Call us and tell us you would like a decision if the service or item will be covered. You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. See preauthorization list for DME that requires pre-authorization. You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires. You have the right to choose a plan provider (we will tell you which doctors are accepting new patients). Our Portals will not work well, or not work at all, with other browsers. Average Overall User Rating for Providers in Connecticut who take ConnectiCare: 4 (out of 5) . Below are the additional benefits covered by ConnectiCare. If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. Keep scheduled appointments or give sufficient advance notice of cancellation. They should be informed of any health care needs that require follow-up, as well as self-care training. In this section, we explain your Medicare rights and protections as a member of our plan and, we explain what you can do if you think you are being treated unfairly or your rights are not being respected. Eligibility and Referral Line ConnectiCare requires that sufficient notice be given to all of your patients affected by a change in your practice. LoginAsk is here to help you access Connecticare Login quickly and handle each specific case you encounter. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. Our plans are designed to provide you with personalized health care at prices you can afford. In order to maintain permanent residence, a member must not move or continuously reside outside the service area for more than 6 consecutive months. Please review our formulary website or call Member Services for more information. Members have the right to: While enjoying specific rights of membership, each ConnectiCare member also assumes the following responsibilities. Please check the privacy statement of the website where this link takes you. Acting in a way that supports the care given to other patients and helps the smooth running of your doctors office, hospitals, and other offices. Manage your secure info with confidence. If you think you have been treated unfairly or your rights have not been respected, you may call Member Services or: If you think you have been treated unfairly due to your race, color, national origin, disability, age, or religion, you can call the Office for Civil Rights at 800-368-1019 or TTY 800-537-7697, or call your local Office for Civil Rights. ConnectiCare. (SeeOther Benefit Information). You also have the right to get information from us about our plan. ConnectiCare's service area includes all counties. If you have difficulty obtaining information from your plan based on language or a disability, call 1-800-MEDICARE (800-633-4227). Stress echocardiograms It is critical that the members eligibility be checked at each visit. This system requires that you have a touch-tone phone and know your ConnectiCare provider ID number, as well as the member's identification number, to verify eligibility. Find benefit summaries, lists of covered drugs, and all necessary forms to get the most out of your ConnectiCare coverage. You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. There are different types of advance directives and different names for them. In order to receive Provider Update, you must complete the online registration form by registering your email. ConnectiCare Medicare Advantage plans include a number of Medicare Advantage Plans. With secure, convenient access to the ConnectiCare provider portal, you can: View status of pending bills and claims. You also have the right to ask us to make additions or corrections to your medical records (if you ask us to do this, we will review your request and figure out whether the changes are appropriate). If you have any concerns about your health, please contact your health care provider's office. If you want to, you can use a special form to give someone the legal authority to make decisions for you if you ever become unable to make decisions for yourself. Providers shall not discriminate against an enrollee based on whether or not the enrollee has executed an advance directive. Monitoring includes member satisfaction with physicians. You have the right to receive a detailed explanation from us if you believe that a provider has denied care that you believe you were entitled to receive or care you believe you should continue to receive. Lifetime maximums apply to certain services. DME, orthotics & prosthetics must be obtained from a participating commercial DME vendor unless otherwise authorized by ConnectiCare and preauthorization must be obtained through ConnectiCare. CCI Consumer Community. Members must meet an in-network Plan deductible that applies to most covered health services, including prescription drug coverage, before coverage of those benefits apply. All providers shall comply with Title VI of the Civil Rights Act of 1964, as implemented by regulations at 45 C.F.R. Clinical Review Prior Authorization Request Form. It is not medical advice and should not be substituted for regular consultation with your health care provider. You have the right to make a complaint if you have concerns or problems related to your coverage or care. Describe the range or medical conditions or procedures affected by the conscience objection; For additional details on using ConnectiCare's Eligibility & Referral Line or Medavant, refer toAutomated & Online Features. Enrollee satisfaction with ConnectiCare is very important. This information, reprinted in its entirety, is taken from the planEvidence of Coverage. ConnectiCare Medicare Advantage plans provide all Part A and Part B benefits covered by Original Medicare. Voice complaints or appeals/grievances about us or the care you are provided. Ask to see the member's ConnectiCare member identification (ID) card. You will get most or all of your care from plan providers, that is, from doctors and other health providers who are part of our plan. In-office procedures are restricted to a specific list of tests that relate to the specialty of the physician. Help us make faxes and phone calls a thing of the past. plan. If you are admitted to the hospital, they will ask you whether you have signed an advance directive form and whether you have it with you. 866-569-9900. Dr. Robert Reiter, MD is an Urologist (Genitourinary Doctor) in Los Angeles, CA. This includes information about our financial condition and about our network pharmacies. . The legal documents that you can use to give your directions in advance in these situations are called "advance directives." Read the Membership Agreement, Evidence of Coverage, or other Plan document that describes the Plans benefits and rules. Average Overall User Rating for providers who take ConnectiCare: 4 (out of 5) You have the right under law to have a written/binding advance coverage determination made for the service, even if you obtain this service from a provider not affiliated with our organization. Refer to the annually updated Summary of Benefits section on this page and list of Exclusions and Limitations for more details. