a newsletter for participants of amerihealth caritas ...€¦ · • reduce sensitivity. •...

Vol. 2, Issue 1, Spring 2019

Visit your doctor and dentist today! 2We need your help! 3If you have long-term services and supports (LTSS), additional supports are available to you! 4Formulary 5Have you checked out our website? 5Important numbers 6Physical and behavioral health: We can help you get the care you need 7An update from our advisory committees 7Have a healthy mouth for life 8Do you also have Medicare? 9

GET CARE, A newsletter for Participants of AmeriHealth Caritas Pennsylvania Community HealthChoices

STAY WELL

Don’t delay.Visit your doctor and dentist today!

Please see page 2 for more information.

Visit your doctor and dentist today!

• Call the doctor now to schedule an annual checkup.

• Make sure to see the dentist 2 times a year for dental checkups.

Need help finding a doctor or dentist? Visit www.amerihealthcaritaschc.com and click Find a Provider. You can also call us at 1-855-235-5115 (TTY 1-855-235-5112).

AmeriHealth Caritas Pennsylvania Community HealthChoices2

We need your help!

Participants can help AmeriHealth Caritas Pennsylvania (PA) Community HealthChoices (CHC) uncover provider fraud, waste, and abuse. You should keep track of the following things: • Who provided your health care. • What services you received during the

visit and any additional tests or visits the doctor ordered.

• When you got a health care service. • Where the service took place.

Call AmeriHealth Caritas PA CHC if you think the provider may have billed incorrectly or offered a service you didn’t think you needed. Please remember, do not: • Give your ID card or numbers to anyone

other than your doctor, clinic, hospital, or other health care provider.

• Ask your doctor or any other health care provider for medical services or supplies that you don’t need.

• Sign your name to a blank form. • Share your medical records with anyone

other than your doctor, clinic, hospital, or other health care professional.

AmeriHealth Caritas PA CHC has a team that works hard to identify and prevent fraud, waste, and abuse. But we still need all Participants to report possible fraud, waste, and abuse.

Please call the Fraud Hotline at 1-866-833-9718 (TTY 711). You can remain anonymous at all times.

Participant Services: 1-855-235-5115 (TTY 1-855-235-5112) 3

If you have long-term services and supports (LTSS), additional supports are available for you!

Participants who have LTSS will have a Person-Centered Planning Team and a Service Coordinator.

What is a Person-Centered Planning Team?

The Person-Centered Planning Team focuses on you and what your life can be. Your team is led by you. Your Service Coordinator is there to help you.

The goal of having a team is to have open communication. Important information is shared with you and with those who support you, with your consent.

What is the role of your Service Coordinator?

Your Service Coordinator will meet with you in person. Your Service Coordinator will:• Go over and document your health care

needs and goals.• Coordinate your care with other health

and service providers, like Personal Assistance agencies and your primary care practitioner (PCP).

• Schedule your team meetings.• Help you develop your Person-Centered

Service Plan.• Update your plan as needed.• Guide you and your team through the

CHC program.

Remember, you are the most important person on your team. It will be important for you to share your needs and concerns with your team. This will help keep you as independent as possible.

What is a Person-Centered Service Plan?

The Person-Centered Service Plan is your plan of care. We will put your plan in writing for you. Here are some things your plan will include:• What you need, including your:

• Health care needs.• LTSS needs.• Wellness goals.

• All of the covered services that were approved for you. Also, the community resources you will get in order to reach your goals.

• Your health conditions and current medicines.

Have questions? We are here to help. We want to help you get the care and services you need. Just call our Personal Care Connection Team at 1-855-332-0116 (TTY 711). We are here Monday through Friday, 8:30 a.m. to 5 p.m.


Formulary

The AmeriHealth Caritas PA CHC drug formulary is a list of medicines covered by AmeriHealth Caritas PA CHC. For the most up-to-date formulary list, visit www.amerihealthcaritaschc.com. You can also call Participant Services at 1-855-235-5115 (TTY 1-855-235-5112).

Have you checked out our website?

Visit www.amerihealthcaritaschc.com for more information about your health care as an AmeriHealth Caritas PA CHC Participant!


Important numbers

Participant Services: 1-855-235-5115

Participant Services TTY: 1-855-235-5112

Nurse Call Line: 1-844-214-2472 (TTY 711)

Care Management and Personal Care Connection Team: 1-855-332-0116 (TTY 711)

Bright Start® (pregnancy): 1-877-364-6797 (TTY 711)

Pennsylvania Tobacco Cessation Information: 1-800-QUIT-NOW (1-800-784-8669)

Medical Assistance Transportation Program (MATP): Call your county number for more information. MATP phone numbers may change. Visit http://matp.pa.gov for the most up-to-date phone numbers.

Behavioral health treatment contact numbers: Call your county number for more information.

