BadgerCare Plus. Standard/Benchmark Plan. Health Tradition. Member Handbook

Transcription

1 BadgerCare Plus Standard/Benchmark Plan Health Tradition Member Handbook

2

3 Contents Welcome to Health Tradition...2 Important Information...3 ForwardHealth ID Card...4 The Nurse Line at Mayo Clinic Health System - Franciscan Healthcare...4 Mayo Clinic Tobacco Quitline...5 Primary Care Selection...7 Emergency and Urgent Care...10 Care Away from Home...13 Billing...14 Services That Are Covered...16 Pregnancy and Delivery...18 HealthCheck...19 Lead Poisoning...20 Transportation...21 Eligibility...23 Special Medical Situations...24 Advance Directives...25 Complaints, Grievances & Appeals...26 Doctor Information...28 Your Rights...29 Notice of Privacy Practices...30 Immunizations...36 Important Numbers...37 Mission Health Tradition commits to providing both access to high quality healthcare coverage and the best service possible, in collaboration with Mayo Clinic Health System Franciscan Healthcare, to improve the health of individuals and the communities we serve. Customer Service (toll free) 1

4 Welcome to Health Tradition Health Plan BadgerCare Plus HMO Welcome Health Tradition Health Plan welcomes you to our BadgerCare Plus HMO. An HMO is a network of doctors, clinics and hospitals that work together to help you manage your healthcare. As a member of Health Tradition, you will receive all your health care from Health Tradition doctors, clinics and hospitals. Please refer to your Health Tradition Health Plan/ Mayo Clinic Health System directory for a list of these healthcare providers. Your Health Tradition welcome packet contains a directory of healthcare providers, a member handbook and other important information for you to keep. Please refer to your Health Tradition member handbook to help you answer any questions or call the Member Advocate at or toll-free at Member Advocate If you have any questions about your health insurance or the information in this new member packet, contact the Member Advocate at or toll-free at Interpreter Services (TTY) or Hearing Impaired call the Wisconsin Relay Line then ask to be connected to Interpreter services, including sign language, are provided free of charge to you. 2

5 Important Information Health Tradition «Member Advocate - for questions on your health insurance benefits or (TTY) Monday - Friday 8:00 am 4:30 pm «Nurse Line at Mayo Clinic Health System - Franciscan Healthcare 24 hour Nurse Line Call 24 hours a day, seven days a week Hearing Impaired: (TDD) Wisconsin Relay Line , then ask for «Mayo Clinic Tobacco Quitline (TDD) Monday-Friday 7:00 am - 11:00 pm «Health Tradition Website Wisconsin Department of Health Services «HMO Enrollment Specialists - for questions on HMO enrollment Monday through Friday, 7 am - 6 pm «HMO Ombuds Program - for questions or concerns about your HMO (see page 26) Monday through Friday, 8 am - 4:30 pm «Member Services - for questions about BadgerCare Plus benefits Monday through Friday, 7 am - 5 pm We Value What You Say. Quality Commitment Health Tradition Health Plan is here to serve you. If you have an idea that could improve our service or make the information we provide better, we d like to hear from you. Please call our member advocate and let us know your thoughts. BadgerCare Plus members call (608) , or toll-free at Thank you! Customer Service (toll free) 3

6 Important Information (continued) ForwardHealth ID Card Always carry your ForwardHealth ID card with you and show it each time you get care. You may have problems getting care or prescriptions if you do not have your card with you. If you misplace your ForwardHealth card or need a replacement card, contact Member Services toll-free at Wisconsin serving you ID No Ima Recipient Authorized Signature For questions about your plan coverage, call: State of Wisconsin, PO Box 7190, Madison, WI If you are a provider, call Ask A Nurse The Nurse Line at Mayo Clinic Health System - Franciscan Healthcare is a toll-free, 24-hour nurse line for Health Tradition Health Plan members. The Nurse Line is staffed with registered nurses who can answer your questions about sickness, health conditions and medications. Healthcare professionals are available to you any time of the day or night. For information on yourself or your family call toll-free at Hearing Impaired: call the Wisconsin Relay Line at and ask to be connected to the Nurse Line at Mayo Clinic Health System Franciscan Healthcare at

7 Mayo Clinic Tobacco Quitline Mayo Clinic Tobacco Quit Line Mayo Clinic Tobacco Quitline is provided to you and your family at no charge by Health Tradition Health Plan. That s because giving up tobacco is the single best thing you can do to improve and protect your health, now and for the rest of your life. When you call Mayo Clinic Tobacco Quitline, our friendly, professional counselors will talk about how ready you are to quit using tobacco. If you are ready, a counselor will help you set a quit date. You will receive a self-paced workbook, lots of helpful quit tips and strategies for staying quit. Your counselor will make several follow-up phone calls to help you through the quitting process. If you are not quite ready to quit yet, that is okay. You will receive an information packet in the mail and you can call back when you decide the time is right. No pressures, no hassles just support and encouragement, along with reliable health information from Mayo Clinic. Quitting is about more than willpower «It is about seeing yourself as an ex-smoker or ex-chewer. Mayo Clinic Tobacco Quitline counselors help build your self-confidence and belief in your ability to quit. You can do this! «It is about being in control of your health, your choices, your life. As you learn about your triggers for tobacco use and the ways that have been used to keep you hooked, you will regain control. Mayo Clinic Tobacco Quitline counselors will help you develop personal plans for fighting cravings and living tobacco-free. «It is about support and encouragement. We will not tell you that quitting is easy you know better. Breaking your nicotine dependence may be the toughest thing you ever attempt. But this is our commitment to you: Mayo Clinic Tobacco Quitline will be here for you. It is great to know that when you are stressed, tired or tempted, you can reach for the phone instead of reaching for tobacco. Why is it so hard to quit? If giving up tobacco was just a matter of willpower, you would have quit long ago. Most tobacco users make three or four serious attempts to quit on their own. The truth is, tobacco use is more than just a bad habit. In fact, for many people nicotine is just as addictive as heroin or cocaine. Becoming tobacco-free means breaking your physical and emotional dependence on nicotine. For most people, that requires the support of a professional counselor. Customer Service (toll free) 5

