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«Member Handbook: Integrated Health Services For Physical and Behavioral Health Services Amerigroup Louisiana LA-MHB-0018-16 05.16 1-800-600-4441 (TTY ...»

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 If you wish to request a copy of the Amerigroup Notice of Privacy Practices; this notice describes:

- How medical information about you may be used and disclosed

- How you can get access to this information

–  –  –

For members who do not speak English:

 We can help in many different languages and dialects  We can help interpret for visits with your doctor at no cost to you  Please let us know if you need an interpreter at least 24 hours before your appointment  Call Member Services for more details

For members who are deaf or hard of hearing:

 Call 711  We will set up and pay for you to have a person who knows sign language help you during your doctor visits Please let us know if you need an interpreter at least 24 hours before your appointment.

Online and automated self-service features You can take advantage of these services online at www.myamerigroup.com/LA. Or you can call our

automated line at 1-800-600-4441. This is available 24 hours a day, 7 days a week. You can:

 Choose or find a primary care provider (PCP) in the Amerigroup network  Change your PCP  Request an ID card  Update your address or phone number  Request a member handbook, provider directory or pharmacy directory Amerigroup On Call

Call Amerigroup On Call at 1-866-864-2544 if you need to speak with a nurse for advice on:

 How soon you need to get care for an illness  What kind of health care you need  What to do to take care of yourself before you see the doctor  How you can get the care that is needed You can also call this same number if you need help setting up an appointment with a doctor for an urgent medical issue. Amerigroup On Call is here for you 24 hours a day, 7 days a week, 365 days a year.

–  –  –

24-hour Behavioral Health Crisis Line Call our 24-hour Behavioral Health Crisis Line at 1-800-600-4441 when you are having a mental or substance use crisis. You can call the Behavioral Health Crisis Line 24 hours a day, 7 days a week. The

following are signs that a person may be having a mental health or a substance use crisis:

 Trouble coping with daily problems and activities  Restlessness and pacing  Suicidal or homicidal ideas or plans  Hopelessness  Social withdrawal  Excessive fear, worry or anxiety  Chronic pain  Changes in sleeping and/or eating habits  Fatigue  Extreme mood swings  Getting angry or hostile easily  Angry outbursts  Racing thoughts, talking fast  Threatening or aggressive behavior  Alcohol or substance use  Inappropriate sexual behavior  Hearing voices others don't hear  Believing others are plotting to harm him or her  Grandiosity (feeling unrealistically powerful, important and invincible)  Seeing or hearing things that are not there Behavioral Health Warm Line Call the Behavioral Health Warm Line at 1-800-730-8375 to talk to someone who knows what you’re going through. The Warm Line is available every day from 5 p.m. to 10 p.m.

The Behavioral Health Warm Line is a peer-support line where you talk to people who have experienced similar behavioral health issues or gone through a similar situation. When the Behavioral Health Warm Line is not available, please call the 24-hour Behavioral Health Crisis Line at 1-800-600-4441.

–  –  –

For members who do not speak English, we offer oral interpretation services for all languages.

These services are free of charge. If you need these services, call Member Services toll free at 1-800-600-4441.

Para miembros que no hablan inglés, ofrecemos servicios de interpretación oral para todos los idiomas. Estos servicios son gratuitos. Si necesita estos servicios, llame a la línea gratuita de Servicios al Miembro al 1-800-600-4441.

Nếu quý vị cần thông tin này bằng tiếng Việt, hãy gọi tới đường dáy miễn phí của Dịch Vụ Thành Viên theo số 1-800-600-4441.

–  –  –

Personal disaster plan Your health is important to us. To help you keep track of your health records, Amerigroup offers you a way to keep them safe. Our online disaster plan can help you get ready before a disaster happens.

LA-MHB-0018-16 Updated 05/16

All you need to do is follow these easy instructions:

1. Log in to the secure member website at www.myamerigroup.com/LA 2. /f you don’t have a login͕ register with your Amerigroup /D

3. On the right side, select Personal Disaster Plan

4. Fill in your health information and click the Save button Make sure your personal health records are current and safe today. /t’s ũust one more way Amerigroup helps you have peace of mind.

Your Amerigroup member handbook This handbook will help you understand your health plan. If you have questions or need help understanding or reading your member handbook, call Member Services. We also have this member

handbook in:

 A large-print version  An audio-taped version  A Braille version  A Spanish version  A Vietnamese version If you want a copy of this handbook in one of these versions, call Member Services.





For members who do not speak English, we offer oral interpretation services for all languages. These services are free of charge. If you need these services, call Member Services toll free at 1-800-600-4441.

Para miembros que no hablan inglés, ofrecemos servicios de interpretación oral para todos los idiomas. Estos servicios son gratuitos. Si necesita estos servicios, llame a la línea gratuita de Servicios al Miembro al 1-800-600-4441.

Nếu quý vị cần thông tin này bằng tiếng Việt, hãy gọi tới đường dáy miễn phí của Dịch Vụ Thành Viên theo số 1-800-600-4441.

Your Amerigroup ID card If you do not have your Amerigroup ID card yet, you will get it soon. You will also get a Louisiana Medicaid ID card if you do not already have one.

 Please carry your Amerigroup ID card and your Medicaid ID card with you at all times.

 Your Amerigroup ID card can be used to get services covered by Healthy Louisiana. It tells providers

and hospitals:

- You are a member of our health plan

- We will pay for the medically needed benefits listed in the section Your Health Care Benefits

Your Amerigroup ID card shows:

 The name and address of your PCP  The phone number of your PCP, including an after-hours number  The date you became an Amerigroup member  Your date of birth

–  –  –

Your Medicaid ID card can be used to get services covered through Medicaid. These services are not covered under your Amerigroup health plan. It is important to carry both your Medicaid ID card and your Amerigroup ID card as they are needed for different services.

