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Welcome to the <strong>GBUAHN</strong> Health Home!<br />
We are proud and honored to serve you. Our dedicated team<br />
of professionals is committed to providing Medicaid patients<br />
in Western New York with improved, more efficient, and more<br />
coordinated care.<br />
This ember andbook was designed to introduce you to<br />
<strong>GBUAHN</strong> and provide you with helpful information for many of<br />
your health care and social service questions.<br />
Please use this guide as a first step. If more questions arise or<br />
anything is unclear, please contact our office at (716) 247-5282 and<br />
your care team will be happy to assist you further. Please keep<br />
your ember andbook in a safe place for your reference.<br />
Thank you for choosing <strong>GBUAHN</strong> Health Home as your care<br />
coordination team. We are glad to have you and strive to serve you<br />
well. Your care matters to us!<br />
Sincerely,<br />
The <strong>GBUAHN</strong> Health Home Team<br />
Main Office<br />
564 Niagara Street<br />
Building 2<br />
Buffalo, NY 14201<br />
Phone: (716) 247-5282<br />
Toll-Free: 1-855-4<strong>GBUAHN</strong><br />
Fax: (716) 332-0075<br />
Website: <br />
Please see the back cover for more office locations.<br />
1
WHAT IS <strong>GBUAHN</strong>?<br />
The Greater Buffalo United Accountable Healthcare Network<br />
(<strong>GBUAHN</strong>) is designed to be a person-centered system of care<br />
that facilitates access to and coordinates health services, mental<br />
health services, and community based services to improve care for<br />
Medicaid patients in Western New York.<br />
<strong>GBUAHN</strong> is a lead Health Home with over 140 physician members<br />
in Western New York.<br />
OUR MISSION<br />
To remove barriers created by social determinants of health in<br />
underserved communities.<br />
OUR VISION<br />
To become the Health Home of choice for our chosen marketplace.<br />
HOW TO USE THIS HANDBOOK<br />
This handbook will help you when you join <strong>GBUAHN</strong> Health<br />
Home. It will tell you how you can get the most from your<br />
membership with <strong>GBUAHN</strong>. This handbook is your guide to health<br />
services. It tells you the steps to take to make the health home work<br />
for you.<br />
Part II of the <strong>GBUAHN</strong> Member <strong>Handbook</strong> shares with you what<br />
you need to know right away and what you can expect next. The<br />
rest of the handbook has helpful information for use when and if<br />
you need it.<br />
When you have a question, check this handbook or call ember<br />
ervices. You can also call your ealth avigator.<br />
2
PART 1<br />
HIPAA<br />
NOTICE OF<br />
PRIVACY<br />
PRACTICES<br />
“Guidance when YOU need it most.”
HIPAA NOTICE OF PRIVACY<br />
PRACTICES<br />
We value your privacy. This policy explains how we handle<br />
personal information. You receive our policy the first time we do<br />
business with you and every year that you are a <strong>GBUAHN</strong> ember.<br />
It is also available on www.gbuahn.org.<br />
Our Privacy Principles:<br />
• We do not sell customer information.<br />
• We do not allow those who are doing business on our behalf to<br />
use our customer information for their own purposes;<br />
• We contractually require any person or organization providing<br />
products or services on our behalf to protect <strong>GBUAHN</strong> customer<br />
information;<br />
• We do not share member medical information with anyone<br />
within the <strong>GBUAHN</strong> family of companies unless:<br />
o You expressly authorize it; or<br />
o It is permitted or required by law; or<br />
o Your agreement with us allows us to do so.<br />
• We afford our prospective and former members the same<br />
protection existing members with respect to the use of<br />
personalinformation.<br />
Information We Collect<br />
Types of information we collect and how we gather it may<br />
include:<br />
• From your applications and other forms related to our servicesand<br />
through your conversations with <strong>GBUAHN</strong> representatives,<br />
including our subcontractors and/or downstream providers;<br />
• When you visit gbuahn.org, our mobile sites and applications, our<br />
social media sites and applications, and your interactions with our<br />
online connections with our subcontractors/downstream<br />
providers;<br />
4
• From your experiences with us such as calls, or visits to our<br />
providers;<br />
• From within the amily of ompanies;<br />
We Protect Customer<br />
Information<br />
We maintain physical, electronic<br />
and procedural safeguards to guard<br />
non-public personal information<br />
and to comply with ederal and<br />
tate laws. In addition, we<br />
regularly review our policies and<br />
practices, monitor our computer<br />
networks, and test the strength of<br />
our security.<br />
How We Use Information About You<br />
We use member information,including electronic<br />
information, to:<br />
• Value your needs and place priorities on the services we offer and<br />
deliver to you;<br />
• Assist us in determining the proper and best plan of care tosuit<br />
your needs;<br />