8 Mayo Clinic Tobacco Quitline (continued) How can Mayo Clinic Tobacco Quitline help me? The experts at the Mayo Clinic Nicotine Dependence Center have treated more than 24,000 tobacco users at our Rochester, MN, facility. Now you can receive the same type of professional counseling over the phone, in the privacy and convenience of your own home. Thousands of people just like you have called Mayo Clinic Tobacco Quitline for help. Does phone counseling really work? Yes! On average, 40 percent of Mayo Clinic Tobacco Quitline members are tobacco-free six months after enrollment! (compared to about five percent of people who are able to quit on their own). How do I enroll in Mayo Clinic Tobacco Quitline? Call the toll-free number: An intake specialist will schedule your assessment call with one of our professional counselors. Your counselor will help you set a quit date and enroll you in the program. It s that simple! Throughout the quitting process you will receive regular phone calls from your Mayo Clinic Tobacco Quitline counselor. You will get personal attention and a link to the resources of Mayo Clinic as you work with your counselor to develop ways to avoid triggers and prevent relapse. You will also receive educational materials chosen by your counselor just for you, and a workbook called Tobacco-Free...One Day at a Time. Remember, Mayo Clinic Tobacco Quitline is provided at no charge to you by Health Tradition Health Plan. Start living tobacco-free today! Call today to enroll: Toll-free: TDD: Hours: 7:00 am - 11:00 pm 6

9 Primary Care Clinic Selection Health Tradition Health Plan wants you to choose a primary care clinic for health services. We want you to choose a primary care clinic for yourself and your family members. Each family member can choose a different clinic location. This choice will not change your healthcare in any way. It will only help to coordinate the care that you do receive. Do I need to select a primary care clinic with Health Tradition Health Plan? Yes, you must choose a primary care clinic. If you are a current member, select the clinic your new doctor is at. If you need help selecting a clinic, please call or toll-free at Hearing Impaired: call the Wisconsin Relay Line then ask to be connected to Will I be able to switch clinic locations if I want to go to a different doctor? Members will be able to switch clinics or doctors at any time. To make a change, call or toll-free at Why do we need to choose a primary clinic to go to? We decided to do this to give members a better chance to build a relationship with a family doctor. Your doctor will then be able to coordinate your healthcare for you in the event that you need a specialist or a referral. Your doctor will be able to keep better track of the preventive care you need on a proper schedule. What if I need to go to a chiropractor, eye doctor or mental health doctor? You can go to any chiropractor, eye doctor or mental health doctor that is in our Health Tradition network. If you have any questions about this or need a Directory of Healthcare Providers please call the Member Advocate at or toll-free at You only need to choose a primary care clinic for medical care. Customer Service (toll free) 7

10 Primacy Care Selection (continued) Primary Care Clinic Locations Each family member covered by Health Tradition Health Plan needs to select a clinic location from the list below. If you have any questions, please call the Member Advocate at or toll-free at Mayo Clinic Health System Mayo Clinic Health System Arcadia Clinic 464 South Saint Joseph Avenue, Arcadia, WI Clinic Phone: (608) Mayo Clinic Health System Holmen Clinic 1303 Main Street South, Holmen, WI Clinic Phone: (608) Mayo Clinic Health System La Crosse Campus 700 West Avenue South, La Crosse, WI «General Phone: (608) «Center for Women s Health: (608) «Family Medicine: (608) «Internal Medicine: (608) «Pediatrics: (608) «Family Health Clinic: (608) South 10th Street, La Crosse, WI Mayo Clinic Health System Onalaska Clinic 191 Theater Road, Onalaska, WI Clinic Phone: (608) Mayo Clinic Health System Prairie du Chien Clinic 800 East Blackhawk Avenue, Prairie du Chien, WI Clinic Phone: Mayo Clinic Health System Sparta Campus 310 West Main Street, Sparta, WI Clinic Phone: (608) Mayo Clinic Health System Tomah Clinic 325 Butts Avenue, Tomah, WI Clinic Phone: (608) Mayo Clinic Health System La Crescent, MN Clinic 524 North Elm Street, La Crescent, MN Clinic Phone: (507)

11 Help in Choosing a Doctor Mayo Clinic Health System Mayo Clinic Health System Franciscan Healthcare is an integrated healthcare delivery network serving residents of an 11-county area covering Western Wisconsin, Southeastern Minnesota and Northeastern Iowa. Based on a Christian heritage and belief in human dignity, Mayo Clinic Health System Franciscan Healthcare commits to putting the needs of patients first and to collaborate in improving the health of individuals and the communities served. Mayo Clinic Health System Franciscan Healthcare is home to more than 200 healthcare providers in primary and specialty care fields at 12 campus or clinic locations. Need Help Finding a New Doctor? «Call or «Ask for Assistance selecting a physician, «Or learn about each of the Franciscan Healthcare doctors online at the Medical Staff link or the Our Locations link at: Rural Area Resident (When there is only on HMO in your county) If you live in a rural area with only one HMO and your Primary Care Physician is not in network, you may continue to see this provider for up to 60 days. If this provider is still not in the HMO network after 60 days, you will be given a choice of participating providers to move to. Customer Service (toll free) 9

12 Emergency and Urgent Care Emergency Care Emergency care is care needed right away. This may be caused by an injury or a sudden illness. Some examples are: «Choking «Trouble breathing «Serious broken bones «Unconsciousness «Severe burns «Severe pain «Severe or unusual bleeding «Suspected poisoning «Suspected heart attack «Suspected stroke «Convulsions «Prolonged or repeated seizures If you need emergency care, go to a Health Tradition doctor for help if you can. BUT, if the emergency is severe, go to the nearest doctor (hospital, doctor, or clinic). Call 911 or your local police or fire department emergency services if the emergency is severe. If you must go to a non-health Tradition hospital or doctor, call Health Tradition toll-free at as soon as you can and tell us what happened. This is important so we can help you get follow up care. Remember, hospital emergency rooms are for true emergencies only. Call your doctor or our 24-hour emergency number toll-free at before you go to the emergency room, unless your emergency is severe. 10

