Total Care Bulletin DECEMBER 2016 Welcome to the Magellan Complete Care Florida newsletter. Happy Holidays! As we enter into the holiday season, we would like to remind you of how important your health is. This is your newsletter from Magellan Complete Care. It has important information about your health plan and staying healthy. If you want a paper copy of anything you read you can call us at 1-800-327-8613, TTY: 1-800-424-1694. We hope you enjoy the newsletter. ATTENTION: Language assistance services, free of charge, are available to you. Call 1-800-327-8613 (TTY: 1-800-424-1694). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-327-8613 (TTY: 1-800-424-1694). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-800-327-8613 (TTY: 1-800-424-1694). Magellan Complete Care complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Magellan Complete Care is a Managed Care Plan with a Florida Medicaid contract. The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the Managed Care Plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. Magellan Complete Care PO BOX 4418 Lutherville, MD 21094-4418 MagellanCompletecareofFL.com
Protected Health Information (PHI) We have rules to keep your protected health information (PHI) safe. Magellan Complete Care follows the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This includes oral, written and electronic protected health information. Your member handbook explains what information is protected. We send the Notice of Privacy Practices within your new member package. We also send this out within 60 days of a major change to the notice. You can also visit our website under Protected Health Information to see our Notice of Privacy Practice Statement on MCCofFL.com. If you would like a paper copy of this or a new Member handbook you can call us at 1-800-327-8613, TTY: 1-800-424-1694. Women have easy access to preventive healthcare services Magellan Complete Care lets women have easy access to in-network women s health specialists for covered routine and preventive health care services. You do not need a referral from your primary care doctor for your yearly visit to an OB/GYN that is in the Magellan Complete Care network. A few preventive healthcare services: Services Age group How often Breast Cancer Screening Women ages 50 74 Every 3 years Cervical Cancer Screening Women ages 21 64 Every 3 years Cervical Cytology/ Human Papillomavirus (HPV) Co-testing Chlamydia Screening Ambulatory or Preventive Health Services Women ages 30 64 Women ages 16 24 who are sexually active Ages 20 and up Every 5 years Every year Every year If you have any questions, you can call us at 1-800-327-8613, TTY: 1-800-424-1694.
Your benefits and services You can find information about your benefits and medical services by going to MCCofFL.com and clicking on the My Plan drop down menu under the Members tab. You can also find benefit information in the Member Handbook. You can also call us at 1-800-327-8613, TTY: 1-800-424-1694. Access to care If Magellan Complete Care cannot give you a needed and covered service by a provider in our network, we will cover these services by an out-of-network provider in a timely manner. These out-of-network services will be covered as long as Magellan Complete Care does not have a provider in-network to give you the services. Second medical opinion Members have the right to a second medical opinion. If Magellan Complete Care cannot provide for a second opinion from an innetwork provider, arrangements can be made for a second opinion outside of the network. Please call our Health Services department at 1-800-327-8613, TTY: 1-800-424-1694 for prior authorization requests. New service Mother Baby Connections Incentive program Magellan Complete Care is proud to let you know that we began our Mother Baby Connections Incentive program earlier this year. As part of our Healthy Behaviors program, the Mother Baby Connections Incentive program was created to reward pregnant Magellan Complete Care members for taking care of their health during their pregnancy. The program will help members stay up to date with their prenatal and postnatal visits. This will help mother and baby have a healthy pregnancy and delivery. Program information at a glance: Target goal Enroll in the Mother Baby Connections Program Attend prenatal appointment during 1st Trimester or Attend a prenatal visit within 42 days of enrollment Attend all (100%) of needed prenatal visits Attend postpartum visit within 21 56 days of giving birth Reward $10.00 gift card $10.00 gift card $20.00 gift card $10.00 gift card
Success story Member testimonials Meet Mike Mike was dealing with many mental health problems, because he saw another inmate killed when he was in jail. His experience made him feel unsafe. He could not leave his room without feeling like he was in danger. Mike couldn t see a doctor to get the help that he needed because he couldn t sit in the waiting room for more than a few minutes. Mike had to get mental help by phone. The care manager worked closely with Mike and encouraged him to see a psychiatrist for help. The psychiatrist was able to work with him. Through therapy, Mike is finally able to get out of the house and enjoy life without feeling like he is in danger. Mike is now taking control of his life. He is also looking into going back to school. Mike is very grateful to all of the staff who helped him get the care that he needed to turn his life around. Disease management programs We have disease management programs that will help you care for your ongoing illness. Some of the programs we offer are: Asthma Hypertension Diabetes Cancer Your Member Handbook is a good tool for getting more information on what is included in the program. It also has information on how to opt in or out of the program. You can get a copy of the Member Handbook on our website by clicking on the Members tab and choosing View or Print Member Handbook under the Member Materials drop down menu. If you would like to enroll or find more information on the disease management programs, please visit MCCofFL.com. You can also call us toll free at 1-800-327-8613, TTY: 1-800-424-1694. Reminder!! Please remember to have your child visit their Primary Care Doctor for their scheduled immunizations, well visits, and health screenings. Please call your child s Primary Care Doctor to make an appointment.