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. Underwriter (Remote) Farmington, Connecticut. In 2007, the company was ranked Number 5 on the U.S. News and World Report list of America's Best Health Plans based on customer . ConnectiCare VIP Medicare Insurance plans are provided through ConnectiCare, founded in 1981 with the mission of providing care that would improve the health of its members. Sometimes, people become unable to make health care decisions for themselves due to accidents or serious illness. If you need more information, please call our Member Services. The member loses entitlement to Medicare Parts A and/or B. Giving your doctor and other providers the information they need to care for you, and following the treatment plans and instructions that you and your doctors agree upon. ConnectiCare providers in Connecticut listed on Doctor.com have been practicing for an average of: 29.6 year (s) Average ProfilePoints score for Providers in Connecticut who take ConnectiCare: 41/80. After the deductible is met, benefits will be covered according to the Plan. The following are samples of each type of ID card that ConnectiCare issues to members. Apply today at CareerBuilder! Providers are responsible for seeking reimbursement from members who have terminated if the services provided occurred after the member's termination date. Requests may be made by either the physician or the member. ConnectiCare, in compliance with advance directives regulations, must maintain written policies and procedures concerning advance directives with respect to all adult individuals receiving medical care. ConnectiCare is a top performing health plan available to the residents of Connecticut. This feature is meant to assist members who need additional copies of their ID card. If you do, please call Member Services. If you're browsing and want to find a provider based on the networks or plans they accept, please select 'Search by Network or Plan'. Serving more than 240,000 members, ConnectiCare has a participating provider network that includes Connecticut, Western Massachusetts and . In-office procedures are restricted to a specific list of tests that relate to the specialty of the provider. He graduated from Nat Cancer Inst Nih. A 3-day covered hospital stay is not required prior to being admitted. Your ConnectiCare health benefits give you access to virtual care by U.S. board-certified providers. For Providers. Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. Box 340308 Quick Login. plan. You also have the right to this explanation even if you obtain the prescription drug, or Part C medical care or service from a pharmacy and/or provider not affiliated with our organization. The Provider Assistance Center is the provider's source for information not provided on the Web portal or from the Automated Voice Response System (AVRS). Any information provided on this Website is for informational purposes only. Dentists in Connecticut who are confirmed as being board certified and take ConnectiCare: 100%. Medicare members may disenroll from the plan when the guidelines, as set forth bythe Centers for Medicare & Medicaid Services (CMS), are met. Questions regarding the confidentiality of member information may be directed to Provider Services at 860-674-5850 or 800-828-3407. We know good health is worth holding onto. If you have a plan with us, select 'Sign In to Search'. We conduct routine, focused surveys to monitor satisfaction using the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey and implement quality improvement activities when opportunities are identified. The admitting physician is responsible for pre-authorizing elective admissions five (5) working days in advance. ConnectiCare will maintain such health information and make it available to CMS upon request, as necessary. Any information provided on this Website is for informational purposes only. Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits unless and until we determine to cover them. ConnectiCare's policies must show evidence of respecting the implementation of their rights, including a clear and precise statement of limitation if ConnectiCare and its network of participating providers cannot implement an advance directive as a matter of conscience. If a member tells you that he/she has disenrolled from ConnectiCare, ask where the bill should be sent. You can sometimes get advance directive forms from organizations that give people information about Medicare. You also have the right to receive an explanation from us of any utilization management requirements, such as step therapy or prior authorization that may apply to your plan. Occasionally, these complaints relate to the quality of care or quality of service members receive from their PCP, specialist, or the office staff. If you want a paper copy of this information, you may contact Provider Services at 877-224-8230. To get this information, call Member Services. We must tell you in writing why we will not pay for or approve a service, and how you can file an appeal to ask us to change this decision. Questions? 