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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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 Refer to the online Amerigroup provider directory  Call Member Services Specialists Your PCP can take care of most of your health care needs, but you may also need care from other kinds of providers. Amerigroup offers services from many different kinds of providers who provide other medically needed care. These providers are called specialists because they have training in a special

area of medicine. Examples of specialists are:

 Allergists (allergy doctors)  Dermatologists (skin doctors)  Cardiologists (heart doctors)  Podiatrists (foot doctors)  Behavioral health (mental health and substance use) providers A referral is not needed to see an in-network specialist. Out-of-network specialists will need a referral.

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GOING TO THE PRIMARY CARE PROVIDER

Your first primary care provider appointment You should call your primary care provider (PCP) to set up your first visit.

 Call your PCP for a wellness visit (a general checkup) within 90 days of enrolling in Amerigroup.

 If you have already been seeing the PCP who is now your Amerigroup network PCP, call the PCP to see if it is time for you to get a checkup. If it is, set up a visit with your PCP as soon as you can.

 If you want our help setting up your first visit. Just call Member Services at 1-800-600-4441.

By finding out more about your health now, your PCP can take better care of you if you get sick.

How to make an appointment It is easy to set up a visit with your PCP.

 all the WW’s office. The phone number is on your Amerigroup /D card.

 Let the person you talk to know what you need (for example, a checkup or a follow-up visit).

 Tell the WW’s office if you are not feeling well. This will let them know how soon you need to be seen.

If you need help, call Member Services. We will help you make the appointment.

Wait times for appointments We want you to be able to get care at any time. When your WW’s office is closed͕ an answering service will take your call. If it is not an emergency, someone should call you back within 30 minutes to tell you what to do. Talk to your PCP and set up an appointment. You will be able to see the PCP as follows.

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When you go to your WW’s or specialist’s office for your appointment͕ you should not have to wait more than 45 minutes to be seen, including time in the waiting room and examination room, unless your provider is delayed. Your PCP or specialist may be delayed if he or she needs to work in an urgent case. If this happens, you will be told right away. If your PCP or specialist expects the wait to be more than 90 minutes, you will be offered a new appointment.

What to bring when you go for your appointment

When you go to your WW’s office for your visit͕ be sure you bring:

 Your ID cards  Any medicines you take now  Any questions you may want to ask your PCP /f the appointment is for your child͕ be sure you bring your child’s:

 ID cards  Shot records  Any medicine he or she takes now

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How to get to a doctor’s appointment or to the hospital Members age 16 and older can call Southeastrans toll free for help with getting a ride to medically

needed appointments and treatments. Call:

 1-866-430-1101 for reservations  1-866-430-1101 and press option 2 for ride assistance You can also call Member Services for help. These services can be in or out of the community where you live.

If you have an emergency and need transportation, call 911 for an ambulance.

 Be sure to tell the hospital staff you are an Amerigroup member.

 Get in touch with your PCP as soon as you can so your PCP can:

- Arrange your treatment

- Help you get the needed hospital care Disability access to Amerigroup network providers and hospitals Amerigroup network providers and hospitals help members with disabilities get the care they need.

Members who use wheelchairs, walkers or other aids may need help getting into an office. If you need

a ramp or other help:

 Dake sure your provider’s office knows this before you go there. This will help them be ready for your visit.

 Call Member Services if you want help talking to your doctor about your special needs.

WHAT DOES MEDICALLY NECESSARY MEAN?

Your primary care provider (PCP) will help you get the services you need that are medically necessary.

Medically necessary health services:

 Are given by doctors and other providers and considered to be the standard of care  Wrevent or treat illness͕ help find out what’s making you feel bad or find out what’s causing your pain  Should be person centered and specific to your condition  Should not cost more than an alternative service or treatment recommendation  Have been approved by the Food and Drug Administration (FDA)  Are not excluded from the Louisiana Medicaid covered benefits and services

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The Amerigroup medical director, in talking with the Medicaid medical director, may decide to approve services on a case-by-case basis. The Amerigroup Medical director will request any exceptions to these exclusions in writing from the Medicaid Medical director.





UTILIZATION MANAGEMENT NOTICE

Sometimes, we need to make decisions about how we pay for care and services. This is called Utilization Management (UM). All utilization management (UM) decisions are based solely on a member’s medical needs and the benefits offered. The Amerigroup policies do not support the underuse of services through our UM decision guide. Practitioners and others involved in UM decisions do not receive any type of reward for denial of care or coverage.

YOUR HEALTH CARE ENEFITS

Your covered services Here is a summary of the health care services and benefits Healthy Louisiana covers when you need

them. Your primary care provider (PCP) will either:

 Give you the care you need  Refer you to a provider who can give you the care you need In some cases, your PCP may need to get prior approval from Amerigroup before you can receive a benefit. Your PCP will work with us to get approval.

If you have a question or are not sure if we offer a certain benefit or if there are coverage limits, you can call Member Services for help.

Here is a list of the services covered under Amerigroup.

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Extra Amerigroup benefits Amerigroup covers extra benefits eligible members cannot get from fee-for-service Medicaid. These extra benefits are called value-added services. We offer the following:  Free adult dental care

- Oral exam every six months

- X-rays once a year

- Teeth cleaning every six months

- Tooth extraction and fillings* *Limited to $500 total benefit per year To make an appointment or find a dentist near you, call DentaQuest at 1-844-234-9835 (TTY 1-800-466-7566)  Free adult vision care

- Eye exam once a year

- Glasses (frames and lenses) once a year

- $40 allowance toward the cost of nonstandard glasses once a year To make an appointment or find an eye doctor near you, call Superior Vision (formerly known as Block Vision) at 1-800-787-3157 (TTY 1-800-735-2258)  Healthy Rewards: dollars put onto a gift card when you go to doctor visits and screenings

- $20 incentive for yearly well-child visits from birth through age 9

- $25 incentive for yearly well-child visits for ages 10-20

- $15 for yearly adult-wellness visits

- $10 for diabetic screening

- $10 for sexually transmitted infection screening

- $5 for getting a flu shot Sign up today. Call 1-877-868-2004 or visit www.myamerigroup.com/HealthyRewards to enroll.

