Dependent Coverage Extended

www.qualchoice.com
Summer 2010
QCARE at Your Service
for Chronic Conditions
For members with a chronic
condition, such as diabetes,
hypertension, or asthma, we
offer QCARE. This program puts
our care managers and health
coaches at a member’s disposal.
They’ll work with you and your
physician to achieve better
health. The service includes:
nA
ssistance
from a care
manager at regular intervals
to discuss medication and
other health concerns
nA
ccess to a 24-hour Nurse
Line which includes an Audio
Library covering many health
related topics. Just call
1-866-232-0447.
Get started today! Our QCARE
health management program is
voluntary and available at no
additional cost to all plan
members. To participate in
QCARE, or to speak to a care
manager or health coach, please
contact us at 1-800-235-7111
ext. 7014 or 1-888-795-6810.
Find out about your health by
completing the online QCARE
Personal Health Appraisal.
Log in to the members’ site at
www.qualchoice.com.
Customer Service
Dependent Coverage Extended
QualChoice will take steps to prevent a gap in coverage that
could leave many young Arkansans uninsured.
In mid-May QualChoice announced that it
will take steps to prevent a gap in coverage
that could leave many young Arkansans
uninsured as a result of provisions in the
new health reform law. We’ll be extending
health coverage to individuals who would
historically no longer be eligible as dependents because of college graduation or age.
Under the new health care reform law,
the age for a child to stay on their parents’
employer-offered or individual health plan
is extended to age 26 for plan years beginning on or after September 23, 2010.
Beginning June 1, 2010, QualChoice will
work with its customers to eliminate the
coverage gap young Arkansans may face
before this health care reform
provision takes effect.
QualChoice president and CEO,
Mike Stock, said, “It has always been
our goal to provide Arkansans with
access to affordable, quality health
care. We want college graduates and
other dependents to be able to concentrate on finding employment in this
competitive environment and not
worry that they’ll lose their existing
coverage.”
Call Customer Service at 1-501-228-7111
or 1-800-235-7111 if you have any
coverage questions.
1-501-228-7111
1-800-235-7111 (toll-free)
Monday–Friday, 8 a.m. to 5 p.m.
INSIDE: Know Where to Go for Care \ Find Health Info Fast
Living Well
Watch for Provider
Fraud and Abuse
Arkansas’s Department of Health
and Human Services (DHHS) is
urging Arkansans to be mindful of
potential provider fraud and abuse.
This is in keeping with QualChoice’s
initiative to enhance fraud
prevention.
A recent article on fraud and
abuse published by Arkansas DHHS
found that health care fraud has
resulted in more than $10 billion in
added costs per year. The article,
which is available on DHHS’
website, www.arkansas.gov/dhs,
warns Arkansans to watch for:
n Billing for services not rendered
nBilling both the member or
multiple insurance carriers for
the same services
nBilling for services that are not
medically necessary
n Providing unnecessary services
nBilling for a more expensive item
when a less expensive item was
actually provided (upcoding)
nBilling related services
separately to charge a higher
amount than if they were
combined and billed as one
service (unbundling)
n Falsifying records
n Patient neglect or abuse
QualChoice monitors fraud, waste,
and abuse to protect our members
and providers. If you suspect fraud,
waste, or abuse, please e-mail us
at [email protected].
Where to Go for Immediate Care
Not sure where to go for an immediate
health problem or service? Here’s a
guide to help you decide.
At Home or Away
Your primary care doctor. Whenever
you have a health concern, contact your
primary care doctor first. It’s your least
expensive option. In addition, your doctor knows your health history and
keeps a record of it. He or she can
access it fast and save important time.
mergency rooms (ERs). When you
E
have a life-threatening medical situation—such as a stroke or heart attack—
call 911 or go to the nearest emergency
room facility. Emergency symptoms
may include:
n Chest pain
n Trouble breathing
n Poisoning
n B
leeding or vomiting that
won’t stop
n Major burns, cuts, or breaks
Know Before You Go
Please refer to your Evidence of
Coverage information for the full
definition of an emergency medical
condition. A medical emergency is
defined as a condition of recent onset
and sufficient severity, including
but not limited to, severe pain, that
would lead a person with average
knowledge of health and medicine to
expect the condition or illness, if
not treated immediately, to result in
serious harm to their health.
If your condition does not meet the
defined criteria, your treatment may
not be covered.
Join Today!
1-888-795-6810
www.qualchoice.com
Kick the Nic may not be available
under all plans. To see if your plan
participates, contact QualChoice.