How to contact the Utilization Management department As a member, you have the right to contact the Utilization Management department. The Utilization Management department is the team that makes decisions about things like medical needs for healthcare services and authorizations. For questions or concerns for the Utilization Management department, please call 1-800-327-8612, TTY: 1-800-424-1694. Get your flu shot Getting a yearly flu shot is the best tool on hand to avoid catching the flu. Millions of people have safely gotten flu shots. Tips to help you from getting sick: Get your flu shot Cover your nose and mouth with a tissue when you cough or sneeze. Do not touch your eyes, nose, and mouth. Wash your hands regularly with soap and water. Try not to get too close to people who are sick. Medicaid Fair Hearing/Subscriber Assistance Program If you do not agree with Magellan Complete Care s decision, you can ask for a Medicaid Fair Hearing or an independent review by the Subscriber Assistance Program (SAP). You do not need to go through the appeal process before you ask for a fair hearing. You can ask for a fair hearing by calling or writing. You can ask for a fair hearing any time up to 90 days after you get our decision on your appeal. You may ask for a fair hearing by calling 1-850-488-1429 or writing to: Mail: Department of Children and Families Office of Appeal Hearings Building 5, Room 255 1317 Winewood Boulevard Tallahassee, FL 32399-0700 Fax: 1-850-487-0662 Email: Appeal_hearings@dcf.state.fl.us Your provider can ask for a fair hearing for you, but you must give your written approval to the provider.
Need help getting to your doctor s appointments? Need help getting to the pharmacy? Magellan Complete Care works with a company called Logisticare for medical needs related transportation. Logisticare will pick you up and take you home. You can call them for all of your medical needs. You can call to reserve a ride. You can even bring one person with you like your caregiver or a family member. Make sure you call at least 3 days before you have to be at the doctor. Call 1-877-796-5843 to reserve a ride. Call 1-877-796-5844 if your ride is late. You can also contact our customer service number at 800-327-8613 or 800-424-1694 (TTY only) Monday Friday 8:00am 7:00pm Eastern Standard Time. We want to hear from you! Each year some of our Magellan Complete Care members are asked to rate their satisfaction with their doctors and with us. To do so, we ask you to complete the Consumer Assessment of Healthcare Providers and Systems (CAHPS ). By doing so, you tell us if you were able to find and see a primary care physician (PCP) and a specialist; how was the customer care that you received from provider and health plan; how well the care was coordinated; if you received flu shots; if you liked advice regarding quitting smoking and more. The results are used by the Centers for Medicare & Medicaid Services (CMS), Agency for Health Care Administration (AHCA), accreditation agencies, and Magellan Complete Care to know your satisfaction. Please help us by completing Consumer Assessment of Healthcare Providers and Systems (CAHPS ), if you are one of our chosen members and have received it in the mail. This will help us and your doctors to improve the quality of care you receive. If you have questions, please call us at 1-800-327-8613 or 1-800-424-1694 (TTY only). Looking for a provider? You can search for a provider by going to our website MCCofFL.com and click on Find A Provider tab. You can also call us and we can search for you. We can also send you a hard copy of the directory. Call 1-800-327-8613 or 1-800-424-1694 TTY. C-N1007 (11/16) 2016 Magellan Health, Inc.