How Healthshare Works with UHSM, it's Awesome! We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. ConnectiCare limits and terminates access to information by employees who are not or no longer authorized to have access. Your Explanation of Payment (EOP) will specify member responsibility. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. Refuse treatment and to receive information regarding the consequences of such action. Your right to get information about our plan PHCS Network | AvMed Balance Bill defense is available for all members with a Reference Based Pricing Plan. 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. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. PPM/10.16 Overview of Plans Overview of products Stress echocardiograms 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. Specialists:Provide continuity and coordination of care by sending a written report to the member's PCP regarding any treatment or consultation provided to the member. Note: These procedures are covered procedures, but do not require preauthorization when performed by in-network providers. Members pay a copayment cost-share for most covered health services at the time the services are rendered. Please also be sure to follow any preauthorization procedures required by your plan(usually a telephone number on your ID card). UHSM is not insurance. Your right to get information about your prescription drugs, Part C medical care or services, and costs PDF PHCS Network and Limited Benefit Plans - MultiPlan Medical claims can be sent to: Insurance Benefit Administrators, c/o Zelis, Box 247, Alpharetta, GA, 30009-0247; EDI Payor ID: 07689. Out of network benefits will apply when receiving care from non-participating providers. 100 Garden City Plaza, Suite 110 Garden City, NY 11530. sales@ibatpa.com. Contact the pre-notification line at 866-317-5273. Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits unless and until we determine to cover them. Answer 1. Please call Member Services if you have any questions. Provider Page | Medi-Share Members pay a copayment as cost-share for most covered health services at the time services are rendered. ConnectiCare provides each member with a statement of member rights and responsibilities. On a customer service rating I would give her 5 golden stars for the assistance I received. allergenic extracts (or RAST allergen specific testing); 2.) Register for an account For No Surprises Act First time visitor? SeeMedical Management. To begin the precertification process, your provider(s) should contact, Transition and Continuity of Care - Information and Request Form, Performance Health Open Negotiation Notice. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. If you want a paper copy of this information, you may contact Provider Services at 860-674-5850 or 800-828-3407. 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. Each members enrollment is generally in effect as long as the member chooses to stay in ConnectiCare. 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. Point-of-Service High Deductible Health Plans have an additional Plan deductible requirement for services rendered by non-participating providers. It is important to sign this form and keep a copy at home. Your right to know your treatment options and participate in decisions about your health care Customer Service at 800-337-4973 Renal dialysis services for members temporarily outside the service area. 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. View the video below for additional information on the MyMedicalShopper pricing tool: The Member Resource Document includes details for your reference on: You can reference your plan document for the complete list. Make recommendations regarding our members rights and responsibilities policies. You also have the right to this explanation even if you obtain the prescription drug, or Part C medical care or service from a pharmacy and/or provider not affiliated with our organization. View sample member ID cards forcopayandhigh-deductibleplans for details. For non-portal inquiries, please call 1-800-950-7040 . Eligibility Claims Eligibility Fields marked with * are required. 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. Female members may directly access a women's health care specialist within the network for the following routine and preventive health care services provided as basic benefits: Annual mammography screening (age restrictions apply) To inquire about an existing authorization - (phone) 800-562-6833 Answer 5. Asking at the time of each visit if he/she is still enrolled in a ConnectiCare plan. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; Nutritionist and social worker visit To get any of this information, call Member Services. The temporary card is a valid form of ConnectiCare member identification. Limited to a maximum of $315 every two (2) calendar years for: 1.) Click on the link and you will then have immediate access to the Member portal. Lifetime maximums apply to certain services. Members receive in-network level of benefits when they see participating providers. (800) 557-5471. No referrals needed for network specialists. PHCS PPO Network - Health Depot Association Prior Authorizations are for professional and institutional services only. To obtain a copy of the privacy notice, visit our website atconnecticare.com, or call Provider Services at the number below. High Deductible Health Plan (Health Savings Account [HSA] Compatible). You have the right to get information from us about our network pharmacies, providers and their qualifications and how we pay our doctors. 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. In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. Paying your co-payments/coinsurance for your covered services. Members > MultiPlan ConnectiCare distributes its privacy notice to members annually, and to new members upon enrollment in the plan. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. This would also include chronic ventilator care. 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. The provider must agree to accept network rates for the defined period of time. What insurance carrier is PHCS? - InsuredAndMore.com There are different types of advance directives and different names for them. Their services are offered to health care plans, not individuals, as they do not sell insurance or offer any medical services. Your providers must explain things in a way that you can understand. A candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage. UHSM serves as a connector, we administer the cost-sharing program and help health share members support each otherits AWESOME! MedAvant Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and 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. Some plans may have deductible and coinsurance requirements. Benefits - Penn Medicine Princeton Health You should consider having a lawyer help you prepare it. 