• Report the points of care given to you as part of a global reportto<br />
NYS as part of their requirements to satisfy the need for a<br />
standard quality of care extended for each of our members;<br />
• Enhance your member experience;<br />
• Determine which other services may best suit your needs.<br />
5
How We Share Information<br />
We share information about you, including information gathered<br />
from our interactions and experiences with you, within our<br />
<strong>GBUAHN</strong> amily of ompanies, and with <strong>GBUAHN</strong> approved<br />
and contracted partners and down stream providers to help meet<br />
your current service needs. We share information about you with<br />
persons or organizations inside or outside our family of companies<br />
for our everyday business purposes and as permitted and allowed<br />
by law.<br />
We share information about you with downstream providers that<br />
perform services for us, or with whom we have joint contractual<br />
agreements. Those agreements allow us to provide services<br />
specifically geared to your specific needs. We share information<br />
with downstream providers so that the services we have contracted<br />
for on your behalf will commence in a quick and efficient manner.<br />
We share your information only with the providers for which you<br />
consented via the <strong>GBUAHN</strong> <br />
consent form.<br />
Social Media Information<br />
<strong>GBUAHN</strong> may or may not use common tracking technologies like<br />
browser cookies, analytical tools, or other technologies to<br />
customize our websites and enhance your overall experience. Our<br />
mobile and social media applications may also collect<br />
demographic information such as age, gender, and<br />
location, about the users of each application. Prior to the<br />
installation of any application, you should see a statement<br />
describing what information is collected from your use of that<br />
particular application.<br />
END OF PRIVACY POLICY<br />
6
PART 2<br />
WHAT TO EXPECT<br />
AFTER JOINING<br />
<strong>GBUAHN</strong><br />
HEALTH HOME<br />
“Guidance when YOU need it most.”
WHAT TO EXPECT AFTER JOINING<br />
<strong>GBUAHN</strong> HEALTH HOME<br />
After you enroll, we will send you a welcome letter. Shortly after<br />
receiving your welcome letter, you can expect to hear from a<br />
member of the <strong>GBUAHN</strong> Care Team.<br />
DESCRIPTION OF YOUR <strong>GBUAHN</strong> CARE TEAM<br />
Community Worker (CW) – You were likely enrolled by a<br />
ommunity orker. The CW is responsible for outreach,<br />
engagement, enrollment retention of our members.<br />
Patient Health Navigator (PHN) - Soon after being enrolled in<br />
<strong>GBUAHN</strong> and receiving your welcome letter, you will be assigned<br />
and contacted by your atient ealth avigator. The PHN conducts<br />
your , creates your care plan,<br />
set goals with you, identifies family/community support, and<br />
provides helpful health and social services links. The PHN is the<br />
bridge between you and your providers. You can expect that the<br />
PHN will regularly be in contact with your providers. Please<br />
provide your PHN with as much information as possible, so that he<br />
or she can provide you with the best possible care.<br />
Care Manager (CM) – There are a group of people that serve our<br />
members behind the scenes. The are anager is responsible for<br />
making sure <strong>GBUAHN</strong>’s atient ealth avigators are providing<br />
the highest levels of care to you, the member.<br />
8
Member Services - There is someone to help you in ember<br />
ervices Monday through Friday from 9 a.m. to 6 p.m. Call<br />
716-247-5282 if you need assistance. If you need help or health<br />
careadvice at other times, you will be transferred to a atient<br />
otline.Follow the options to speak with someone 24 hours a<br />
day, 7 daysa week. You can call to get help anytime you have a<br />
question orconcern.<br />
KEEPING YOUR CARE TEAM INFORMED<br />
Call ember ervices or your atient ealth avigator<br />
whenever these changes happen in your life:<br />
• You change your name, address or telephone number.<br />
• You have a change in Medicaid eligibility.<br />
• There is a change in insurance for you.<br />
NON-ENGLISH SPEAKING MEMBERS<br />
If you do not speak English, we can help. Call us and we will find a<br />
way to talk to you in your own language. We have a group of<br />
people who can help. We will also help you find a <br />
who can serve you in your language.<br />
MEMBERS WITH DISABILITIES<br />
For people with disabilities: f you use a wheelchair, are blind, or<br />
have trouble hearing or understanding, call us if you need extra<br />
help. We can tell you if a particular provider’s office is wheelchair<br />
accessible or is equipped with special communications devices.<br />
We also have access to services like:<br />
• Toll-free access (ur phone number is 1-855-4<strong>GBUAHN</strong> or<br />
855-442-8246)<br />
• Information in large print<br />
• Case management<br />
• Help in making or getting to appointments<br />
• Names and addresses of providers who specialize in your<br />
disability<br />
9
PART 3<br />
ADVANCE<br />
DIRECTIVES<br />
“Guidance when YOU need it most.”
