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Caresource Mycare Ohio (Medicare-Medicaid Plan) Medicaid

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Caresource Mycare Ohio (Medicare-Medicaid Plan) Medicaid CareSource | Medicaid-Only Member Handbook CareSource® MyCare Ohio (Medicare-Medicaid Plan) Medicaid-Only Member Handbook 2019 CareSource.com/MyCare I CareSource | Medicaid-Only Member Handbook CONTACT US Member Services Department Phone: 1-855-475-3163 Street Address: 230 N. Main Street, Dayton, Ohio, 45402 Hours: Monday through Friday, 8 a.m. to 8 p.m. Online: CareSource.com/MyCare CareSource24® (24-hour Nurse Advice Line) Phone: 1-866-206-7861 Care Management Phone: ____________________________________ (write your care manager’s direct phone number here) 1-855-475-3163 (during business hours shown above) 1-866-206-7861 (after hours) Behavioral Health Crisis Line Reporting Fraud, Waste and Abuse Phone: 1-866-206-7861 Phone: 1-855-475-3163 Email: [email protected] CareSource Privacy Officer TTY for the hearing impaired: 1-800-750-0750 or 711 Phone: 937-531-2023 ATTENTION: If you speak English, language services, free of charge, are available to you. Call 1-855-475-3163 (TTY: 1-800-750-0750 or 711), Monday – Friday, 8 a.m. – 8 p.m. The call is free. ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-475-3163 (TTY: 1-800-750-0750 o 711), el lunes a viernes, 8 a.m. a 8 p.m. La llamada es gratuida. If you have any problem reading or understanding this information or any other CareSource MyCare Ohio information, please contact our Member Services at 1-855-475-3163 (TTY: 1-800-750-0750 or 711), Monday – Friday, 8 a.m. – 8 p.m. for help at no cost to you. We can explain this information in English or in your primary language. You can get this document for free in other formats, such as large print, braille, or audio. Call 1-855-475-3163 (TTY: 1-800-750-0750 or 711), Monday – Friday, 8 a.m. – 8 p.m. The call is free. CareSource® MyCare Ohio (Medicare - Medicaid Plan) is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. CareSource may not discriminate on the basis of race, color, religion, gender, gender identity, sexual orientation, age, disability, national origin, military status, ancestry, genetic information, health status, or need for health services in the receipt of health services. II CareSource.com/MyCare CareSource | Medicaid-Only Member Handbook TABLE OF CONTENTS Welcome .........................................................................................................................................................1 How to Reach Us .......................................................................................................................................1 Who Is Eligible to Enroll in a MyCare Ohio Plan? ...........................................................................................2 New Member Information ................................................................................................................................3 Network Providers ..........................................................................................................................................4 When You Travel Outside of Our Service Area ...............................................................................................4 Identification (ID) Cards ............................................................................................................................... ...5 Always Keep Your ID Card(s) With You ......................................................................................................5 Doctor Appointments ......................................................................................................................................6 Primary Care Provider ....................................................................................................................................6 Changing Your PCP ........................................................................................................................................6 Provider Directory ...........................................................................................................................................7 Member Services ............................................................................................................................................7 Interpreter Services ...................................................................................................................................8 CareSource24® Nurse Advice Line .................................................................................................................9 My CareSource® .............................................................................................................................................9 CareSource Mobile App ................................................................................................................................10 Care Management ........................................................................................................................................10 Preventive Care Is Important ........................................................................................................................11 Where to Get Medical Care .........................................................................................................................12 Primary Care Services .............................................................................................................................12 Convenience Care Clinics ........................................................................................................................13 Urgent Care Centers ................................................................................................................................13 Emergency Services ................................................................................................................................13 Follow-Up Care (Also Called Post-Stabilization Care) ..............................................................................14 When You Can See a Non-Network Provider ..........................................................................................14 Services Covered by CareSource MyCare Ohio ...........................................................................................15 Services That Do Not Require a Prior Authorization ................................................................................15 Services That Require a Prior Authorization ............................................................................................18 Prescription Drugs – Not Covered by Medicare Part D ............................................................................20 Medication Therapy Management ...........................................................................................................21 Healthchek (Well Child Exams) ............................................................................................................... 22 Additional Benefits or Services ................................................................................................................ 23 CareSource.com/MyCare III CareSource | Medicaid-Only Member Handbook Services Not Covered by CareSource MyCare Ohio ....................................................................................24 Member Rights .............................................................................................................................................25 Privacy Practices ..........................................................................................................................................27 Your Rights ..............................................................................................................................................27 Your Choices ...........................................................................................................................................28 Consent to Share Health Information .......................................................................................................29 Other Uses and Disclosures ....................................................................................................................29 Our Responsibilities .................................................................................................................................31 Member Responsibilities ...............................................................................................................................32 Fraud, Waste and Abuse ..............................................................................................................................32 If You Suspect Fraud, Waste or Abuse ................................................................................................... 33 How to Let CareSource MyCare Ohio Know if You Are Unhappy or Do Not Agree With a Decision We Made – Appeals and Grievances .......................................................... 34 State Hearings ............................................................................................................................................. 36 Accidental Injury or Illness (Subrogation) ......................................................................................................39 Other Health Insurance (Coordination of Benefits – COB) ............................................................................39 Loss of Insurance
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