13 Emergency and Urgent Care (continued) Urgent Care Urgent care is care you need sooner than a routine doctor s visit. Urgent care is not emergency care. Do not go to a hospital emergency room for urgent care unless your doctor tells you to go there. Some examples of urgent care are: «Most broken bones «Sprains «Non-severe bleeding «Minor burns «Minor cuts «Bruises «Most drug reactions If you need urgent care, call the 24-hour emergency number or the Member Advocate toll-free at We will tell you where you can get care. You must get urgent care from Health Tradition doctors unless you get our approval to see a non-health Tradition doctor. Remember, do not go to a hospital emergency room for urgent care unless you get approval from Health Tradition first. Customer Service (toll free) 11

14 12

15 Care Away from Home How to Get Medical Care When You Are Away From Home Follow these rules if you need medical care but are too far away from home to go to a Health Tradition primary care doctor (PCP) or clinic: «Severe Emergencies For severe emergencies, go to the nearest hospital, clinic, or doctor. «Urgent or Routine Care For urgent or routine care away from home, you must get approval from Health Tradition to go to a different doctor, clinic or hospital. This includes children who are spending time away from home with a parent or relative. Call us toll-free at for approval to go to a different doctor, clinic or hospital. Customer Service (toll free) 13

16 Billing When You May Be Billed For Services It is very important to follow the rules when you get medical care so you are not billed for services. You must receive your care from Health Tradition doctors and hospitals unless you have our approval prior to being seen. The only exception is for severe emergencies. If you travel outside of Wisconsin and need emergency services, health care doctors can treat you and send claims to Health Tradition. You will have to pay for any service you get outside Wisconsin if the health care doctor refuses to submit claims or refuses to accept Health Tradition s payment as payment in full. Health Tradition does not cover any service, including emergency services, provided outside of the United States, Canada and Mexico. If You Are Billed If you receive a bill for services, call the Health Tradition Member Advocate toll-free at or You do not have to pay for services that Health Tradition is required to provide you. Other Insurance If you have other insurance in addition to Health Tradition, you must tell your doctor or other provider. Your doctor must bill your other insurance before billing Health Tradition. If your Health Tradition doctor does not accept your other insurance, call the HMO Enrollment Specialist at The Enrollment Specialist can tell you how to match your HMO enrollment with your other insurance so you can use both insurance plans. 14

17 Billing (continued) Covered and Non-Covered Services «Under the BadgerCare Plus Standard Plan: If you receive a bill for services, call our Member Advocate at or You do not have to pay for covered services (other than a required copayment) that are provided by a BadgerCare Plus certified doctor and that Health Tradition is required to provide you unless prior authorization is denied and you are told there will be a charge for the services before it is provided. Generally, charging a member for a non-covered service is allowed, except for certain non-covered services or activities related to covered services, like missed appointments, telephone calls and translation services. «Under BadgerCare Plus Benchmark Plan: The HMO and its doctors and subcontractors may bill you for deductibles for covered services that are provided by a BadgerCare Plus certified doctor. You may request non-covered services from doctors, and doctors may collect payment for non-covered services from you if you accept responsibility for payment and make payment arrangements with the doctor. Doctors may bill you up to their usual and customary charges for non-covered services. Copayments «Under the BadgerCare Plus Standard Plan: The HMO and its doctors and subcontractors may bill you for nominal copayments. The following are exempt from copayments: «Medicaid SSI members «Nursing home residents «Pregnant women «Members under 19 years of age and under who are members of a federally recognized tribe «Members under 19 years of age with incomes at or below 100 percent of the Federal Poverty Level (FPL). «Under BadgerCare Plus Benchmark Plan: The HMO and its doctors and subcontractors may bill you for copayments for covered services or for other medical services that are provided by a BadgerCare Plus certified doctor. The following members are exempt from copayments: «Pregnant women, «Members under 19 years of age who are members of a federally recognized tribe. Customer Service (toll free) 15

18 Services That Are Covered Services Covered by Health Tradition Members may need to pay a copayment to receive these covered services, and there may be limitations on the amount of services you can receive. Please call a Member Advocate at if you have questions about possible copayments or limitations on covered services. Health Tradition provides all medically necessary covered services under BadgerCare Plus Standard and Benchmark Plans. Some services may require a doctor s referral or a prior authorization. Covered services include: «Services by doctors and nurses, including nurse practitioners and certified nurse midwives «Inpatient and outpatient hospital services «Laboratory and X-ray services «HealthCheck for members under 21 years of age, including referral for other medically necessary services «Certain podiatrist s (foot doctor s) services «Inpatient care at institutions for mental disease «Optometrist s (eye doctor s) or optician s services, including eyeglasses (Benchmark Plan does not cover eyeglasses). «Mental health treatment «Substance abuse (drug and alcohol) services «Family planning services and supplies, except for infertility treatment «Certain chiropractic services «Appropriate transportation to obtain medical care by specialized medical vehicle (Benchmark Plan does not cover this service). «Ambulance for emergency (life-threatening) medical care (Benchmark Plan only covers emergency transportation via ambulance) «The following services when a doctor gives a written referral for both Standard and Benchmark Plans: «Prostheses and other corrective support devices «Hearing aids and other hearing services (Benchmark Plan covers hearing aids and other hearing services for members 17 years and younger) «Home health care «Personal care (Benchmark Plan does not cover this service) «Independent nursing services «Medical supplies and equipment «Occupational therapy (Benchmark Plan covers 20 visits) «Physical therapy (Benchmark Plan covers 20 visits) «Speech therapy (Benchmark Plan covers 20 visits) «Respiratory therapy «Nursing home services «Medical nutrition counseling «Hospice care 16