ADVANCE DIRECTIVES<br />
There may come a time when you can’t decide about your own<br />
health care. By planning in advance, you can arrange now for your<br />
wishes to be carried out. First, let family, friends and your doctor<br />
know what kinds of treatment you do or don’t want.<br />
Second, you can appoint an adult you trust to make decisions for<br />
you. Be sure to talk with your primary care provider (PCP), your<br />
family or others close to you so they will know what you want.<br />
Third, it is best if you put your thoughts in writing. The documents<br />
listed below can help. You do not have to use a lawyer, but you may<br />
wish to speak with one about this. You can change your mindat<br />
any time. We can help you understand or get these documents.<br />
They do not change your right to quality health care benefits. The<br />
only purpose is to let others know what you want if you can’t speak<br />
for yourself.<br />
Health Care Proxy – With this document, you name another adult<br />
that you trust (usually a friend or family member) to decide about<br />
medical care for you if you are not able to do so. If you do this, you<br />
should talk with the person so they know what you want.<br />
CPR and DNR – You have the right to decide if you want any<br />
special or emergency treatment to restart your heart or lungs if<br />
your breathing or circulation stops. If you do not want special<br />
treatment, including cardiopulmonary resuscitation (CPR), you<br />
should make your wishes known in writing. Your PCP will provide<br />
a Do Not Resuscitate (DNR) order for your medical records. You<br />
can also get a DNR form to carry with you and/or a bracelet to<br />
wear that will let any emergency medical provider know about your<br />
wishes.<br />
Organ Donor Card – This wallet-sized card says that you are<br />
willing to donate parts of your body to help others when you die.<br />
Also, check the back of your driver’s license to let others know if<br />
and how you want to donate your organs.<br />
11
PART 4<br />
MEMBER RIGHTS<br />
&<br />
RESPONSIBILITIES<br />
“Guidance when YOU need it most.”
MEMBER RIGHTS AND<br />
RESPONSIBILITIES<br />
Your rights<br />
As a member of <strong>GBUAHN</strong> Health Home, you have a right to:<br />
• Be cared for with respect without regard for health status, sex,<br />
race, color, religion, national origin, age, marital status or sexual<br />
orientation<br />
• Be told where, when and how to get the services you need from us<br />
• Be referred to a primary care provider (PCP) who can<br />
communicate with you in a language you understand<br />
• Get a second opinion about your care<br />
• Give your approval to any treatment or plan for your care after<br />
that plan has been fully explained to you<br />
• Refuse care and be told what you may risk if you do<br />
• Be assured that your member record is private and will not be<br />
shared with anyone except as required by law or contract or with<br />
your approval<br />
• Get a copy of the Notice of Privacy Practices that tells you<br />
your rights on protected health information (PHI) and our<br />
responsibility to protect your PHI; this includes the right to know<br />
how we handle, use and give out your PHI<br />
• PHI is defined by HIPAA Privacy Regulations as information that:<br />
- Identifies you or can be used to identify you<br />
-Comes from you or has been created or received by a<br />
health care provider, a health plan, your employer or<br />
a health care clearinghouse<br />
-Has to do with your physical or mental health condition,<br />
providing health care to you, or paying for providing health<br />
care to you<br />
• Use our complaint system to settle any complaints, or you can<br />
complain to the New York State Department of Health any time<br />
you feel you are not fairly treated<br />
• Use the state fair hearing system<br />
13
• Appoint someone (relative, friend, lawyer, etc.) to speak foryou if<br />
you are unable to speak for yourself about your care and<br />
treatment or if you simply want someone else to speak for you<br />
• Choose a PCP, choose a new PCP and have privacy during a visit<br />
with a health care provider<br />
• Be referred to a non-network provider if we do not have an<br />
appropriately trained provider in our network<br />
• Get needed medical services within a reasonable amount of time<br />
• Take part in making decisions about your health care with your<br />
health care provider<br />
• Receive information on available treatment options and<br />
alternatives, regardless of cost or benefit coverage<br />
• Receive considerate, respectful care in a clean, safe environment<br />
free of unnecessary restraints<br />
• Be referred to specialists who are experienced in treating<br />
disabilities, if needed<br />
• Receive information about us, our services, policies and<br />
procedures, providers, member rights and responsibilities, and<br />
any changes made<br />
• Receive information about all benefits and services available from<br />
us<br />
• Request information about the plan, including clinical review<br />
criteria used by the plan in a utilization review decision on a<br />
specific disease or condition<br />
• Get a current directory of doctors within our network<br />