County MATP services phone numbers Behavioral health treatment contact number

Allegheny 1-412-350-4476 or 1-888-547-6287 1-800-553-7499

Armstrong 1-724-548-3408 or 1-800-468-7771 1-877-688-5969

Beaver 1-724-375-2895 or 1-800-262-0343 1-877-688-5970

Bedford 1-814-623-2002 or 1-800-323-9997 1-866-773-7891

Blair 1-814-695-3500 or 1-800-458-5552 1-855-520-9715

Butler 1-724-431-3692 or 1-866-638-0598 1-877-688-5971

Cambria 1-814-535-4630 or 1-888-647-4814 1-800-424-0485

Fayette 1-724-628-7433 or 1-800-321-7433 1-877-688-5972

Greene 1-724-627-6778 or 1-877-360-7433 1-877-688-5973

Indiana 1-724-463-3235 or 1-888-526-6060 1-877-688-5969

Lawrence 1-724-652-5588 or 1-888-252-5104 1-877-688-5975

Somerset 1-814-445-9628 or 1-800-452-0241 1-866-773-7891

Washington 1-724-223-8747 or 1-800-331-5058 1-877-688-5976

Westmoreland 1-724-832-2706 or 1-800-242-2706 1-877-688-5977


Physical and behavioral health: We can help you get the care you need

AmeriHealth Caritas PA CHC cares about the whole you.

The health of your mind (your mental health) is a very important part of being healthy. According to the Centers for Disease Control and Prevention (CDC), about half of all Americans have been diagnosed with some sort of mental health illness or disorder. If you need treatment, don’t forget: You are not alone, and there are ways AmeriHealth Caritas PA CHC can help you.

Here are 2 terms that will help you understand how we can help:

1. You get physical health services for the health of your body through a Community HealthChoices managed care organization (MCO).

2. You get behavioral health services for the health of your mind through a behavioral health managed care organization (BH-MCO).

AmeriHealth Caritas PA CHC is an MCO, but we can help connect you to your BH-MCO. You can call your BH-MCO 24 hours a day, 7 days a week. Find the number for the BH-MCO in your county on page 6 of this newsletter.

AmeriHealth Caritas PA CHC can help with your behavioral health needs in other ways, too. We can:• Help you get and manage your behavioral

health medicines. • Connect you with your PCP. Your PCP

and their staff can put you in touch with the right resources.

• Connect you to other behavioral health resources.

For more information, visit www.amerihealthcaritaschc.com. You can also call Participant Services 24 hours a day, 7 days a week, at 1-855-235-5115 (TTY 1-855-235-5112).

An update from our advisory committees

AmeriHealth Caritas PA CHC has 2 advisory committees that come together throughout the year to talk about issues that matter to you:

1. Participant Advisory Committee (PAC).

2. Health Education Advisory Committee (HEAC).

Helping you understand your benefits and services is important to us. You can find more information about these committees and how to become a member at www.amerihealthcaritaschc.com → Community. Be on the lookout for more highlights from the PAC and HEAC in upcoming newsletters!


http://www.amerihealthcaritaschc.com/community/index.aspx

http://www.amerihealthcaritaschc.com/community/index.aspx

Have a healthy mouth for life

Oral health is the health of your mouth, teeth, and gums. Some oral health problems become more common with age. But without the right care, these problems can happen earlier in life, too.

No matter what your age, there are ways to keep your mouth healthy.

1. Brush your teeth at least 2 times a day and floss every day. Regular brushing and flossing help keep bacteria away, which helps keep your teeth and gums strong and healthy. Talk with your dentist about how often you should brush and floss.

Having trouble remembering to brush and floss? Try setting an alarm or keeping your toothbrush and floss in plain sight to help you remember.

2. Use a mouthwash and toothpaste that have fluoride. Fluoride helps to:

• Prevent gum disease.• Reduce sensitivity.• Protect teeth from decay.

3. Keep your mouth moist. Saliva helps protect your mouth from gum disease and tooth decay. Drink plenty of water and use sugar-free mints, gum, or lozenges to increase your saliva.

4. If you smoke, now is the time to quit. Smoking can make your mouth dry and cause other oral health problems. Here’s how we can help you quit:

• As an AmeriHealth Caritas PA CHC Participant, you are eligible for counseling sessions to help you quit. Call Participant Services at 1-855-235-5115 (TTY 1-855-235-5112) for more information. You may be eligible for medicines that can help you quit. Talk with your doctor about what medicine is best for you.

• Call the PA Free Quitline, 1-800-QUIT NOW (1-800-784-8669) or go to http://pa.quitlogix.org.

5. Eat healthy. Choosing the right food can help keep your teeth healthy.


Try to eat:• Fresh fruits.• Vegetables.• Lean protein like chicken, beans,

and fish.

Try not to eat:• Sticky foods like caramels, raisins,

and gummy bears.• Lollipops and other hard candies.• Desserts like cookies, cakes, and

brownies.• Sugar. This includes brown sugar,

honey, and even molasses.

6. Visit your dentist. You should have a dental checkup 2 times a year. Regular checkups will help spot small problems before they become big ones.

