PHF Member Handbook - Parkland Community Health Plan, Inc.

A WELCOME TO OUR PARKLAND HEALTHfirst STAR Members!!
Dear Parkland HEALTHfirst Member:
Parkland HEALTHfirst is a plan that makes it easier for you to get good medical care. With
Parkland HEALTHfirst you will get all the Medicaid benefits you have now – and more. You will
also be able to pick a doctor or health care provider from a list of doctors and health care providers
close to where you live. The doctor or health care provider you pick will be your Parkland
HEALTHfirst Primary Care Provider (PCP) and will help you take care of all your healthcare
needs.
If you, or your child, have a behavioral health emergency and need behavioral health treatment, go
to the nearest Emergency Room or call toll-free at 1-888-800-6799 and someone will help you get
care right away. You or someone on your behalf will need to call the behavioral health provider
line at 1-888-800-6799 and let them know you had an emergency.
Here are a few important things you will need to do to help us give you the best care:
Your PCP’s name will appear on your Parkland HEALTHfirst ID Card. Check your ID card to
make sure the information is correct.
Make an appointment with your PCP soon to get to know your doctor.
When you call your PCP for appointments, tell them you are a Parkland HEALTHfirst member.
Call your PCP when you need care.
Follow your PCP’s advice.
Always carry your Parkland HEALTHfirst ID card and Medicaid Form 3087
Use the hospital Emergency Room (ER) only for emergencies.
As a member of Parkland HEALTHfirst Health Plan you can ask for and receive the following
information each year:
Names, locations, telephone numbers, languages spoken (other than English) by network
providers, and identification of providers who are not accepting new patients. The information
provided will be, at a minimum, information on primary care physicians, specialists, and
hospitals in the Dallas Service Area (Collin, Dallas, Ellis, Hunt, Kaufman, Navarro, and
Rockwall counties).
Any restrictions on the member’s freedom of choice among network providers
Member rights and protections
Information on complaint, appeal and fair hearing procedures
The amount, duration, and scope of benefits available under the contract in sufficient detail to
ensure that members understand the benefits to which they are entitled
How to get benefits including authorization requirements
How members may get benefits, including family planning services, from out-of-network
providers, and/or limits to those benefits
How after hours and emergency coverage are provided and/or limits to those benefits,
including:
093-MH-050509
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