• Have access 24 hours a day, 7 days a week toll free at<br />
247-5282 or 1-855-4<strong>GBUAHN</strong><br />
• Call our ember ervices department toll free at 716-247-5282<br />
from 8 a.m. to 6 p.m. Monday through Friday<br />
• Get help from someone who speaks your language<br />
• Make suggestions about our member rights and responsibilities<br />
policy<br />
14
Your responsibilities<br />
As a member of <strong>GBUAHN</strong> Health Home, you agree to:<br />
• Find out how your health care plan works.<br />
• Share your membership in <strong>GBUAHN</strong> Health Home to each<br />
provider and tell us about any health care providers you are<br />
currently seeing.<br />
• Work with your atientealth avigator toguardand improve<br />
your health.<br />
• Give us and your health care provider the information he or she<br />
needs to take care of your medical needs.<br />
• Listen to your PCP’s advice and ask questions when you are in<br />
doubt.<br />
• Know and get involved in your health care. You should talk with<br />
your health care provider about recommended treatment. You<br />
should then follow the plans and instructions for care agreedupon<br />
with your provider.<br />
• Get information to understand your health problems andconsider<br />
treatments so you can participate in developing mutuallyagreed<br />
upon treatment goals before services are performed.<br />
• Call or go back to your PCP if you do not get better or ask for a<br />
second opinion.<br />
• Treat <strong>GBUAHN</strong>’s staff with the same respect you expect.<br />
• Tell us if you have problems with any of <strong>GBUAHN</strong>’s staff by<br />
calling ember ervices.<br />
• State any complaint or concern clearly.<br />
• Keep your appointments. If you must cancel, call as soon as you<br />
can.<br />
• Use the emergency room for emergencies.<br />
• Call your PCP when you need medical care, even if it is afteroffice<br />
hours.<br />
• Get a referral from your PCP before you go to a hospital or see a<br />
specialist (except for emergencies and self-referral services).<br />
• Ask your PCP how to take your medicines the right way, or<br />
request that your atient ealth avigator provides a link to<br />
someone who can assist you.<br />
15
• Be aware that refusing the treatment your provider suggests may<br />
have serious consequences for your health.<br />
• Tell your PC and your atient ealth avigator about your<br />
health.<br />
• Authorize your PCP and your atient ealth avigator to get a<br />
copy of your old medical records.<br />
• Learn and follow our membership rules stated in this handbook.<br />
MEMBER COMPLAINT PROCESS<br />
Complaints<br />
We hope our health home serves you well. If you have a problem,<br />
please contact <strong>GBUAHN</strong>’s ompliance fficer. Most problems can<br />
be solved right away. Problems that are not solved right away over<br />
the phone and any complaint that comes in the mail will be<br />
handled according to our complaint procedure described below.<br />
You can ask someone you trust (such as a legal representative, a<br />
family member, or friend) to file the complaint for you. If you need<br />
our help because of a hearing or vision impairment, or if you need<br />
translation services, or help filing the forms we can help you. We<br />
will not make things hard for you or take any action against you for<br />
filing a complaint.<br />
16
How to file a complaint with <strong>GBUAHN</strong> Health Home<br />
To file by phone, call <strong>GBUAHN</strong>’s ompliance fficer at<br />
855-877-2940, Monday through Friday, from 8 a.m. to 6 p.m. If you<br />
call us after hours, leave a message. We will call you back the next<br />
day. If we need more information to make a decision, we<br />
will tell you.<br />
You can write us with your complaint or call the ember ervices<br />
number and request a complaint form. It should be mailed back to:<br />
<strong>GBUAHN</strong> Health Home<br />
ATTN: Quality Department<br />
564 Niagara Street - Building 2<br />
Buffalo, NY 14201<br />
You can also fax the complaint to (716) 332-0075.<br />
What happens next?<br />
If we don’t solve the problem right away over the phone or after<br />
we get your written complaint, we will send you a letter within 15<br />
business days. The letter will tell you:<br />
• Who is working on your complaint<br />
• How to contact this person<br />
• If we need more information<br />
Your complaint will be reviewed by one or more qualified people. If<br />
your complaint involves clinical matters, your case will be reviewed<br />
by one or more qualified health care professionals.<br />
After we review your complaint:<br />
• We will let you know our decision in 45 days of when we have all<br />
the information we need to answer your complaint, but you will<br />
hear from us in no more than 60 days from the day we get your<br />
complaint. We will write you and will tell you the reasons for our<br />
decision.<br />
17
• When a delay would risk your health, we will let you know our<br />
decision in 48 hours of when we have all the information we need<br />
to answer your complaint but you will hear from us in no more<br />
than seven days from the day we get your complaint. We will call<br />