19 Services That Are Covered (continued) Mental Health and Substance Abuse Services Health Tradition offers mental health and substance abuse (drug and alcohol) services to all members. If you need these services, call the Health Tradition Mental Health Coordinator toll-free at or Family Planning Services Health Tradition provides confidential family planning services to all members. This includes minors. If you do not want to talk to your primary care doctor about family planning, call the Health Tradition Member Advocate toll-free at We will help you choose a Health Tradition family planning doctor who is different from your primary care doctor. We encourage you to receive family planning services from a Health Tradition doctor. That way we can better coordinate all your health care. Federal law allows members to choose their doctor, including physicians and family planning clinics, for reproductive care and supplies. Therefore, you can also go to any family planning clinic that will accept your ForwardHealth ID card even if the clinic is not part of Health Tradition. Dental Services Health Tradition does not provide dental services. You may get dental services from any dentist who will accept your ForwardHealth ID card. Your dental services are provided by the State, not Health Tradition. Chiropractic Services Health Tradition provides covered chiropractic services for BadgerCare Plus members, but you must go to a Health Tradition chiropractor. See the Health Tradition Directory of Healthcare Providers or call the Member Advocate toll-free at for the names of our chiropractors. Pharmacy Benefits Your prescriptions and certain over-the-counter items are provided by the State, not Health Tradition. You may receive a prescription from a Health Tradition doctor, specialist, or dentist. You can fill your prescription at Mayo Clinic Health System Franciscan Pharmacies or any pharmacy that is a provider for BadgerCare Plus. Please show your ForwardHealth ID card to the pharmacy when you get your prescriptions filled. You may have co-payments or have limits on covered medications. Customer Service (toll free) 17

20 Pregnancy and Delivery Pregnant Women and Deliveries If you become pregnant, please let Health Tradition Health Plan and your county human services department know right away. This is to make sure you get the extra care you need. You may also not have co-pays when you are pregnant. You must go to a Health Tradition hospital to have your baby. Talk to your Health Tradition doctor to make sure you understand which hospital you are to go to when it s time to have your baby. Also, talk to your doctor if you plan to travel in your last month of pregnancy. We want you to have a healthy birth and a good birthing experience. It may not be a good time for you and your unborn child to be traveling. Your Health Tradition doctor knows your history and is the best doctor to help you have a healthy birth. Do not go out of area to have your baby unless you have Health Tradition approval. You may also wish to pick a doctor for your child before you give birth. We will be able to help you pick a doctor for your unborn child. Text 4 Baby: Free Information for You and Your Baby What if you could get news from your cell phone that would give your baby the best possible start in life? Text4baby is a free mobile service that promotes mom and baby health. Pregnant women and new moms can sign up by texting BABY (or BEBE, for a message in Spanish) to Text4baby will send texts each week, timed to your baby s due date or date of birth. The messages focus on many topics critical to the health of moms and babies. These include birth defect prevention, shots, healthy eating, flu, mental health, and safe sleep. Text4baby is free, even if you do not have a text messaging plan. And if you have limited texting per month, text4baby will not count against your total amount of messages. This is due to The Wireless Association, and other wireless service providers. You can find out more about text4baby by going online to

21 HealthCheck HealthCheck is a preventive health checkup program for members under the age of 21. The HealthCheck program covers complete health checkups. These checkups are very important for those under 21. Children may look and feel well, yet may have a health problem. Your doctor wants to see those under 21 for regular checkups, not just when they are sick. The HealthCheck health program has three purposes: 1. To find and treat health problems for those under To let you know about the special health services for those under To make those under 21 eligible for some health care not otherwise covered. The HealthCheck program covers the medical care for any health problems found during the checkup including medical care, eye care and dental care. The HealthCheck checkup includes: «Health and developmental history (including assistance in planning for a child s health needs. «Unclothed physical examination. «Vision Screening. «Hearing Screening. «Dental screening and a referral to a dentist beginning at age one. «Immunizations appropriate for age (shots). HEALTHCHECK SCHEDULE Birth to 1 years 6 screenings 1 to 2 years 3 screenings 2 to 3 years 2 screenings 3 to 6 years 1 screen/year 6 to 21 years 1 screen every other year «Blood and urine lab tests (including blood lead level testing when appropriate for age). If you need a ride to your HealthCheck appointment you can call LogistiCare to arrange your ride. Call LogistiCare at (or TTY ). LogistiCare is open between 7:00 am and 6:00 pm, Monday through Friday. You must call at least two days before a routine appointment to schedule a ride. Have this information ready when you call for a ride: «Your name, address and telephone number «Your ForwardHealth member identification number «The street address and telephone number where you want to be picked up «The name, telephone number, address and ZIP code of the doctor or other health care provider with whom you have the appointment «The date and time of your appointment «Any special transportation needs «A general reason for the appointment (HealthCheck appointment). At the end of the call, LogistiCare will give you a confirmation number for your ride and tell you when your ride will pick you up. Customer Service (toll free) 19

22 Health Tradition pays for the simple blood test that can detect high levels of lead. Consult your healthcare provider for more information. Simple Steps to Protect Your Family from Lead a a a a a a a Have your home tested for lead hazards. If you rent, notify your landlord of peeling or chipping paint. Wash your children s hands, bottles, pacifiers and toys often. Clean floors, window sills and other surfaces weekly. Use warm water and a general all-purpose cleaner or a cleaner made specifically for lead. Don t let your children chew on window sills or other painted surfaces don t use old cribs that may have leadbased paint. Clean or remove shoes before entering your home to avoid tracking in lead from soil. When remodeling, take precautions to avoid exposure to lead dust (call LEAD for guidelines). Make sure your children eat nutritious, low-fat meals high in iron and calcium such as green vegetables and dairy products. Children with good diets absorb less lead. Dangers of Lead: Nervous system and kidney damage Learning disabilities, attention deficit disorder and decreased intelligence Speech, language and behavior problems Poor muscle coordination Decreased muscle and bone growth How do Children Get Lead in their Bodies? Putting hands or toys into their mouths. Eating paint chips that contain lead. From soil around your home that contains lead. Breathing in lead dust, especially during renovations. Hearing damage Fertility problems / damage to fetus Digestive problems High blood pressure Memory and concentration problems Muscle and joint pain Childhood lead poisoning remains a major health problem in the United States. Even children who appear healthy can have dangerous levels of lead in their bodies. Protect your family! 20

