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GBUAHN Handbook - January 6 2020

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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


Approved by NYSDOH New York State Department of Health<br />

<strong>January</strong> 6, <strong>2020</strong><br />

36


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