If you have questions about your teeth, talk with your dentist. To find a dentist, visit www.amerihealthcaritaschc.com and click Find a Provider or call Participant Services at 1-855-235-5115 (TTY 1-855-235-5112).

Do you also have Medicare?

If you are an AmeriHealth Caritas PA CHC Participant and also have Medicare, your Medicare plan is your primary insurance. This means that in most cases, your Medicare plan will pay your health care providers before AmeriHealth Caritas PA CHC will pay.

Here are some important things to keep in mind for using your Medicare plan and your AmeriHealth Caritas PA CHC plan.• Call Participant Services 1-855-235-5115

(TTY 1-855-235-5112) to let us know that you have Medicare. Also, make sure to tell your County Assistance Office.

• Make sure to bring both your Medicare insurance card* and your AmeriHealth Caritas PA CHC ID card to all your doctor appointments and to the pharmacy.

• You can see the Medicare doctors of your choice. They do not need to be AmeriHealth Caritas PA CHC network doctors.

Have questions? You can call AmeriHealth Caritas PA CHC Participant Services 24 hours a day, 7 days a week, at 1-855-235-5115 (TTY 1-855-235-5112).

* If you have Medicare and you have chosen AmeriHealth Caritas VIP Care as your Medicare plan and AmeriHealth Caritas PA CHC as your Community HealthChoices plan, you will get one ID card for both plans. Your ID card will show logos for both plans.


Nondiscrimination Notice

Page 1 of 2

AmeriHealth Caritas Pennsylvania Community HealthChoices complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

AmeriHealth Caritas Pennsylvania Community HealthChoices does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

AmeriHealth Caritas Pennsylvania Community HealthChoices provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats)

AmeriHealth Caritas Pennsylvania Community HealthChoices provides free language services to people whose primary language is not English, such as:

• Qualified interpreters • Information written in other languages

If you need these services, contact AmeriHealth Caritas Pennsylvania Community HealthChoices at 1-855-235-5115 (TTY 1-855-235-5112).

If you believe that AmeriHealth Caritas Pennsylvania Community HealthChoices has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation, you can file a complaint with:

AmeriHealth Caritas Pennsylvania Community HealthChoices, Participant Complaints Department, Attention: Participant Advocate, 200 Stevens Drive Philadelphia, PA 19113-1570 Phone: 1-855-235-5115, TTY 1-855-235-5112, Fax: 215-937-5367, or Email: [email protected]

The Bureau of Equal Opportunity, Room 223, Health and Welfare Building, P.O. Box 2675, Harrisburg, PA 17105-2675, Phone: (717) 787-1127, TTY/PA Relay 711, Fax: (717) 772-4366, or Email: [email protected]

You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, AmeriHealth Caritas Pennsylvania Community HealthChoices and the Bureau of Equal Opportunity are available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

ATTENTION: If you speak English, language assistance services, free of charge, are available to you.

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www.amerihealthcaritaschc.com Page 2 of 2


Page 1 of 2

AmeriHealth Caritas Pennsylvania Community HealthChoices complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

AmeriHealth Caritas Pennsylvania Community HealthChoices does not exclude people or treat them differently because of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation.

AmeriHealth Caritas Pennsylvania Community HealthChoices provides free aids and services to people with disabilities to communicate effectively with us, such as:

• Qualified sign language interpreters • Written information in other formats (large print, audio, accessible electronic formats, other formats)

AmeriHealth Caritas Pennsylvania Community HealthChoices provides free language services to people whose primary language is not English, such as:

• Qualified interpreters • Information written in other languages

If you need these services, contact AmeriHealth Caritas Pennsylvania Community HealthChoices at 1-855-235-5115 (TTY 1-855-235-5112).

If you believe that AmeriHealth Caritas Pennsylvania Community HealthChoices has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, creed, religious affiliation, ancestry, sex gender, gender identity or expression, or sexual orientation, you can file a complaint with:

AmeriHealth Caritas Pennsylvania Community HealthChoices, Participant Complaints Department, Attention: Participant Advocate, 200 Stevens Drive Philadelphia, PA 19113-1570 Phone: 1-855-235-5115, TTY 1-855-235-5112, Fax: 215-937-5367, or Email: [email protected]

The Bureau of Equal Opportunity, Room 223, Health and Welfare Building, P.O. Box 2675, Harrisburg, PA 17105-2675, Phone: (717) 787-1127, TTY/PA Relay 711, Fax: (717) 772-4366, or Email: [email protected]

You can file a complaint in person or by mail, fax, or email. If you need help filing a complaint, AmeriHealth Caritas Pennsylvania Community HealthChoices and the Bureau of Equal Opportunity are available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Room 509F, HHH Building, Washington, DC 20201, 1-800-368-1019, 800-537-7697 (TDD).

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

www.amerihealthcaritaschc.com

CHCPA_19456757-1

11 Stanwix Street, Suite 1100Pittsburgh, PA 15222

a newsletter for participants of amerihealth caritas ...€¦ · • reduce sensitivity. •...

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