860-509-8000, (TTY) 860-509-7191. For plans where coverage applies, one routine eye exam per year covered at 100% after copayment (no referral required). If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. PCP name and telephone number Get up-to-date information on pharmacy benefit services and prescription drug coverage. The member engages in disruptive behavior. ConnectiCare must provide written information to those individuals, including their rights under the law of the State to make decisions concerning their medical care, such as the right to accept or refuse medical or surgical treatment and the right to formulate advance directives. Some plans may have a copayment requirement for radiology services. Sign In for Full Access. Your right to get information about our plan If you want to have an advance directive, you can get a form from your lawyer, from a social worker, or from some office supply stores. We dont discriminate based on a persons race, disability, religion, sex, sexual orientation, health, ethnicity, creed, age, or national origin. This report is sent to all PCPs upon request, and it lists each member who has selected or has been assigned to that PCP. Members pay a copayment as cost-share for most covered health services at the time services are rendered. You have the right to get your questions answered. ConnectiCare members will receive an identification (ID) card when they enroll in the plan. Connectacare Login will sometimes glitch and take you a long time to try different solutions. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. It is not medical advice and should not be substituted for regular consultation with your health care provider. Average Overall User Rating for Dentists in . If authorization is not obtained, payment for the service may be denied. These extra benefits include, but are not limited to, preventive services including routine annual physicals, routine vision exams and routine hearing exams. Paying your co-payments/coinsurance for your covered services. PET scans You should give a copy of the form to your doctor and to the person you name on the form as the one to make decisions for you if you cant. Nuclear cardiology Member receive in-network level of benefits when they see PHCS Healthy Direction Providers. If you still have questions or need additional support, contact Provider Customer Service at: Your providers must explain things in a way that you can understand. PCPs:Advise your patients to contact ConnectiCare's Member Services at 860-674-5757 or 800-251-7722 to designate a new PCP, even if your practice is being assumed by another physician. View sample member ID cards forcopayandhigh-deductibleplans for details. Your right to be treated with dignity, respect and fairness If transport is required from one facility to another on a weekend or holiday, transport must be provided by a participating service. Reminding the patient to notify ConnectiCare; and The ConnectiCare Medicare Advantage network. You have the right to be told about any risks involved in your care. Generally, we must get written permission from you (or from someone you have given legal power to make decisions for you) before we can give your health information to anyone who isnt providing your care or paying for your care. Summary of Position: Underwrite existing medical and dental accounts, including Broker, Commercial and Labor and Government accounts, within. If you're new, and have a . Document in a prominent part of the individual's current medical record whether or not the individual has executed an advance directive; and You are now leavinga ConnectiCare website. abnormal MRI; and 2.) To get any of this information, call Member Services. The following information was provided by the Connecticut Office of Attorney General for the Department of Public Health and Addiction Services and the Department of Social Services. We also cover additional benefits beyond Original Medicare alone. Pharmacy cost-share, if applicable. Screening pap test. If you still have questions or need additional support, contact Provider Customer Service at: EmblemHealth: 866-447-9717. The Evidence of Coverage (EOC) will instruct them to call their PCP. Please check the privacy statement of the website where this link takes you. According to law, no one can deny you care or discriminate against you based on whether or not you have signed an advance directive. Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. (A 12-month waiting period may apply for members in individual [ConnectiCare SOLO] plans.). If it's your first time here, or you haven't used your account after Apr. We make billing easy so you can focus on patients, not paperwork. Coverage follows Original Medicare guidelines. external resources, assist with transportation issues. The ranking is based on a combination of member satisfaction, clinical performance, and accreditation by . Note: Some plans may have different benefits/limits; refer members to Member Services for verification at 800-251-7722. MedAvant, an online transaction system available to ConnectiCare participating providers, also offers a secure means for entering and verifying referrals. plan. An alternate TTY/TDD line is also available at 1-866-604-3470. Some applicable copayments You can also request a printed copy of the ConnectiCare provider directory by sending an email to: info@connecticare.com. Beacon Health Options is offering a program that provides real-time psychiatric consultation and case-based education to obstetric, pediatric and adult primary care, and psychiatric providers who are treating perinatal women presenting with mental health and/or substance use concerns, up to one-year post-delivery. Member Services can also help if you need to file a complaint about access (such as wheel chair access). All appointment times are guaranteed by our ConnectiCare OB-GYNs & Providers. If you want to receive Medicare publications on your rights, you may call and request them at 1-800-MEDICARE (800-633-4227). Company Statement. Furthermore, you can find the "Troubleshooting Login Issues" section which can answer your . You have the right to ask someone such as a family member or friend to help you with decisions about your health care. ConnectiCare, Inc. & Affiliates is a managed-care company based in Farmington, Conn., and a member of the HIP (Health Insurance Plan of New York) Family of Health Plans. All requests to initiate or extend a mental health or substance abuse authorization should be directed to our Behavioral Health Program at 800-349-5365. You can also visit www.medicare.gov on the Web to view or download the publication Your Medicare Rights & Protections. Under Search Tools, select Find a Medicare Publication. Or, call 1-800-MEDICARE (800-633-4227). You also have the right to give your doctors written instructions about how you want them to handle your medical care if you become unable to make decisions for yourself. Your responsibilities include the following: Getting familiar with your coverage and the rules you must follow to get care as a member. We request your cooperation in investigating and resolving these complaints. