MEMBER HANDBOOK - BMC HealthNet Plan
MEMBER HANDBOOK - BMC HealthNet Plan
MEMBER HANDBOOK - BMC HealthNet Plan
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TABLE OF CONTENTS<br />
When Prior Authorization is needed for other services................................................... 6<br />
Timeframes for Prior Authorization Decisions ................................................................ 6<br />
Receiving care from Providers outside of the <strong>BMC</strong> <strong>HealthNet</strong> <strong>Plan</strong> Network ................ 6<br />
Coverage if you change plans .........................................................................................7<br />
If you get a bill for Covered Services .............................................................................. 7<br />
Extras “free” for our Members ........................................................................................8<br />
Process to evaluate new technology ..............................................................................8<br />
Section 5. Your Primary Care Provider (PCP) ............................................................ 8<br />
Primary Care Provider (PCP) ...........................................................................................8<br />
Picking a PCP ................................................................................................................. 8<br />
Providers who are PCPs ................................................................................................. 8<br />
Call your PCP for an appointment .................................................................................. 9<br />
Call your PCP first when you’re sick – unless you think it’s an Emergency ....................9<br />
Changing your PCP ........................................................................................................ 9<br />
Getting a Second Opinion ...............................................................................................9<br />
Section 6. Your Health Care ..................................................................................... 9<br />
Emergencies and Urgent Care ........................................................................................9<br />
Behavioral Health care .................................................................................................. 10<br />
Health Risk Assessment ................................................................................................11<br />
How long it should take to get care ..............................................................................11<br />
Children in the care or custody of the<br />
Department of Children and Families (DCF)...................................................................12<br />
Utilization Management .................................................................................................12<br />
Quality Improvement Program........................................................................................12<br />
Clinical Practice Guidelines ...........................................................................................12<br />
Transportation assistance ..............................................................................................12<br />
Staying healthy ..............................................................................................................13<br />
Prescription medication coverage .................................................................................13<br />
If you can’t pay the Co-payment ...................................................................................14<br />
Mail order pharmacy program .......................................................................................14<br />
Pharmacy programs ......................................................................................................14<br />
Medicare part D .............................................................................................................15<br />
<strong>BMC</strong> <strong>HealthNet</strong> <strong>Plan</strong> Member Services Department<br />
8:00 a.m. – 6:00 p.m., (Eastern Time) Monday-Friday 1.888.566.0010 (English and other languages) • 1.888.566.0012<br />
(en Español) • 1.866.765.0055 (TTY/TDD for hearing impaired) • 1.800.421.1220 (relay operator for hearing impaired) •<br />
1.888.217.3501 (Behavioral Health: mental health and substance abuse questions 24 hours a day/7 days a week managed by<br />
Beacon Health Strategies) • 1.888.727.9441 (Behavioral Health TTY/TDD for hearing impaired) • 1.800.973.6273 (Nurse Advice<br />
Line) • Web Site www.bmchp.org • www.beaconhealthstrategies.org (Behavioral health)<br />
MassHealth Customer Service<br />
8:00 a.m. – 5:00 p.m., Monday-Friday<br />
1.800.841.2900 • 1.800.497.4648 (TTY/TDD for hearing impaired)
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