It's Your Choice 2013 - Decision Guide (ET-2128d-13) - ETF

MercyCare Health Plans
(800) 895-2421
mercycarehealthplans.com
What’s New for 2013
MercyCare’s network has expanded to
include a new emergency care facility at
Mercy Clinic North in Janesville. Holding your
place in line at a Mercy emergency room or
urgent care is easy. Choose the facility you
want, select a projected treatment time, fill
out a form, then relax from the comfort of
your home until it’s time to go. This is a FREE
service provided by Mercy Health System.
Visit the mercyinquicker.org website.
Provider Directory
Go to mercycarehealthplans.com, click
on State of Wisconsin Members, click on
Provider Directory.
Referrals and Prior Authorizations
You have open access to your primary
care provider. A referral from your primary
care provider is required to see a specialist
in MercyCare’s network. If the care is not
available in MercyCare’s network, your
primary care physician must request a prior
authorization from MercyCare. MercyCare
will notify you in writing if authorization is
approved or denied. Prior authorization
is also required for specific services. If you
have questions, contact customer service at
(800) 895-2421.
Care Outside Service
Area
If you require
emergency care, you
should seek care from
the nearest physician,
hospital or clinic.
Contact customer
service at (800) 895-2421
for all emergency or
out-of-state inpatient
admissions within 48
hours or as soon as
reasonably possible.
Overall Quality Rating
See Report Card section
MERCYCARE (MC)
Qualified Plan
Non-Qualified Plan
See Glossary for definitions
Mental and Behavioral Health Services
Mental health and substance abuse
services must be obtained from a provider
in MercyCare’s network. Outpatient visits do
not require prior authorization. Inpatient and
transitional care require prior authorization.
Contact customer service at (800) 895-2421
with any questions.
Dental Benefits
No routine dental coverage provided.
Health Risk Assessment Information for Enrolled Members at:
mercycarehealthplans.com, go to “Members,” then “Health Risk Assessment”
Decision Guide Page 45