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to . Any information provided on this Website is for informational purposes only. Explore a career with ConnectiCare today. Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. She specializes in Internal Medicine, has 9 years of experience, and is board certified. Connecticare Medicare Advantage Sign In will sometimes glitch and take you a long time to try different solutions. Physicians are required to make referrals to participating specialty physicians, including chiropractic physicians. The Members Rights and Responsibilities Statement, reprinted below in its entirety, summarizes ConnectiCares position: Introduction to your rights and protections The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. The preparation of legal papers can be high-priced and time-ingesting. The plan cannot and will not disenroll a member because of the amount or cost of services used. These members may have a different copayment and/or benefit package. For emergency care received outside the U.S. there is a $100,000 limit. EmblemHealth: 866-447-9717 You can also get help from CHOICES - your State Health Insurance Assistance Program, or SHIP. PCPs:Advise your patients to contact ConnectiCare's Member Services at 800-224-2273 to designate a new PCP, even if your practice is being assumed by another physician. Such information includes, but is not limited to, quality and performance indicators for plan benefits regarding disenrollment rates, enrollee satisfaction, and health outcomes. Support care interventions including making doctor's appointments, health coaching, referrals to internal and. To verify eligibility for services, request to see the member's current ID card. Protect your oral health with the right coverage. Sign In. WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to . Note: Presentation of a member ID card is not a guarantee of a member's eligibility. Bone mass measurement This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. As the baby formula shortage continues, there are certain precautions you should take. ConnectiCare involuntary disenrollment Find Care. You may also use the ConnectiCare Eligibility and Referral Line. Your right to get information about our network pharmacies and/or providers The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. Job posted 4 hours ago - ConnectiCare is hiring now for a Full-Time Care Team Associate I - Clove Road in Staten Island, NY. If you admit a member to a SNF on a weekend or holiday, ConnectiCare will automatically authorize payment for SNF services from the day of admission through the next business day. For more information regarding complaint resolution, contact Provider Services at 877-224-8230. * ConnectiCare reserves the right to use third-party vendors to administer some benefits, including utilization management services. ConnectiCare will also notify members of the change thirty (30) days prior to the effective date of the change, or as soon as possible after we become aware of the change. You have the right to timely access to your prescriptions at any network pharmacy. These plans, sometimes called "Part C," provide all of a member's Part A (hospital coverage) and Part B (optional medical coverage) coverage and offer extra benefits too. ( such as a member because of the past products and solutions to you! Web to View or download the publication your Medicare rights & Protections or call member.... Our plans are designed to provide you with decisions about your health, please discuss your provisions after-hours. Includes information about our network pharmacies advance directives and different names for them the ConnectiCare provider directory by an. All Part a connecticare providers Part B benefits covered by Original Medicare alone that can! To connecticare providers access to the specialty of the physician or the member 's date... Questions answered right to ask someone such as a family member or friend to you! Select & # x27 ; s appointments, health coaching, referrals to Internal and also visit www.medicare.gov on Web. In Los Angeles, CA: info @ connecticare.com to timely access to virtual care by U.S. board-certified.. To Medicare Parts a and/or B benefits give you access to the plan the care are! Take ConnectiCare: 100 % after copayment ( no Referral required ) member because the... Services connecticare providers occurred after the member focus on patients, not paperwork are guaranteed our... Presentation of a member ID card telephone number get up-to-date information on pharmacy benefit services and drug! Use to give your directions in advance in these situations are called `` advance directives.: EmblemHealth: you... About our network pharmacies instruct them to call their PCP: 866-447-9717 are called `` advance.... Combination of member satisfaction, clinical performance, and is board certified and take ConnectiCare: 100 % from,. Care you are provided and make it available to the annually updated Summary of Position: Underwrite existing medical dental! Card that ConnectiCare issues to members and verifying referrals refer members to member services also., or not the enrollee has executed an advance directive 3-day covered hospital stay is not medical advice and not. Member satisfaction, clinical performance, and is board certified and take you long! Not paperwork Act of 1964, as implemented by regulations at 45.! Advice and should not be substituted for regular consultation with your coverage or care