23 Medical Transportation For all non-emergency rides to doctor visits or other covered appointments, you will need to call LogistiCare. Non-emergency rides are rides to a covered service by common carrier. Common Carrier means rides provided by public transportation, by private car, or by special medical vehicle designed to carry wheelchairs or stretchers. If a member drives to an appointment or gets a ride from a friend, neighbor or from the medical facility, neither the driver nor the vehicle is required to meet LogistiCare compliance standards. If your ride is by special medical vehicle you will have a $1.00 co-payment, unless you are exempt from copayments. Members do not pay for gas or tips. How Do I Schedule a Ride? Call LogistiCare at or TTY at «LogistiCare will answer your call between 7:00 a.m. and 6:00 p.m. Monday through Friday. «Call at least two (2) days before a routine appointment to schedule a ride. «For an urgent appointment a ride may be scheduled within three hours. «If you have regular appointments three or more times a week, talk with your doctor. Your doctor can work with LogistiCare to schedule regular rides. What Information Do I Need to Have When I Call for a Ride? LogistiCare will ask for the following information: «Your name, street address, and telephone number «Your ForwardHealth Member identification number (the 10-digit number listed on your card). «The street address and the telephone number where you want to be picked up. «The name, telephone number, address, and ZIP code of the location of your medical visit. «The date and time of your appointment. «Any special transportation needs you have. «General reason for the appointment (doctor s visit, check-up, eye exam, etc.) If you do not have all of this information when you call, you may not be able to schedule your ride and will have to call LogistiCare back. At the end of the call, LogistiCare will give you a confirmation number for your ride and tell you when your ride will pick you up. On the day of your appointment Be ready for your ride at the time LogistiCare told you the ride was coming. If you are more than 10 minutes late, you may miss your ride. If you have been waiting for your ride for more than 15 minutes, call LogistiCare s Where s My Ride number at to ask about your ride. You should also call your doctor to let them know you are running late. You will be asked by the driver to sign a driver log for the trip. After your appointment Your ride should arrive within 15 minutes. If you are not sure when your appointment will be over you can call LogistiCare after the appointment is over and a ride will come to pick you up within one hour. If you have been waiting for longer than one hour, you should call LogistiCare s Where s My Ride number at to ask about your ride. Ambulance Health Tradition covers ambulance service for Emergency Care. You must have approval for all non-emergency ambulance trips. Call LogistiCare at Customer Service (toll free) 21

24 22

25 Eligibility If You Move If you are planning to move, contact your county Department of Social or Human Services. If you move to a different county, you must also contact the Department of Social or Human Services in your new county to update your eligibility. If you move out of Health Tradition s service area, call the HMO Enrollment Specialist toll-free at Health Tradition will only provide emergency care if you move out of our service area. The Enrollment Specialist will help you choose an HMO that serves your area. Health Insurance After Your Eligibility Ends You have the right to purchase a private health insurance policy from Health Tradition when your eligibility ends. Call the Health Tradition Member Advocate toll-free at If you decide to purchase a policy from us, you have 30 days after the date your eligibility ends to apply. Customer Service (toll free) 23

26 Special Medical Matters Second Medical Opinion A second medical opinion on recommended treatments and surgeries may be appropriate in some cases. Contact your doctor or the Health Tradition Member Advocate for information. HMO Exemptions An HMO exemption means you are not required to join an HMO to receive your health care benefits. Most exemptions are granted for only a short period of time so you can complete a course of treatment before you are enrolled in an HMO. If you think you need an exemption from HMO enrollment, call the HMO Enrollment Specialist toll-free at for more information. Living Will Or Power Of Attorney For Health Care You have a right to make decisions about your medical care. You have a right to accept or refuse medical or surgical treatment. You also have the right to plan and direct the types of health care you may receive in the future if you become unable to express your wishes. You can let your doctor know about your feelings by completing a living will or power of attorney for health care form. Contact your doctor for more information. 24

27 Advance Directives Under Wisconsin law, adults have the right to make decisions concerning their medical care, including the right to accept or refuse medical or surgical treatment and the right to create Advance Directives. An Advance Directive is a legal document, such as a living will or durable power of attorney for health care, that relates to the provision of medical care when someone cannot make their own decisions. We do not like to think about having a serious illness, getting in a serious accident, or even dying. But it is important for us to decide what kind of medical care we would like to receive under such circumstances. For example, due to a tragic event, you might not be able to tell anyone whether you would like to be revived or kept on a life-support machine. To avoid this situation, you could have your wishes written down in Advance Directives and share those wishes with the people close to you. If you cannot make your own health care decisions, your family and medical professionals will turn to these directives to determine your medical care. There are mainly two forms of Advance Directives: «Living Will This written, legal document spells out the types of medical treatments and lifesustaining measures you do and do not want. For example, machine assisted breathing and tube feeding. This document may also be called health care declaration or healthcare directive. «Medical Power of Attorney (POA) Sometimes called a durable power of attorney for healthcare, this legal document appoints one person to make decisions on behalf of you when you are not able to do so yourself. Your checklist to use when creating your Advance Directives: «Determine your values and wishes related to your medical care. «Discuss these wishes with your family or friends, doctor, and your attorney if you have one. «Appoint a health care agent, or Medical Power of Attorney. «Put everything in writing and fill out the appropriate forms. «Distribute the completed forms to your doctor, family and health care agent. «Review your directives each year and express any changes to those involved. It is very important for you to discuss your wishes with your primary care doctor. He/she can help you get started creating your own Advance Directives. You may also contact our Member Advocate at or toll-free with questions or to get more information on Advance Directives. - Source: Mayo Foundation for Medical Education and Research (MFMER) You have a right to file a grievance with the Department of Health Services, Division of Quality Assurance if your advance directive, living will or power of attorney wishes are not followed. You may request help in filing a grievance. Customer Service (toll free) 25

