Embed Size (px)
Citation preview
A HealthCare USA Member Newsletter | Volume 2 · 2015
The Bear Facts
Get the Dental
Care you need!
Smiling StorkDental Program helps pregnant
membersWe offer the Smiling Stork™ educational program to all pregnant members.
This program provides “Moms-to-be” with information about the value of good oral health for mom and baby. It also helps you access covered dental services during pregnancy and up to 60 days after delivery.
Please talk to your HealthCare USA Case Manager about the Smiling Stork™ Program or call Member Services for more information.
All HealthCare USA members have a dental benefit. Not sure what benefit you have? Call us in Member Services at 800-566-6444 and we will help you. We will even help make your appointment and help with transportation.1
1 Not all members are eligible for Transportation. Call Member Services if you are not sure.
Getting an annual well care visit may be the most important thing you can do to get or stay healthy!
Children age two and younger require even more frequent check ups. Adolescents and adults should also have an annual exam…EVEN IF YOU ARE HEALTHY!
By getting regular check-ups your Primary Care Provider (PCP) can tell you things about your health that you didn’t know. They can give you tips about your weight, immunizations, exercise and nutrition among other things.
Matterannual
Well Care Visits
HEALTHCARE USA Member Services 800-566-6444 Transportation 800-688-3752 Transportation Fax 888-513-1610 Transportation email [email protected] Behavioral Health 800-377-9096 24-Hour Nurse Line 800-475-1142 CMPCN 24-Hour Nurse Line 888-670-7264 (Children's Mercy Pediatric CARE Network)
Family Support Division (FSD) Information Center 855-373-4636 Child Abuse/Neglect Missouri Hotline 800-392-373824-Hour Parent Support Line 888-281-3000Missouri School Violence Hotline 866-748-7047Poison Control Center 800-222-1222Child Support General Information 800-859-7999Food Stamp Hunger Line 800-392-1261MO HealthNet Participant Services 800-392-2161Smoking Cessation 800-QUITNOWTTY/TDD 711 or 800-735-2966
It is very important that HealthCare USA has your current address and phone number. We want to make sure you get all of your mail from HealthCare USA and MO HealthNet. To update your address and phone number just call 1-855-FSD-INFO (1-855-373-4636) or visit their website at www.dss.mo.gov to access the FSD Program Enrollment System online to let them know when your address changes.
You may lose your coverage if you are not able to get important mail about your eligibility.
As a HealthCare USA member, you have certain rights and duties. You can get a complete copy of your Rights and Responsibilities at any time. Here’s how:
• Call Member Services at 1-800-566-6444
• Go to www.hcusa.org
• Look in your Member Handbook
MeMber rights and responsibilities
please update your address & phone
iMportant toll-Free nuMbers
Call your PCP and schedule YOUR well
care visit TODAY! It’s a COVERED
BENEFIT!
Matter
We don’t want the language you speak to keep you from getting the health care you deserve. If you do not speak or understand English, HealthCare USA will provide an interpreter at no cost to you:• When you call Member Services• When you call Transportation• At your medical appointment
The interpreter may be on the phone, in person or via video conference at some providers.
Call Member Services at 800-566-6444 and we will get someone who speaks your language to help you.
interpreter services available at medical appointments
Contamos con servicios de interpretación para las citas con su médico
ةيبطلا ديعاوملل ةرفوتم ةيوفشلا ةمجرتلا تامدخ
Dịch Vụ Thông Dịch Viên Sẵn Có tại Các Cuộc Hẹn Khám Sức Khỏe.Russian
Услуги переводчика на встречах с врачами
BeneFit updateMO HealthNet and HealthCare USA will no longer cover or pay for early childbirth prior to 39 weeks unless your doctor says it is medically needed.
did ?you
knowAll members have vision benefit coverage for eye exams and glasses.
Call Member Services or look in your member Handbook for details.
We talked about the importance of going to see your diabetic care provider. Checking your Hemoglobin A1c value is important too. The next topic is kidney disease. It is also called nephropathy. The kidneys have many tiny blood vessels. The blood vessels filter waste chemicals from your blood. High blood sugar from diabetes can damage these blood vessels. The kidneys are not able to do their job as well as usual when this happens. It’s important to have your diabetic provider check you for nephropathy.
screening
Your diabetic provider can check you by using tests that see if you have protein (albumin) in the urine. Finding out if you have protein in the
diabetes?
are you at riSk
The first step to prevent diabetes is to understand your risk. Type 2 diabetes is the most common form of diabetes. To find out if you are at risk for Type 2 diabetes ask yourself the questions below.
It is important to find out early if you are at risk for developing Type 2 diabetes. Early diagnosis and treatment can prevent serious health problems that Type 2 diabetes can cause. Diabetes can cause heart disease, kidney disease and stroke.
