As a Member of Community Health Choice, you can ask for and get the following information each year:
- Information about network Providers – at a minimum primary care doctors, specialists, and hospitals in our service area. This information will include names, addresses, telephone numbers, and languages spoken (other than English) for each network provider, plus identification of Providers who are not accepting new patients.
- Any limits on your freedom of choice among network Providers.
- Your rights and responsibilities.
- Information on complaint, appeal, and fair hearing procedures.
- Information about benefits available under the Medicaid program, including amount, duration, and scope of benefits. This is designed to make sure you understand the benefits to which you are entitled.
- How you get benefits, including authorization requirements.
- How you get benefits, including family planning services, from out-of-network Providers and limits
to those benefits. - How you get after hours and emergency coverage and limits to those kinds of benefits, including:
- What makes up emergency medical conditions, emergency services, and post-stabilization services.
- The fact that you do not need prior authorization from your Primary Care Provider for emergency care services.
- How to get emergency services, including instructions on how to use the 9-1-1 telephone system or its local equivalent.
- The addresses of any places where Providers and hospitals furnish emergency services covered by Medicaid.
- A statement saying you have a right to use any hospital or other settings for emergency care.
- Post-stabilization rules.
- Policy on referrals for specialty care and for other benefits you cannot get through your Primary Care Provider.
- Community Health Choice’s practice guidelines.
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