28 Complaints, Grievances and Appeals Complaints and Grievances We would like to know if you have a complaint about your care at Health Tradition. Please call the Health Tradition Member Advocate toll-free at if you have a complaint. Or you can write to us at: Attn: Director of Operations Health Tradition Health Plan P.O. Box 188 La Crosse, WI State Of Wisconsin HMO Ombuds Program If you want to talk to someone outside of Health Tradition about your Wisconsin BadgerCare Plus or Medicaid SSI Health Maintenance Organization (HMO), the State of Wisconsin Ombudsmen (pronounced Om-budz-men ) or Ombuds may be able to help you. The Ombuds can tell you how to get the care you need from your HMO. The Ombuds can also help you solve problems or complaints you may have about the HMO Program or your HMO. What do the Ombuds do? «Research and resolve member grievances about the care or services provided by BadgerCare Plus or Medicaid SSI HMOs. «Help BadgerCare Plus or Medicaid SSI HMO members with grievances, whether informal (telephone calls) or formal (written). «Help BadgerCare Plus or Medicaid SSI HMO members understand their rights and responsibilities. «Represent member rights with BadgerCare Plus or Medicaid SSI HMOs. «Act as a fair and impartial go-between. Why would you call the Ombuds? «Your BadgerCare Plus or Medicaid SSI HMO is billing you for services during the time of enrollment. «You are unsure of your rights as a member. «You are unable to get a BadgerCare Plus or Medicaid SSI-covered service from your HMO. «Your HMO has denied, reduced, or stopped BadgerCare Plus or Medicaid-SSI-covered services. «You feel you were treated unfairly or disrespectfully. BadgerCare Plus or Medicaid SSI HMO members have the right to: «Voice complaints. «Be treated with respect and dignity. «Be treated fairly and impartially. «Receive interpreter services during the grievance process. 26

29 Complaints, Grievances and Appeals (continued) How do you file a grievance? 1. Call and ask to speak with an Ombud. 2. Write a letter to the Ombuds explaining your problem and send it to: BadgerCare Plus or Medicaid SSI HMO Ombudsmen P.O. Box 6470 Madison, WI As a BadgerCare Plus or Medicaid SSI HMO member, you may call the Ombuds anytime during your HMO enrollment. If your complaint or grievance needs action right away because a delay in treatment would greatly increase the risk to your health, please call Health Tradition as soon as possible at We cannot treat you differently than other members because you file a complaint or grievance. Your healthcare benefits will not be affected. Appeals You have the right to appeal to the State of Wisconsin Division of Hearings and Appeals (DHA) for a Fair Hearing if you believe your benefits are wrongly denied, limited, reduced, delayed or stopped by Health Tradition. An appeal must be made no later than 45 days after the date of the action being appealed. If you appeal this action to DHA before the effective date, the service may continue. You may need to pay for the cost of services if the hearing decision is not in your favor. If you want a Fair Hearing, send a written request to: Department of Administration Division of Hearings and Appeals P.O. Box 7875 Madison, WI The hearing will be held in the county where you live. You have the right to bring a friend or be represented at the hearing. If you need a special arrangement for a disability, or for English language translation or a sign language interpreter, please call (voice) or (hearing impaired). We cannot treat you differently than other members because you request a Fair Hearing. Your health care benefits will not be affected. If you need help writing a request for a Fair Hearing, please call: BadgerCare Plus Ombuds or HMO Enrollment Specialist Customer Service (toll free) 27

30 Information about your Healthcare Team Physician Incentive Plans Health Tradition does not have special financial arrangements with Mayo Clinic Health System Franciscan Healthcare providers that can affect the use of referrals and other services you might need. Doctor s Credentials You have the right to information about our doctors and other healthcare specialists education, Board Certification and recertification. To get this information, call the Health Tradition Member Advocate toll-free at

31 Your Rights Member Rights «You have the right to ask for an interpreter and have one provided to you during any BadgerCare Plus covered service. «You have the right to receive the information provided in this member handbook in another language or another format. «You have the right to receive health care services as provided for in Federal and State law. All covered services must be available and accessible to you. When medically appropriate, services must be available 24 hours a day, 7 days a week. «You have the right to receive information about treatment options including the right to request a second opinion. «You have the right to make decisions about your health care. «You have the right to be treated with dignity and respect. «You have the right to be free from any form of restraint or seclusion used as a means of force, control, ease or reprisal. Right To Medical Records You have the right to ask for copies of your medical record from your doctor(s). We can help you get copies of these records. Please call the Health Tradition Member Advocate toll-free at for help. Please note: You may have to pay to copy your medical record. You also may correct wrong information in your medical records if your doctor agrees to the correction. Civil Rights Health Tradition provides covered services to all eligible members regardless of: «Age «Race «Religion «Color «Disability «Sex «Sexual Orientation «National Origin «Marital Status «Arrest or Conviction Record «Military Participation All medically necessary covered services are available to all members. All services are provided in the same manner to all members. All persons or organizations connected with Health Tradition who refer or recommend members for services shall do so in the same manner for all members. Translating or interpreting services are available for those members who need them, including sign language for members who are hearing impaired. This service is free. Customer Service (toll free) 29

32 Notice of Privacy Practices Dear Health Tradition Health Plan Member: Health Tradition Health Plan has always been a leader in protecting members health plan information. Maintaining member privacy is part of our mission. Controlled use of health plan information by staff at Health Tradition Health Plan is essential to providing optimum service. The United States government created new rules for the use and protection of medical and health plan information by hospitals, clinics and others, such as health plans. The rules are a result of the 1996 Health Insurance Portability and Accountability Act (HIPAA). They are meant to provide all health plan members in the United States with standard privacy protections. One new rule requires health plans to provide all members with a Notice of Privacy Practices to explain how member health plan information is used. We are happy to provide you with this copy of Health Tradition Health Plan s Notice of Privacy Practices. We hope it will answer any questions you may have about how member health plan information is used here. If you have questions about anything contained in this notice, please feel free to contact our privacy officer at (608) or Thank you for placing your care, and your trust, in Health Tradition Health Plan. Sincerely, Steven M. Kunes Executive Director THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We are Health Tradition Health Plan (the Health Plan or we ). Under the law we are a separate legal entity distinct from your employer that sponsors your health benefit. By law, Health Tradition must maintain the confidentiality of medical information. Health Tradition takes precautions both in the use and disclosure of information to minimize the risk of inappropriate use or disclosure. Federal law requires this Notice outline the practices of Health Tradition Health Plan in handling medical information. The same law requires that Wisconsin law be referenced when it would further restrict the use or disclosure of information. This Notice reflects the greater privacy protections and rights afforded by the Wisconsin patient confidentiality, mental health, and HIV testing statutes. When state and federal privacy laws differ, and Wisconsin law is more protective of your information or provides you with greater access to your information, then state law will override federal law. The federal government defines protected health information as any information, whether oral, electronic or paper, which is created or received by Health Tradition and relates to a member s health care or payment for the provision of health care. This includes medical information used to make a decision about your health care coverage, as well as your name, address and telephone number. 30