you with our decision or try to reach you to tell you. You will get a<br />
letter to follow up our communication in three business days.<br />
• You will be told how to appeal our decision if you are not satisfied<br />
and we will include any forms you may need.<br />
• If we are unable to make a decision about your complaint because<br />
we don’t have enough information, we will send a letter and let<br />
you know.<br />
Complaint appeals<br />
If you disagree with a decision we made about your complaint, you<br />
or someone you trust can file a complaint appeal with the plan.<br />
How to make a complaint appeal<br />
If you are not satisfied with what we decide, you have at least 60<br />
business days after hearing from us to file an appeal. You can do<br />
this yourself or ask someone you trust to file the appeal for you. The<br />
appeal must be made in writing. If you make an appeal by phone it<br />
must be followed up in writing. After your call, we will send you a<br />
form your phone appeal. If you agree with our<br />
summary, you must sign and return the form to us. You can make<br />
any needed changes before sending the form back to us.<br />
What happens after we get your complaint appeal?<br />
After we get your complaint appeal we will send you a letter within<br />
15 business days. The letter will tell you who is working on your<br />
complaint appeal, how to contact this person and if we need more<br />
information.<br />
Your complaint appeal will be reviewed by one or more qualified<br />
people at a higher level than those who made the first decision<br />
18
about your complaint. If your complaint appeal involves clinical<br />
matters your case will be reviewed by one or more qualified health<br />
professionalwith at least one clinical peer reviewer, were not<br />
involved in making the first decision about your complaint.<br />
If we have all the information we need you will know our decision<br />
in 30 business days. If a delay would risk your health you will<br />
get our decision in two business days of when we have all the<br />
information we need to decide the appeal. You will be given the<br />
reasons for our decision and our clinical rationale, if it applies.<br />
If you are still not satisfied, you or someone on your behalf can file<br />
a complaint at any time with the New York State Department of<br />
Health at 1-800-206-8125.<br />
RIGHT TO A FAIR HEARING<br />
Fair hearings<br />
A air earing is a chance for you to tell an dministrative aw<br />
udge from the New York State Office of Temporary and Disability<br />
Assistance, Office of Administrative Hearings, why you think a<br />
decision about your case made by a local social services agency is<br />
wrong. The Office of Temporary and Disability Assistance will then<br />
issue a written decision which will state whether the local agency’s<br />
decision was right or wrong. The written decision may order the<br />
local agency to correct your case.<br />
Request resources:<br />
• Request a air earing - Requests for earings can be completed<br />
online, by US Mail, by telephone or by fax.<br />
• Request an djournment or eopening - If you cannot appear at a<br />
hearing that has been scheduled but hasn’t been held yet, you may<br />
request that it be adjourned (postponed) to another date. You may<br />
submit your request for an adjournment online, by US Mail, by<br />
telephone or by fax. If the hearing date has already passed and you<br />
19
didn’t attend the hearing, under some limited circumstances, you<br />
may be able to have the hearing rescheduled.<br />
• Cancel a air earing - If you no longer need a hearing thatyou<br />
have requested, you may let us know online, by US Mail, by<br />
telephone or by fax.<br />
• Request ompliance with a air earing ecision - If you have<br />
received a fair hearing decision that says that your local agency<br />
should do something and you believe that they haven’t done it,<br />
you may submit a ompliance omplaint to us. You may do this<br />
online, by US Mail, by telephone or by fax.<br />
• Search the air earing ecision rchive - The Office of<br />
Administrative Hearings publishes all of its air earing<br />
ecisions on the Internet. These decisions have all personal and<br />
confidential information removed. If you want to look at old<br />
decisions or find other decisions whose facts are similar to yours,<br />
you may search this archive.<br />
For all other issues, including inquiries or complaints regarding<br />
a specific fair hearing decision, obtaining an additional copy of a<br />
decision, or requests to amend a decision and/or reopen a hearing,<br />
you may contact the Office of Administrative Hearings at:<br />
Office of Temporary and Disability Assistance<br />
Office of Administrative Hearings<br />
PO BOX 1930<br />
Albany, NY 12201-1930<br />
Fax: (518) 473-6735<br />
Phone: (518) 474-8781 or 1-800-342-3334 (toll free)<br />
Speech or Hearing Impaired Individuals<br />
Please contact the New York Relay Service at 711 and request that<br />
the operator call us at 1-800-502-6155. Service at this number will<br />
only be provided to callers using TDD equipment.<br />
20
PART 5<br />
DISENROLLING OR<br />
TRANSFERRING<br />
FROM <strong>GBUAHN</strong><br />
HEALTH HOME<br />
“Guidance when YOU need it most.”