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. If you have questions or concerns about privacy of your personal information and medical records, please call Member Services. You also have the right to get information from us about our plan. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. We also cover additional benefits beyond Original Medicare alone. Copyright 2022 Unite Health Share Ministries. Do I have any Out of Network benefits and what happens when doctor says we do not take your insurance? Payors > MultiPlan Network providers and practitioners are also contractually obligated to protect the confidentiality of members information. Go > However, the majority of PHCS plans offer members . The plan cannot and will not disenroll a member because of the amount or cost of services used. We must investigate and try to resolve all complaints. Eligibility and Benefits | ConnectiCare ConnectiCare takes all complaints from members seriously. No prior authorization requirements. Submit a Coverage Information Form. 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. Check Claims & Eligibility Verify patient eligibility and check the status of submitted claims through our online services below. Be considerate of our providers, and their staff and property, and respect the rights of other patients. For a specific listing of services and procedures that require pre-authorization refer to the Appendices within this manual. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Healthcare Provider FAQs > MultiPlan Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. In addition, to ensure proper handling of your claim, always present yourcurrent benefits ID card upon arrival at your appointment. 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. Any information provided on this Website is for informational purposes only. Examples of qualifying medical conditions can be found below. (SeeOther Benefit Information). You may also search online at www.multiplan.com: If you are currently seeing a doctor or other healthcare professional who does not participate in the PHCS Network,you may use the Online Provider Referral System in the Patients section of www.multiplan.com, which allows you tonominate the provider in just minutes using an online form. You have the right to be treated with dignity, respect, and fairness at all times. Best of all, it's free- no downloads required or software to install. Member satisfaction with ConnectiCare is very important. 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. As always, confirm benefits by contacting Provider Services at 877-224-8230. It is important to note that not all of the Sutter Health network . 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. 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. After the deductible is met, benefits will be covered according to the Plan. If you have any questions please review your formulary website or call Member Services. Customer Service number: 877-585-8480. . 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. Pelvic exam ConnectiCare will communicate to your patients how they may select a new PCP. Question 5. This includes the right to stop taking your medication. 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. drug, biological or venom sensitivity. Get coverage information. 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. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). Provider Portal - 90 Degree Benefits In addition, the ID card also includes emergency instructions and a toll-free telephone number for out-of-area and after-hours notifications, the Member Services phone number, and the claims submission address. PHCS / Multiplan Provider Search for CommunityCare Life & Health PPO Question 3. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. PCP name and telephone number I really appreciate the service I received from UHSM. The laws that protect your privacy give you rights related to getting information and controlling how your health information is used. (SeeOther Benefit Information). Pharmacy cost-share, if applicable. As a member of a ConnectiCare plan, each individual enjoys certain rights and benefits. Yes, PHCS provides coverage for therapy services. Providers are also required to contact ConnectiCares Notification Line at 888-261-2273 to advise ConnectiCare of the transport. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. ConnectiCare members must continue to pay the Medicare Part B premium directly to the Medicare program. ConnectiCare will communicate to your patients how they may select a new PCP. It is your responsibility to confirm your provider or facilitys continued participation in the PHCS Network and accessibilityunder your benefit plan. Members who develop ESRD after enrollment may remain with a ConnectiCare plan. Premier Health Solutions, LLC operates as a Third-Party Administrator in the state of California under the name PHSI Administrators, LLC and does business under the name PremierHS, LLC in Kentucky, Ohio, Pennsylvania, South Carolina and Utah. CT scans (all diagnostic exams) plan. Ask to see the member's ConnectiCare member identification (ID) card. This information is not used in contracting or credentialing decisions or for any discriminatory purpose. Note: Refractions (CPT 92015) are considered part of the office visit and are not separately reimbursed. This feature is meant to assist members who need additional copies of their ID card. For more information or assistance specific to our portal, please call MultiPlan Customer Service at 1-877-460-0352. The ConnectiCare Medicare Advantage network. Our goal is to be the best healthcare sharing program on the planet and to provide. Simplifying the benefits experience, so you can focus on patient care. 860-509-8000, (TTY) 860-509-7191. To contact our office for any eligibility, benefits and claims assistance: Performance Health Claims Administrator P.O. You have the right to know how your health information has been given out and used for non-routine purposes.

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