If your Amerigroup ID card is lost or stolen, call us right away at 1-800-600-4441. We will send you a new one. If your Medicaid ID card is lost or stolen, call the Louisiana Medicaid and LaCHIP assistance line at 1-888-342-6207.

YOUR PROVIDERS

Picking a primary care provider All Amerigroup members must have a primary care doctor. This doctor is called a primary care provider (PCP).

 Your PCP must be in the Amerigroup network unless you have other primary health insurance.

 Your PCP will give you a medical home. That means he or she will get to know you and your health history.

 Your PCP can help you get quality care.

 Your PCP will give you all of the basic health services you need. He or she will also send you to other doctors or hospitals when you need special medical services and behavioral health.

The name and phone number of your PCP are on your Amerigroup ID card.

You should have picked a PCP when you enrolled in Amerigroup. /f you didn’t choose a PCP, we

assigned one to you who:

 Has given you care before based on claims history and/or a past association, is part of our network and is right for you based on your age and sex  Is assigned or was assigned to one of your current family members, is part of our network and is right for you based on your age or sex (if we do not find a PCP who was assigned to one of your family members, then we will assign one who is right for you based on your age and sex)  Has demonstrated higher quality and efficiency performance than other participating PCPs near you, whenever possible  Is closest to where you live, based on required Medicaid guidelines If we assign a PCP to you, we also look at your language needs if we know them.

–  –  –

Members who are expectant moms can choose a PCP for their newborns by calling Member Services at 1-800-600-4441. If you do not choose a PCP for your newborn, we will assign one as stated above.

If we assigned a PCP to you or you wish to change your PCP, you can pick a new one. You can change your PCP at anytime.

 Go to www.myamerigroup.com/LA for a current list of Amerigroup network providers.

 Call Member Services for help. We can also help you pick a PCP.

If you are already seeing a PCP, you can look in the provider directory to see if that provider is in our network. If so, you can tell us you want to keep that PCP. Your PCP can be any of the following, as long

as he or she is in the Amerigroup network:

 Family or general practitioners  Advance nurse practitioner  Internists  Pediatricians  Obstetricians or gynecologists (for women when they are pregnant)  Attending specialists (for members with a range of disabilities, or acute or chronic conditions)  Federally Qualified Health Centers and Rural Health Clinics Family members do not have to have the same PCP.

Second opinion Amerigroup members have the right to ask for a second opinion about the use of any covered health care services. You can get a second opinion from a network provider or a non-network provider if a network provider is not available.

Ask your PCP to submit a request for you to have a second opinion. This is at no cost to you. Once the

second opinion is approved:

 You will hear from your PCP  Your PCP will let you know the date and time of the appointment  Your PCP will also send copies of all related records to the doctor who will provide the second opinion After your visit with the provider giving a second opinion, this provider will give you your results. This provider will also share the results with your first provider and Amerigroup.

If you had a different primary care provider before you joined Amerigroup You may have been seeing a PCP who is not in our network for an illness or injury before you joined Amerigroup. In some cases, you may be able to keep seeing this PCP for care while you pick a new PCP.

 Call Member Services to find out more.

–  –  –

If your primary care provider’s office moves, closes or leaves the Amerigroup network

Your WW’s office may move͕ close or leave the Amerigroup network. /f this happens͕ we will:

 Call or send you a letter to tell you; in some cases, you may be able to keep seeing this PCP for care while you pick a new PCP; call Member Services to find out more about this or if you need help transferring your records  Help you pick a new PCP if you ask us for help; call Member Services  Send you a new ID card within 10 working days after you pick a new PCP How to change your primary care provider If you need to change your PCP, you may pick another PCP from the network. You can change your PCP

at anytime. For a list of PCPs in our network, do one of the following:

 Look in the Amerigroup provider directory that came with your new member package.

 Go to www.myamerigroup.com/LA to view the provider directory online.

 Call Member Services for help at 1-800-600-4441 and let them know if you also need help transferring your medical records to your new PCP.

When you ask to change your PCP:

 We can make the change the same day you ask for it.

 The change will be effective right away.

 You will get a new ID card in the mail within 10 working days after your PCP has been changed.

all the WW’s office if you want to make an appointment. The phone number is on your Amerigroup ID card. If you need help, call Member Services. We will help you make the appointment.

If your primary care provider asks for you to be changed to another primary care provider

Your PCP may ask for you to be changed to another PCP. Your PCP may do this if:

 Your PCP does not have the right experience to treat you  The assignment to your WW was made in error ;like an adult assigned to a child’s WWͿ  You fail to keep your appointments  Your PCP agrees that a change is best for you

–  –  –

Please read the section Specialists to learn more about referrals.

Picking an obstetrician or gynecologist Female members can see an Amerigroup network obstetrician and/or gynecologist (OB-GYN) for

OB-GYN health needs. These services include:

 Well-woman visits  Prenatal care  Care for any female medical condition  Family planning You do not need a referral from your PCP to see an OB-GYN. If you do not want to go to an OB-GYN, your PCP may be able to treat you for your OB-GYN health needs.

 Ask your PCP if he or she can give you OB-GYN care. If not, you will need to see an OB-GYN.

 Choose an OB-GYN from the list of OB-GYNs in the Amerigroup network. You can find the provider directory online at www.myamerigroup.com/LA.

While you are pregnant, your OB-GYN can be your PCP. Our nurses can help you decide if you should see your PCP or an OB-GYN. To speak with a nurse, call Amerigroup On Call at 1-866-864-2544. If you

need help picking an OB-GYN, you can:



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