 Programs and incentives for pregnant women and new moms

- Up to $75 in gift cards for pregnant members and new moms with our Taking Care of Baby and Me program

- Free portable crib or infant car seat for going to 7 or more prenatal doctor visits

- Warm Health, a program for eligible pregnant members to get tips on how to have a healthy pregnancy. Eligible new moms will also get tips on caring for her new baby.

- In-home postpartum visits for new moms unable to get to the doctor office

- Circumcisions for boys 29 LA-MHB-0018-16 Updated 05/16  Healthy lifestyle and weight management programs:

- Booster seat after completing required well-child visits

- Free Boys & Girls Club membership for eligible members ages 6-18

- Free Weight Watchers** meetings for eligible members age 18 and older  Community outreach and support: Helping you access care and services beyond what is traditionally covered by the plan.

- Outreach events in the community at set times  Free community back-to-school drives  Free community baby showers  Community health educators  Community diaper drives

- Up to 350 additional minutes and unlimited texts every month for your SafeLink®+ phone for eligible members

- Low copays for over-the-counter medicine with a prescription from a doctor

- Healthy Families nutrition and fitness program for qualified families

- 24-hour Nurse HelpLine to answer your health questions day or night

- Up to eight hours of respite services each month for caregivers  Online and mobile resources:

- Amerigroup Community Resource Link: Need help finding housing, rides, work or more?

Amerigroup Community Resource Link is a site where you can search for free or low-cost local services. This easy to use search tool can help you find services and resources in your area. You ũust have to enter your /W code and select the type of service you’re looking for. /t’s that easy͊ To learn more, visit www.myamerigroup.com/LA and select Community Resources or call 1-800-600-4441.

- Amerigroup mobile app: Check your symptoms, find a doctor and more from your smartphone

- Inhaler sensor for members with asthma to track use of asthma medicine  Online Peer Support, offered through Big White Wall:

Online Peer Support connects you with others who might be experiencing the same challenges you are. Online Peer Support offers support groups and resources for people living with anxiety,

depression, diabetes and other health conditions. With Online Peer Support, you get:

- 24/7 support from people living with similar health conditions

- A safe͕ private environment where you’re in control of who sees what

- Access to support on your mobile phone or online ** Weight Watchers is the registered trademark of Weight Watchers International, Inc.

+ SafeLink Wireless® is a Lifeline-supported service. Lifeline is a government benefit program. Only those who qualify may enroll in ifeline. /t can’t be transferred. /t is limited to one per household. You may need to show proof of income or that you take part in the program to enroll.

We give you these benefits to help keep you healthy.

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If this describes how you feel or act, you might need behavioral health services. We can help find out what services and treatment you need. Here are some signs or symptoms of behavioral health

problems:

 Eating or sleeping too much or too little  Pulling away from people and usual activities  Having low or no energy  Feeling numb or like nothing matters  Having unexplained aches and pains  Feeling helpless or hopeless  Smoking, drinking or using drugs more than usual  Feeling unusually confused, forgetful, on edge, angry, upset, worried or scared  Yelling at or fighting with family and friends  Experiencing severe mood swings that cause problems in relationships  Having persistent thoughts and memories you can’t get out of your head  Hearing voices or believing things that are not true  Thinking of harming yourself or others  Inability to perform daily tasks like taking care of your kids or getting to work or school

We can help you if:

 You have an alcohol or drug addiction  You have a gambling problem  You have depression, anxiety, bipolar disorder, schizophrenia or any other mental health diagnosis  You use drugs such as heroin or methamphetamine  You have children and have a substance use problem  Your child gets services from the Department of Family and Child Services or the Office of Youth Development and your child doesn’t qualify for specialinjed mental health services  You are pregnant and have any of the mental health, alcohol and substance use issues listed above  You are in need of permanent supportive housing  You have a gambling problem We can help your child if he or she has a mental health or substance use problem and receives services from the Department of Child and Family Services or the Office of Youth Development.

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Families Helping Families Serving Acadia, Evangeline, Iberia, Lafayette, 1-800-378-9854 of Acadiana Region 4 St. Landry, St. Martin and Vermilion parishes (Acadiana area) Families Helping Families Serving Allen, Beauregard, Calcasieu, 1-800-894-6558 of Southwest Louisiana Cameron and Jefferson Davis parishes Region 5 (Southwest area) Families Helping Families Serving Avoyelles, Catahoula, Concordia, 1-800-259-7200 Region 6 (Central LA Grant, LaSalle, Rapides, Vernon and Winn area) parishes Families Helping Families Serving Bienville, Bossier, Caddo, Claiborne, 1-877-226-4541 Region 7 (Northwest Desoto, Natchitoches, Red River, Sabine and area) Webster parishes Families Helping Families Serving Caldwell, East Carroll, Franklin, 1-888-300-1320 of Northeast Jackson, Lincoln, Madison, Morehouse, Louisiana, Inc. Ouachita, Richland, Tensas, Union and West Region 8 (Northeast Carroll parishes area)

–  –  –

Child Protection The Child Protective Services program looks 1-855-4LA-KIDS Investigation, Child into reports of child abuse and neglect. The 1-855-452-5437 Welfare program provides helpful services to Department of Children children and families.



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