33 Notice of Privacy Practices (continued) Health Tradition s Legal Duties: «By law, Health Tradition must keep protected health information private; «Health Tradition will follow the rules of its Privacy Notice currently in effect; «We are also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information; and «This notice takes effect April 14, 2003, and will remain in effect until we replace it. We reserve the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that we maintain, including medical information we created or received before we made the changes. Before we make a significant change in our privacy practices, we will change this notice and send the new notice available to our health plan subscribers at the time of the change. You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice. Information About This Notice «The effective date of this Notice is April 14, 2003; «A paper copy of this Notice will be provided upon request; «Health Tradition reserves the right to change the terms of this Notice and make the new Notice provisions effective for all Protected Health Information maintained; and «When the Notice is revised, it will be available upon request either at Health Tradition facilities or by mail and will be posted in a clear and prominent location at each physical service delivery sites. How Health Tradition May Use or Disclose Your Protected Health Information The following categories describe the ways that Health Tradition may use and disclose your health information. For each category of uses and disclosures, we will explain what we mean and present some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories. Treatment We may use or disclose your medical information to a doctor or other health care doctor in order to provide treatment to you. Payment Health Tradition may use or disclose health information to determine eligibility for plan benefits, obtain premiums, facilitate payment for the treatment and services received from health care doctors, determine plan responsibility for benefits, to issue explanation of benefits to the person who subscribes to the Plan and to coordinate benefits. For example, payment functions may include reviewing the medical necessity of health care services, determining whether a particular treatment is experimental or investigational, or determining whether a treatment is covered under your plan. We may disclose your medical information to a health care doctor or entity subject to the federal Privacy Rules so they can obtain payment or engage in these payment activities. We may need your written permission to disclose information taken from your mental health treatment records or HIV test results for payment purposes. Healthcare Operations Health Tradition may use and disclose protected health information to carry out necessary insurance-related activities. For example, such activities may include: «Underwriting, premium rating and other activities relating to plan coverage; «Reviewing the competence or qualifications of health care professionals, evaluating practitioner and doctor performance, conducting training programs, accreditation, certification, licensing or credentialing activities; «Conducting quality assessment and improvement activities; submitting claims for stop-loss coverage; «Conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; Customer Service (toll free) 31

34 Notice of Privacy Practices (continued) «Business planning and development; «Business management and general administration, including management activities relating to privacy, customer service, resolution of internal grievances, and creating de-identified medical information or a limited data set. We may disclose your medical information to another entity, which has a relationship with you and is subject to the federal Privacy Rules, for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse. We may need your written permission to disclose medical information or information taken from your mental health treatment records or HIV test results for health care operations. On Your Authorization You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any reason except those described in this notice. Health-Related Benefits and Services Health Tradition may use your medical information to contact you with information about health-related benefits and services or about treatment alternatives that may be of interest. With your written permission, we may disclose your medical information to a business associate to assist us in these activities. We may use or disclose your medical information to encourage you to purchase or use a product or service by face-toface communication or to provide you with promotional gifts. Individuals Involved in Care and Notification With your written permission, Health Tradition may disclose Protected Health Information to a family member or legal representative to the extent necessary to help with the care of or payment for a Health Tradition member. If a member is accompanied by family or friends while insurance related activities are provided, permission to disclose Protected Health Information will be presumed by the health plan unless the member states otherwise. Before we disclose your medical information to a person involved in your health care or payment for your health care, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest. Wisconsin law requires a written authorization to release health information in most situations to family members or friends except in the case of an emergency. We may not disclose confidential medical information or any information taken from mental health treatment records or HIV test results in these circumstances without your written permission. Required By Law Health Tradition will use or disclose Protected Health Information when required by federal, state or local law. You may be able to opt out of use or disclosure of your medical information for (a) research purposes or (b) pursuant to a written request from a government agency, unless law requires the disclosure. We may not disclose HIV test results and certain confidential medical information or mental health treatment records for certain of these purposes without your written permission, unless required by law. Disaster Relief Health Tradition may use or disclose your name and location to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. We may not disclose confidential medical information (except in response to a written request from a government agency) or any information taken from mental health treatment records or HIV test results in these circumstances without your written permission. 32

35 Notice of Privacy Practices (continued) To Avert a Serious Threat of Harm Health Tradition may use and disclose Protected Health Information to warn of a serious threat to the health or safety of a member or the health or safety of the public or another person. Organ and Tissue Donation Health Tradition may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues, as necessary. Military and Veterans If a member is a member of the Armed Forces, Health Tradition may release Protected Health Information as required by military command authorities. Health Tradition may also release Protected Health Information about foreign military personnel to the appropriate foreign military authority. Worker s Compensation Health Tradition may disclose Protected Health Information regarding work-related illness or injury, including to employers, when a member is pursuing a workers compensation claim, as authorized by state worker s compensation laws. Public Health Purposes Health Tradition may disclose Protected Health Information for public health purposes. Release may occur for the following reasons: «To prevent or control disease or injury; «To report births and deaths; «To report maltreatment of a child or vulnerable adult, or domestic violence; «To report to the federal government adverse reactions to medication or safety problems with FDA-regulated products; or «To notify people of product recalls. HIV Test Results Your HIV test results, if any, may be disclosed as set forth in Wisconsin Statutes (5)(a). A listing of the persons or circumstances set forth in that statute is available on request. Health Oversight Activities Health Tradition may disclose Protected Health Information to health oversight agencies where authorized by law. Oversight activities might include, for example, licensure, accreditation, audits and investigations. Lawsuits and Other Judicial Proceedings Health Tradition may disclose Protected Health Information in response to a Court or Administrative Order. Health Tradition may also disclose Protected Health Information in response to certain types of subpoenas, discovery requests or other lawful process. Law Enforcement Activities Health Tradition may disclose Protected Health Information to law enforcement officials: «In response to a Court Order, subpoena, warrant or other type of process; «To identify a suspect, fugitive or missing person; «About the victim of a crime under certain limited circumstances; «About a death believed to be a result of criminal conduct; «About a crime committed on Health Tradition premises; «In emergency circumstances when necessary to maintain safety and security of Health Tradition personnel and members; or «To correctional institutions regarding inmates. Coroners, Medical Examiners and Funeral Directors Health Tradition may release Protected Health Information to a coroner or medical examiner when necessary to identify the deceased or determine the cause of death. Release of information to funeral directors may occur when necessary to carry out the function of the funeral director. Customer Service (toll free) 33

