Beruflich Dokumente
Kultur Dokumente
Member Handbook
Website www.bcbsilcommunityicp.com
Write Blue Cross Community ICP P.O. Box 3865 Scranton, PA 18505
(For General Correspondence)
Member Services:1-888-657-1211
MemberServices: 1-888-657-1211TTY/TDD
TTY/TDD711
711www.bcbsilcommunityicp.com
www.bcbsilcommunityicp.com24/7 Nurseline:1-888-343-2697
24/7Nurseline: 1-888-343-2697
Whats Inside
Member Handbook
Get Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
How to Use this Book . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Important Things to Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Get Care How to Use Your Blue Cross Community ICP Plan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Help in Other Languages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Your ID Card. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Additional Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
How to Resolve a Problem with Blue Cross Community ICP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Other Things You May Need to Know. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Your Health Care Rights and Responsibilities. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
E
MEMBERS: Medical & Behavioral Health Claims:
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MEMBERS: Medical & Behavioral Health Claims:
P
Member Services: <888-657-1211>
Member Services: <888-657-1211> BlueBlue
CrossCross Community
Community ICP ICP
my doctor?
M
TDD/TTY: 711 Attn: Claims
TDD/TTY: 711<888-343-2697> Attn: Claims
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24/7 Nurse Line: PO Box 805107
24/7 Nurse Line: <888-343-2697>
PROVIDERS: PO Box
Chicago, 805107
IL 60680-4112
PROVIDERS:
<888-657-1211> Chicago, IL 60680-4112
The Plan offers interpreter services for many
For all other claims (including dental,
PHARMACISTS ONLY: vision, and transportation) call <888-
<888-657-1211>
<888-274-5218> For allforother
657-1211> paperclaims (including
claim address. dental,
PHARMACISTS ONLY: vision, andBlue
transportation) call <888-
languages, and includes: Blue Cross and Blue Shield
<888-274-5218>
of Illinois, a
Division of Health Care Service
licensee of the
657-1211>
Shield
Cross and Blue
for paper claim address.
Association.
Member Services staff that speaks English Member Name: Medicaid ID: <123456789>
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and Spanish <John A Doe>
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Member ID: <123456789>
Can I choose any WHCP as my PCP? What are the reasons a request to change a PCP may
A woman can go to a WHCP as her PCP, however be denied?
the WHCP must be an in-network provider and PCP is not taking new patients
accepting new patients. PCP is not in your network
PCP is outside your service area
Can I stay with my WHCP if he or she is not with the
Plan? Will I need prior authorization? When will my PCP change be made?
The WHCP must be included as part of the network. If you ask to change your PCP anytime during the
No prior authorization is needed to see a WHCP. month, you may see your new PCP the first
calendar day of the next month.
How do I choose a WHCP or PCP? For example: If you call on April 13, you may see
your new PCP on or after May 1.
Look in the Plan Provider Directory for PCPs and
WHCPs who work with the Plan and who are taking
Please get care from your current PCP until the
change takes place.
new patients.
Youll get a new ID card with your PCPs name and
Call Member Services or visit the website to get the contact details on it
most up-to-date information about the network.
Healthy Living
Below is a list of yearly recommended preventive exams you should review this with your PCP.
Substance Abuse
If you see a provider in the network, you dont
need a referral; however you may need a prior
authorization from us before you get services.
Substance abuse treatments we cover include:
Inpatient treatment
Outpatient treatment
Detoxification
Day treatment
Psychiatric evaluation services
Mail-Order Program
We offer a mail-order program that lets you get up to a
90-day supply of your medicines sent directly to your
home. There is no cost to you. Call Member Services for
more information.
Make sure to take your Member ID card, HFS medical
card and your prescription/medicine order from your
doctor when you visit the pharmacy.
227552.1214
added-use limits would make your treatment less effective and/or would be
ILCFHPLTSS14
harmful to your health.
You or your doctor can ask for a rush decision if you both believe that your health could be harmed by
waiting up to 10 days for a decision. If we agree to rush, we must give you a decision within 24 hours
(one day) after we get the statement from your doctor.
Time Limits for Filing a Grievance In the grievance letter, give us as much information
as you can. For example, include the date and
You may file a grievance either by phone or in
place the incident happened, names of the people
writing within 90 calendar days of the problem. We
involved and details about what happened.
will send you a letter within three business days
after we receive your grievance to let you know we Be sure to include your name and your member
received it and are working to resolve it within 90 ID number. You can ask us to help you file your
calendar days. If you have information that supports grievance by calling Member Services.
your grievance, please send that to us as well. We will If you do not speak English, we can provide an
add it to your file for consideration. interpreter at no cost to you. Please include this
Time Frame for an Answer to a Grievance request when you file your grievance. If you are
hearing-impaired, call TTY/TDD 711.
Blue Cross Community ICP has 90 calendar days to
review and respond to your concerns or as fast as At any time during the grievance process, you can
your health condition requires. Your grievance will have someone you know represent you or act on
be reviewed by someone who was not involved and your behalf. This person will be your representative.
can research the problem. We will send you another If you decide to have someone represent you or act
letter within 90 calendar days to let you know how for you, inform Blue Cross Community ICP in writing
your concerns were answered. the name of your representative and his or her
contact information.
8. You have a right to know that your health d. Treat your providers and other health care
plan cant prevent doctors, hospitals and others employees with respect and courtesy
who care for you from advising you about your 8. Be involved in service and treatment
health status, medical care and treatment, even option decisions. Make personal choices
if the care or treatment is not a covered service. to keep yourself healthy. That includes the
9. You have a right to know that youre not responsibility to:
responsible for paying for covered services. a. Work as a team with your provider in
Doctors, hospitals and others cant require you deciding what health care is best for you
to pay copayments or any other amounts for
b. Understand how the things you do can
covered services.
affect your health
Your Responsibilities: c. Do the best you can to stay healthy
1. Read and follow the member handbook. d. Treat providers and staff with respect
2. Keep your scheduled appointments or call your e. Talk to your provider about all of your
provider to reschedule or cancel at least 24 medications
hours before your appointment.
If you think you have been treated unfairly or
3. Show your ID card to each provider before discriminated against, call the U.S. Department of
getting medical services. Health and Human Services (HHS) toll-free at
4. Call your PCP or 24/7 Nurseline before going to 1-800-368-1019. You can also view information
an emergency room, except in situations that concerning the HHS Office for Civil Rights online
you believe are life threatening or that could at www.hhs.gov/ocr.
permanently damage your health.
5. Be sure you have approval from your primary
care provider before going to a specialist.
6. Call Member Services if you change your phone
number or your address. You also should
contact your Case Worker at Department of
Human Services (DHS).
7. Share information about your health with your
primary care provider and learn about service
and treatment options. That includes the
responsibility to:
a. Tell your primary care provider about
your health
b. Talk to your providers about your health
care needs and ask questions about the
different ways your health problems can
be treated
c. Help your providers get your
medical records
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