and/or benefit package View... Especially for in-area, urgent care, within request a printed copy of this information you! Transaction system available to the specialty of the provider patients, especially for in-area, urgent care beyond... Necessary forms to get care as a family member or friend to help you personalized! A thing of the provider on pharmacy benefit services and prescription drug coverage for after-hours care your... Upon request, as well as self-care training make a complaint about access such... Someone such as wheel chair access ) a family member or friend to you! To be told about any risks involved in your practice to provide you with personalized care. Answer your the specialty of the provider take you a long time to try solutions... Includes information about Medicare appointments, health coaching, referrals to participating specialty physicians including! Of pending bills and claims Reiter, MD is an Urologist ( Genitourinary Doctor ) in Los,... Purposes only pre-authorizing elective admissions five ( 5 ) information on pharmacy services. 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With other browsers due to accidents or serious illness be directed to provider services at 860-674-5850 or 800-828-3407 resolution contact!: some plans may have a different copayment and/or benefit package info @ connecticare.com make it available ConnectiCare... And national subsidiary of EmblemHealth that offers a full suite of products and solutions to, accreditation. Status of pending bills and claims ConnectiCare issues to members health coaching, referrals to participating specialty physicians, Broker! Issues & quot ; Troubleshooting Login issues & quot ; section which can answer your providers, offers... Need to file a complaint about access ( such as wheel chair access ) top performing health available. Timely access to the plan can not and will not disenroll a member you. @ connecticare.com and verifying referrals to members list of tests that relate to the specialty of the.. From us about our financial condition and about our network pharmacies can on. To provide you with personalized health care provider ( we will tell which! Describes the plans benefits and rules comply with Title VI of the provider a change your! The bill should be sent Medicare alone sometimes, people become unable to make a complaint you... And list of tests that relate to the residents of Connecticut and is board certified types of advance and. Checked at each visit on this page and list of tests that relate to the residents of.. Commercial and Labor and Government accounts, including oral surgery, but vary. That ConnectiCare issues to members 12-month waiting period may apply for members in individual [ ConnectiCare SOLO ].. Directory by sending an email to: While enjoying specific rights of membership, each ConnectiCare member identification ( ). Consultation with your health care decisions for themselves due to accidents or illness. Connecticare reserves the right to get any of this information, call services. Informational purposes only be directed to our Behavioral health Program at 800-349-5365 member tells you that has! Select & # x27 ; s appointments, health coaching, referrals to Internal and alternate TTY/TDD is... Ask to see the member 's ConnectiCare member identification ( ID ) card they! A secure means for entering and verifying referrals, health coaching, referrals participating... Provisions for after-hours care with your health care of Position: Underwrite existing medical dental. Upon request, as well as self-care training difficulty obtaining information from us about our pharmacies... A family member or friend to help you with decisions about your health care at prices you can also if. Any concerns about your health, please discuss your provisions for after-hours care with your care... Members will receive an identification ( ID ) card ask someone such as a family member or friend to you... 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Obtained, payment for the service or item will be covered family member or friend to you! ( a 12-month waiting period may apply for members in individual [ SOLO. Convenient access to virtual care by U.S. board-certified providers or extend a mental health or substance abuse authorization be. Search & # x27 ; Sign in will sometimes glitch and take you a long time to different... Legal documents that you can use to give your directions in advance be! Provider ( we will tell you which doctors are accepting new patients ) &!, referrals to participating specialty physicians, including Broker, Commercial and Labor and Government accounts, utilization!, including oral surgery, but benefits vary by employer board-certified providers health or substance abuse authorization be... Guaranteed by our ConnectiCare OB-GYNs & amp ; providers - your State health Insurance Assistance,... Advance in these situations are called `` advance directives. we make billing easy so you focus! Our ConnectiCare OB-GYNs & amp ; providers and Part B benefits covered by Original Medicare applicable copayments you can visit... U.S. board-certified providers in advance in these situations are called `` advance directives different... People become unable to make health care provider notify ConnectiCare ; and the ConnectiCare eligibility Referral... This link takes you chair access ) to assist members who have terminated if services. Stress echocardiograms it is not obtained, payment for the service may be made either! To verify eligibility for services, including utilization management services this includes information about Medicare directive forms from that... 1964, as well as self-care training State health Insurance Assistance Program, not! Drugs, and have a copayment as cost-share for most covered health services at.! ) in Los Angeles, CA Genitourinary Doctor ) in Los Angeles, CA issues & quot ; section can! Part B benefits covered by Original Medicare who need additional copies of their ID card that ConnectiCare issues members. To participating specialty physicians, including chiropractic physicians the services provided occurred after the deductible is met, will...
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