Next step? Make an appointment with your health care provider today for diabetes screening. Look for future articles on how diabetes is diagnosed and the treatment for living a healthy lifestyle with diabetes.
nephropathy
What are the risk factors?• Am I 45 years of age or older?• Am I overweight?• Do I have a mother or father with diabetes?• Do I have a sister or brother with diabetes?• Is my family background African-American, Hispanic/Latino,
American-Indian, Asian-American, or Pacific-Islander?• Did I have diabetes while I was pregnant, or gave birth to a
baby weighing 9 pounds or more?• Do I exercise less than three times a week?
are you at risk for
Out of Network Services
If you need a service and cannot find an in network provider, call your PCP to help you. If your PCP refers you to a provider that is not in the HealthCare USA provider network:
• Your PCP must get a pre-authorization from HealthCare USA
• HealthCare USA will pay for your care, if approved
• We will make sure to cover the needed service timely
If HealthCare USA cannot provide the needed service in network, we will adequately and timely cover the service out of network as long as we are unable to provide the service in network.
not sure?you can get a second or third opinion
You may want an opinion from a different health care provider. In such cases, you must ask your PCP or HealthCare USA to get a second opinion. HealthCare USA will pay for it.
You may get an opinion from a third provider if your PCP and second opinion provider do not agree. HealthCare USA will pay for a third opinion.
urine is important. It could help to prevent further damage to the kidneys.
treatment
Keeping your blood glucose and blood pressure in control will help prevent nephropathy. Even a mild rise in blood pressure can make nephropathy worse. Losing weight and getting regular exercise can help lower your blood pressure. Eating less salt and staying away from alcohol and tobacco can help too. Sometimes, medicines may be needed to lower blood pressure.
Not everyone with diabetes has kidney problems. The better a person keeps diabetes and blood pressure under control, the lower the chance of getting nephropathy.
Sources: American Diabetes Association, Web MD
Diabetes & You
You will not have to pay for covered health care services even if:
• The State does not pay your MO HealthNet Managed Care health plan
• Your MO HealthNet Managed Care health plan does not pay your provider
• Your provider’s bill is more than your MO HealthNet Managed Care health plan will pay
• Your MO HealthNet Managed Care health plan cannot pay its bills
You may have to pay for services you get if:
• You choose to get medical services that are not covered by MO HealthNet Managed Care or
• You go to a provider that is not a HealthCare USA provider without prior approval
If you get a bill, do not wait! Call our Member Services office at 1-800-566-6444. HealthCare USA will look into this for you.
HealthCare USA will pay for all covered MO HealthNet Managed Care services. You should not be getting a bill if the medical service you got is a covered MO HealthNet Managed Care benefit. If you choose to pay for a service, you must agree in writing that you will be responsible for the payment before getting the service. The written agreement must show the date and service. It must be signed and dated by you and the provider. The agreement must be made before you receive the service. A copy of the agreement must be kept in your medical record.
let us know!if you get a bill...
it's your responsibilityshow your cards...
When you receive medical care, all members have the responsibility to:
• Show your HealthCare USA Member ID Card• Show your red or white MO HealthNet card• Show any other insurance card you may have
If you do not show ALL of your cards, you may get billed for a part of your care.
Mileage reimbursement log 60 day limit 1If you are using the Transportation Mileage Reimbursement benefit you must:
• Take the log to your provider visit• Fill out the log• Have the provider staff sign the log • Mail the log to:
MTM Transportation - BSG Dept 16 Hawk Ridge Dr
Lake St Louis, MO 63367 or• Fax your log within 60 days of the appointment
to 1-888-513-1610 or• Take a photo of the log with your phone and email
it within 60 days to: [email protected]
• Save your fax confirmation or email until you are reimbursed
If these steps are not followed in 60 days, you will not be reimbursed. To get a log, or get a postage paid envelope, call Member Services at 1-800-566-6444 or visit our home page at www.hcusa.org. 1 Not all members are eligible for Transportation. Call Member Services if you are not sure.
did ?youknow
You can now take a photo of your mileage reimbursement log to and email it to [email protected]
We are now a part of
we would like you to know that healthcare usa is now part of aetna better health. what does this mean?
• You have the same great health benefits
• We are still HealthCare USA but are now owned by Aetna Better Health
• You may begin to see the Aetna Better Health name and logo on mail we send you
• You may see “Aetna” on your caller ID… it will be one of our friendly staff trying to reach you
aetna better health®
We are excited to be part of AETNA BETTER HEALTH. We know you will be too!
www.hcusa.org
HCU15106 Approved 05/27/15
to receive a translated copy of this document, call member Services at 1-800-566-6444. Para recibir una copia traducida de este documento, llame al servicio para miembros al 1-800-566-6444.
10 South Broadway, Ste. 1200St. louis, mo 63102
in this issue...· Interpreter ServICeS
· If YoU Get A bILL
· WeLL CAre VISItS MAtter
· YoUr DentAL benefItS