36 Notice of Privacy Practices (continued) National Security Activities Health Tradition may release Protected Health Information to the military and authorized federal officials for lawful intelligence, counterintelligence, or other national security activities authorized by law. Members Rights with Respect to Protected Health Information Right to Access A member has the right to look at or get copies of health information in Health Tradition s designated record set about that member. You may request that we provide copies in a format other than photocopies, although we may not be able to accommodate those requests. This includes membership, medical and claims records used to make decisions about your plan benefits. A request to look at and copy must be submitted in writing to Privacy Officer, Health Tradition Health Plan, PO Box 188, La Crosse, WI You may obtain a form to request access from the Privacy Officer also. If a copy is requested, a fee may be charged to cover expenses associated with your request. If you request an alternative format, we will charge a cost-based fee for providing your medical information in that format. If you prefer, we will prepare a summary or an explanation of your medical information for a fee. Contact us using the information listed at the end of the notice for information on our fee structure. Health Tradition may deny a request to inspect and copy a designated record set under certain limited circumstances. If a member is denied access to the information, the member may request a review of the denial. Another licensed health care professional within Health Tradition will review the request and denial. Health Tradition will comply with the outcome of the review. Right to Request Amendment A member has the right to request Protected Health Information, including mental health treatment records, or information in Health Tradition s designated record set be amended. A request to amend must be submitted in writing to Privacy Officer, Health Tradition Health Plan, PO Box 188, La Crosse, WI The request must include a reason to support the amendment. Health Tradition may deny a request for amendment based upon any of the following circumstances: The request is not in writing or does not include a supporting reason; The information you want to change was not created by Health Tradition, and the person or entity that created the information remains available to amend the information; The information would not be available for inspection; The information is not part of designated record set; or The information in the designated record set is accurate and complete. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be appended to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. Right to Accounting of Disclosure A member has a right to the accounting of disclosures made by Health Tradition or our Business Associates of Protected Health Information about that member. This accounting does not include disclosures to carry out payment and health care operations; disclosures authorized by you; and for certain other activities; or that occurred prior to April 14, We will provide you with the date on which we made the disclosure, the name of the person or entity to which we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information. You also have the right to request a disclosure accounting of all written disclosures of your mental health treatment records. 34

37 Notice of Privacy Practices (continued) A request for an accounting must be submitted in writing to Privacy Officer, Health Tradition Health Plan, PO Box 188, La Crosse, WI The request must state a time period (no longer than six years) and indicate in what form the list should be provided. The first list within a 12-month period is free. For additional lists, Health Tradition may charge for the costs of providing the accounting. Contact us using the information listed at the end of the notice for information on our fee structure. Right to Request Restrictions A member has a right to request a restriction or limits on the use or disclosure of Protected Health Information. Such requests for restriction must be in writing. Health Tradition is not required to agree to this request, but if we do, we will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing and signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is so memorialized in writing. Right to Request Confidential Communication You have the right to receive your health information through a reasonable alternative means or at an alternative location. To request confidential communications, you must submit your request in writing to Privacy Officer, Health Tradition Health Plan, PO Box 188, La Crosse, WI We are not required to agree to your request. We must accommodate your request if it is reasonable, specifies the alternative means or location, and continues to permit us to collect premiums and pay claims under your plan, including issuance of explanations of benefits to the subscriber of the plan. An explanation of benefits issued to the subscriber for health care that you received for which you did not request confidential communications or about the subscriber or others covered by the plan may contain sufficient information to reveal that you obtained healthcare for which we paid, even though you requested that we communicate with you about that health care in confidence. Consent/Authorization Except as described above or specifically required or permitted by law, Health Tradition will not use or disclose your protected information without a specific authorization from you or an appropriate legal representative. An authorization is your signed, written permission to release protected health information. You may be asked to sign the same authorization form periodically as required by state or federal law. If authorization is provided, it may be revoked in writing at any time. Written revocation of authorization must be submitted to Privacy Officer, Health Tradition Health Plan, PO Box 188, La Crosse, WI Once authorization is revoked, Health Tradition will no longer use or disclose Protected Health Information, except to the extent Health Tradition has already taken action in reasonable reliance on it. Complaints If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may complain to us using the contact information listed at the end of this notice. Complaints or concerns about Health Tradition s use or disclosure of Protected Health Information may be forwarded to Health Tradition. Submit complaints or concerns to Health Tradition in writing to: Privacy Officer, Health Tradition Health Plan PO Box 188 La Crosse, WI or toll-free A member will not be retaliated against specifically for filing a complaint about Health Tradition s privacy practices. Health Tradition reserves the right, however, to take necessary and appropriate action to maintain an environment that serves the best interests of its members and staff. If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services. We will provide you with the address to file your complaint with DHHS. For more information about any of Health Tradition s Privacy Practices, call: (608) or Customer Service (toll free) 35

38 36

39 Important Phone Numbers Health Tradition Member Advocate Monday Friday 8:00 am 4:30 pm or toll-free For questions on your health insurance benefits HMO Enrollment Specialist Monday Friday 7:00 am 6:00 pm Toll-free For questions on HMO enrollment HMO Ombuds Program Monday Friday 8:00 am 4:30 pm Toll-free For questions or concerns about your HMO Recipient Services Monday Friday 7:30 am 5:00 pm Toll-free For questions about BadgerCare Plus benefits, including dental services Important Information: $ Cut out and carry in your wallet My Primary Care Doctor: Telephone Number: My Dentist: Telephone Number: My Eye Doctor: Telephone Number: My Pharmacy: Telephone Number: My County Case Worker: Telephone Number: Customer Service (toll free) 37

40 1808 East Main Street / Onalaska, WI P.O. Box 188 / La Crosse, WI