Health in Your Hands
Understand
Your Benefits
For many people, the ins and outs of
their medical benefits aren’t important—until they have a reason to use
them. Here are some things to keep in
mind before you need your benefits:
Check the list of health care
providers for your plan. Is your
primary health care provider part of
the QualChoice network? If not, you
may need to switch to an in-network
provider to avoid higher costs.
Understand your costs. In addition
to the plan premium that you or your
employer pays, you may have additional
out-of-pocket costs such as a copayment at the time of service. The
amount may be different for office
visits, prescriptions, emergency care,
and hospital stays.
Our Website Tools Can Help You
To gain entry to your member site, go
to qualchoice.com, click on “login/
register” from the QuicAccess section
on the home page. If you have never
logged in as a member, you will need
to click the self-registration button.
Once logged in as a member, you
will be able to:
n Review your health plan benefits
n Order ID Cards
n Submit a change of address
n View your plan’s drug formulary
nReview your medical statements
and claims
n Compare drugs and their costs
nSearch for QualChoice
in-network providers
nReview
list of services requiring
pre-authorization
nRead QualChoice medical
policies
In our Diabetes Better Day Program, QualChoice
health coaches partner with you to find ways to
improve life with diabetes, and make changes that
are beneficial to you and that you can live with. Our
program provides support, education, counseling
and advocacy for our members living with diabetes.
In addition, this program will allow members (through mail
order only) to receive a 90 day supply of testing strips and
lancets for a lesser copayment.
As an additional incentive, a free bottle of sugar free
multi-vitamins is sent with every order.
Diabetes Better Day Program Offers You
a Special Supply Discount
1. Call QCARE at 1-888-795-6810 to enroll in the Diabetes
Better Day Program.
2. A QCARE health coach will work one on one with you to
assess the management of your diabetes.
3. You will be given access to an online workbook and other
educational tools.
4. If needed, regularly scheduled meetings with your health
coach will be arranged.
Members participating in the Diabetes Better Day
Program will be sent a welcome packet with ordering instructions and the option of choosing one of
the following blood glucose testing machines (to be
sent at no charge to the member):
n AccuChek Compact
nAccuChek Aviva
nTrue Result
How to Get Started
© 2010. All rights reserved.
No material may be reproduced in
whole or in part from this publication
without the express permission of
the publisher. Any reference in this
material to other organizations or
companies, including their Internet
sites, is not an endorsement or
warranty of the services, information,
or products provided by those
organizations or companies.
All models are used for illustrative
purposes only.
The QualChoice Building
12615 Chenal Parkway, Suite 300
Little Rock, AR 72211
PRSRT STD
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Long Prairie, MN
563M
Get The Right Care
Important Reminder:
Services Requiring Prior
Authorization
Find Health Info Fast!
Get 24-hour-a-day access to top-notch
health information by logging on to
www.qualchoice.com and clicking
“Health & Medical Education.” You’ll
have access to our Web portal with
more than 5,000 articles on health and
medication.
HealthSheets™
You can search from A to Z in the
HealthSheets section. It covers
diseases, conditions, diagnoses, treatments, surgery, procedures, and more.
This library is full of evidence-based,
medically-reviewed articles for people
of all ages and walks of life.
Medications Library
The comprehensive Medications
section has information on 33,000
prescriptions, over-the-counter
products, and vitamins. You’ll find
answers to questions such as “What
may interact with this medicine?” and
“What side effects may I notice when I
take this medicine?”
At QualChoice, we realize sometimes
questions slip your mind when dealing
with your healthcare professionals.
That is why it’s important to us that you
can find health answers 24 hours a day.
It is our commitment at QualChoice to
make sure you get the care you need,
the answers you deserve, and the
resources to make it happen.
Get 24-hour assistance! Call
our Nurse Advice Line 24/7
at 1-866-232-0447.
QualChoice provides benefits for
certain services, drugs and supplies only when prior authorization
is received. As the pre-authorization list may change, a current list
is always available to members by
logging into the members’ site at
qualchoice.com. Examples of
services requiring prior
authorization include:
nAll admissions to an inpatient
facility or partial hospital unit
nAny referral to an out-ofnetwork provider
nOB Ultrasounds after the first
one during the term of pregnancy
nHome Healthcare, Home
Infusion Services or Hospice
(Inpatient or Outpatient)
nMental Health or Substance
Abuse Services (beyond the
initial visit)
nTransplant Services (Inpatient
or Outpatient)
nAdvanced Imaging (when
performed on an outpatient
basis)
nSpecialty Medications