DISENROLLMENTS AND TRANSFERS<br />
Membership in <strong>GBUAHN</strong> Health Home is voluntary for all<br />
members.<br />
Members can request to be disenrolled for the following reasons:<br />
• You move out of our service area.<br />
• You and your care team all agree that disenrollment is best for<br />
you.<br />
• You are or become exempt or excluded from managed care.<br />
• We do not offer a Medicaid managed care service that you can get<br />
from another health plan in your area.<br />
• You need a service that is related to a benefit we do not cover and<br />
getting the service separately would put your health at risk.<br />
• We have not been able to provide services as you expected.<br />
• You wish to transfer to another health home in Erie County.<br />
HOW TO CHANGE MANAGED CARE<br />
ORGANIZATIONS<br />
You may be able to transfer to another plan over the phone. Unless<br />
you are excluded or exempt from managed care, you will have<br />
to choose another health plan. <strong>GBUAHN</strong> will be happy to help<br />
facilitate the change to a managed care organization that we accept.<br />
It may take between two and six weeks to process, depending on<br />
when your request is received. You will get a notice that the change<br />
will take place by a certain date.<br />
You can ask for faster action if you believe the timing of the regular<br />
process will cause added damage to your health. You can also ask<br />
for faster action if you have complained because you did not agree<br />
to the enrollment.<br />
22
MEDICAID I<br />
You could become ineligible for Medicaid Managed Care.<br />
You may have to disenroll from <strong>GBUAHN</strong> Health Home if you:<br />
• Move out of the county or service area<br />
• Change to another managed care plan<br />
• Join an HMO or other insurance plan through work<br />
• Become incarcerated<br />
• Become a permanent resident of a nursing home or other<br />
inpatient facility<br />
ADMINISTRATIVE DISENROLLMENTS<br />
We can your <strong>GBUAHN</strong> membership, if you often:<br />
• Don’t follow the rules of <strong>GBUAHN</strong> Health Home<br />
• Do not fill out forms honestly or do not give true information<br />
(commit fraud)<br />
• Cause abuse or harm to plan members, providers or staff<br />
• Act in ways that make it hard for us to do our best for you and<br />
other members even after we have tried to fix the problems<br />
23
PART 6<br />
MANAGED CARE<br />
ORGANIZATIONS<br />
(INSURANCE)<br />
LISTING<br />
“Guidance when YOU need it most.”
MANAGED CARE ORGANIZATIONS<br />
(INSURANCE) CONTACT INFORMATION<br />
Medicaid Call Center<br />
(716) 858-6244<br />
Medicare Hotline<br />
1-800-772-1213<br />
Fidelis Care of Western<br />
New York<br />
40 John Glenn Drive<br />
Amherst, NY 14228<br />
1-888-343-3547<br />
Blue Cross/Blue Shield<br />
(Health Now/Community<br />
Care)<br />
57 W. Genesee Street<br />
Buffalo, NY 14202<br />
(716) 887-7520<br />
Univera<br />
(Community Health)<br />
205 Park Club Lane<br />
Buffalo, NY 14221<br />
(716) 847-0881<br />
Wellcare of Buffalo<br />
255 Delaware Avenue #6<br />
Buffalo, NY 14202<br />
(716) 846-7900<br />
YourCare Health Plan<br />
446 Main Street<br />
Buffalo, NY 14202<br />
(800) 683-3781<br />
United Healthcare<br />
1-877-596-3258<br />
TTY users, call: 711<br />
If you are covered by a anaged are rganization that <strong>GBUAHN</strong><br />
does not accept, but you would like to remain a member of<br />
<strong>GBUAHN</strong>, please contact ember ervices. They will be happy to<br />
place you in contact with someone can guide you through the<br />
process of changing your insurance to one of the anaged are<br />
rganizations above. As a reminder, you must have Medicaid in<br />
order to qualify for membership in a health home.<br />
25
PART 7<br />
HELPFUL<br />
COMMUNITY<br />
RESOURCES<br />
“Guidance when YOU need it most.”
CRISIS SERVICES<br />
If you are dealing with a crisis<br />
situation, know that you are not<br />
alone. Crisis Services can lend a<br />
listening ear and some assistance<br />
for the following crises:<br />
• Homelessness<br />
• Rape<br />
• Domestic iolence<br />
• Suicide revention<br />
• Trauma<br />
• Mental ealth mergencies<br />
24 Hour Hotline Serving<br />
Buffalo and Erie County<br />
(716) 834-3131<br />
Kids Helpline<br />
(716) 834-1144<br />
1 (877) KIDS400<br />
24 Hour Domestic Violence<br />
Hotline - Erie County<br />
(716) 862-HELP (4357)<br />
Call (716) 884-6000 for a shelter<br />
NYS Domestic Violence<br />
and Sexual Violence -<br />
24 Hour Hotline<br />
1-800-942-6906 (English)<br />
1-800-942-6908 (Spanish)<br />
LOCAL FOOD<br />
PANTRIES<br />
Note: Many pantries have restricted<br />
hours. Before visiting a food pantry,<br />
please call to confirm that they are<br />
open and their hours of operation.<br />
Primera Food Pantry<br />
62 Virginia Street<br />
Buffalo, NY<br />
(716) 854-6097<br />
Salvation Army<br />
960 Main Street<br />
Buffalo, NY<br />
(716) 883-9800<br />
Buffalo Urban League<br />
Pantry<br />
86 Pine Street<br />
Buffalo, NY<br />
(716) 847-8951<br />
Buffalo River Food Pantry<br />
61 Republic Street<br />
Buffalo, NY<br />
(716) 856-8613<br />
Matt Urban Center<br />
1081 Broadway Street<br />
Buffalo, NY<br />
27
PART 8<br />
FREQUENTLY<br />
ASKED<br />
QUESTIONS<br />
“Guidance when YOU need it most.”
<strong>GBUAHN</strong> is committed to providing the highest level of care to<br />
our members. Below you will find commonly asked questions.<br />
Q: I think I might be having a medical emergency. What should I do?<br />
A: If you think you might be having an emergency, the first step is<br />
to keep calm. Getting upset or scared can affect your heart rate,<br />
digestion, and breathing, which may cause you to confuse your<br />
symptoms. Keep calm so that you can make the right decision for<br />
your wellbeing. Try to reach your doctor. He or she can give you<br />
the best advice on whether or not you are having an emergency.<br />
<br />
<br />
<br />
• A high fever<br />
• Chest pain and shortness of breath<br />
• Feeling sick or unusual after taking your medications<br />
• Taking too much of your medications<br />
• Coughing or vomiting blood<br />
• Heavy or uncontrollable bleeding<br />
• Seizures<br />
• You feel like you want to hurt yourself<br />
• You feel like you want to hurt someone else<br />
• Voices are telling you to hurt yourself and someone else<br />
If you are experiencing these symptoms and cannot reach your<br />
doctor, go to the hospital immediately.<br />
Q: Who do I call if I have a question about my membership?<br />
A: Member ervices can assist with any membership-related inquiry<br />
and a variety of other questions. Please call (716) 247-5282.<br />
Q: Who do I call for my care coordination needs?<br />
A: Your atient ealth avigator (PHN) is your lead contact person<br />
who assists you with coordinating your medical and social service<br />
needs.<br />
29
Q: Who do I call if I have forgotten my atient ealth avigator’s<br />
name?<br />
A: If you are unsure of who your atient ealth avigator is, call<br />
ember ervices at (716) 247-5282 and a representative will<br />
provide you with the name of your PHN.<br />
Q: How do I recertify my Medicaid?<br />
A: Once a year, Medicaid will mail you the necessary forms for<br />
renewing your Medicaid. It is important to always notify<br />
Medicaid of any changes in address, because mail from<br />
Medicaid cannot be forwarded. This means that if you have<br />
moved and failed to notify Medicaid, you will not receive your<br />
recertification forms, which may put you at risk for losing your<br />
coverage.<br />
Q: I have a rodent/insect infestation in my home. What do I do?<br />
A: First you should call your landlord and inform <br />
the <br />
<br />
<br />
<br />
Q: How can I schedule transportation to my appointments through<br />
<strong>GBUAHN</strong>?<br />
A: Call MAS (Medicaid answering service located in part 9)<br />
or call your atient ealth avigator to assist in arranging<br />
transportation.<br />
Q: I received a 30-day eviction notice. What do I do?<br />
A: Make sure you have a physical copy of your eviction notice<br />
with the stated reason for your eviction. Bring that eviction<br />
notice to the Department of Social Services, located at 158<br />
Pearl Street. You will want to go to the irst loor, indow #7,<br />
and apply for emergency housing. You can also let your atient<br />
ealth avigator know about the eviction notic for further<br />
assistance.<br />
30
Q: I received a utility shutoff notice. What do I do?<br />
A: You can handle this situation in a variety of ways, depending on<br />
your circumstances. If you receive ocial ervices, immediately<br />
call your caseworker and provide with the<br />
information from your shutoff notice. You can also call the<br />
utility company and explain to the representative any financial<br />
changes that have taken place and request an income budget<br />
sheet. This will allow you to get a reduced bill according to the<br />
income change that has been expressed. You can also ask if you<br />
are eligible for a special program through the utility company.<br />
If you would like assistance with speaking with anyone, you can<br />
request that from your atient ealth avigator.
Q: My landlord is not addressing a health hazard in my home.<br />
What do I do?<br />
A: If your landlord is being negligent in regard to safety in your<br />
home, there are two agencies that help with these issues:<br />
•Neighborhood Legal Services - (716) 847-0650<br />
•Housing Opportunities Made Equal (H.O.M.E.) - (716) 854-1400<br />
If you would like assistance with speaking with anyone, you can<br />
request that from your atient ealth avigator.<br />
Q: I need help resolving legal issues. Where can I go for help?<br />
A: Neighborhood Legal Services provides free legal assistance and<br />
guidance for a variety of issues. You can contact them at (716) 847-<br />
0650. If you would like assistance speaking with anyone, you can<br />
request that assistance from your atient ealth avigator.<br />
Q: I work and have children. How can I find affordable child care?<br />
A: There are subsidies and programs for working parents who<br />
need help with daycare or childcare. To apply, go to the<br />
Department of Social Services with documents supporting your<br />
income amount and proof of employment. If you would like<br />
assistance, you can contact your atient ealth avigator.<br />
Q: All of the applications I need to do are online, but I don’t have a<br />
computer. Where can I go?<br />
A: All public libraries in Erie County have free computers for your<br />
use if you need to fill out applications. If you would like to find<br />
the library closest to your home or current location, you can<br />
contact ember ervices and they would be happy to assist you.<br />
Q: I need translation services for appointments, hearings, etc. due<br />
to a language barrier. How can I get help?<br />
A: he International Institute of Buffalo is a very helpful local<br />
agency that helps with translation services. They are located at 864<br />
Delaware Avenue, Buffalo, New York. The phone number is<br />
(716)883-1900 and their hours are 8:30 am - 4:30 pm.<br />
32
PART 9<br />
RESOURCES<br />
&<br />
IMPORTANT<br />
PHONE NUMBERS<br />
“Guidance when YOU need it most.”
Medicaid Answering<br />
Service (MAS Transportation)<br />
1-800-651-7040<br />
The Water Shed<br />
Rehabilitation Drug &<br />
Alcohol Addiction Rehab<br />
24 hours & Confidential<br />
1-844-455-9146<br />
<br />
1526 Walden Avenue<br />
Suite 400<br />
Cheektowaga, NY 14225<br />
(716) 895-6700<br />
463 William Street<br />
Buffalo, NY 14204<br />
(716) 893-0062<br />
1131 Broadway<br />
Buffalo, NY 14212<br />
(716) 896-7350<br />
Horizon Inpatient<br />
Treatment Admission<br />
( 716 ) 831-1800<br />
St. Luke Furniture<br />
(716 ) 892-4049<br />
Buffalo Federation of<br />
Neighborhood Centers, Inc.<br />
(BFNC)<br />
423 Monroe Street<br />
Buffalo, NY 14212<br />
(716) 856-0363<br />
Jewish Family Service of<br />
Buffalo & Erie County<br />
70 Barker Street<br />
Buffalo, NY 14209<br />
(716)883-1914<br />
Hispanics United of Buffalo<br />
(HUB)<br />
254 Virginia Street<br />
Buffalo, NY 14201<br />
(716) 856-7110<br />
Western New York<br />
Independent Living, Inc.<br />
3108 Main Street<br />
Buffalo, NY 14214<br />
(716)836-0822<br />
Child& Family Services<br />
(716)842-2750<br />
To report hild buse,<br />
call 1-800-342-3720<br />
Willcare<br />
1-800-945-5227<br />
34
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<strong>January</strong> 6, <strong>2020</strong><br />
36
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