«Member Handbook: Integrated Health Services For Physical and Behavioral Health Services Amerigroup Louisiana LA-MHB-0018-16 05.16 1-800-600-4441 (TTY ...»
A letter welcoming you to the Taking Care of Baby and Me program A self-care book with information about your pregnancy; you can also use this book to write down things that happen during your pregnancy The Taking Care of Baby and Me reward program brochures; it tells you how to get your gift cards for getting prenatal care A helpful tips brochure with information on:
- Enrolling in Text4baby ʹ a free text-messaging service
- Centering pregnancy group visits
- Delivering a full-term baby
- Getting a flu shot ʹ when to get one
- The Warm Health educational support program and how you can enroll While you are pregnant, you need to take good care of your health. You may be able to get healthy food from the Women, Infants and Children (WIC) program. Member Services can give you the phone number for the WIC program close to you. Just call us.
When you have a new baby
When you deliver your baby, you and your baby may stay in the hospital at least:
Forty-eight hours after a vaginal delivery Seventy-two hours after a Cesarean section (C-section) You may stay in the hospital less time if your PCP or OB-'YE and the baby’s provider see that you and your baby are doing well. If you and your baby leave the hospital early, your PCP or OB-GYN may ask you to have an office or in-home nurse visit within 48 hours.
After you have your baby, you must:
Call Amerigroup Member Services as soon as you can to let your care manager know you had your baby. We will need to get details about your baby.
After you have your baby Amerigroup will send you the Taking Care of Baby and Me postpartum education package after you
have your baby. It will include:
A letter welcoming you to the postpartum part of the Taking Care of Baby and Me program A baby-care book with information about your baby’s growth͖ you can also use this book to write down things that happen during your baby’s first year Taking Care of Baby and Me reward program brochure about going to your postpartum visit A brochure about postpartum depression You’ll also get a call from our postpartum outreach team to see how you’re doing. The team can help you schedule your postpartum visit 21 to 56 days after you have your baby. The team may also call with reminders.
Disease Management Centralized Care Unit Amerigroup has a Disease Management Centralized Care Unit (DMCCU) program. This is a team of licensed nurses and social workers, called DMCCU case managers, who can educate you about your condition and help you learn how to manage your care. Your primary care provider (PCP) and our team of DMCCU case managers will assist you with your health care needs.
In addition to providing support for these conditions, DMCCU case managers focus on providing an inclusive care management approach to help when you have more than one health issue. These are called comorbid conditions.
DMCCU case managers work with you to create health goals and help you develop a plan to reach
them. As a member in the program, you’ll benefit from having a case manager who:
Listens to you and takes the time to understand your specific needs Helps you create a care plan to reach your health care goals Gives you the tools, support and community resources that can help you improve your quality of life Provides health information that can help you make better choices Assists you in coordinating care with your providers As an Amerigroup member enrolled in the DMCCU program, you have certain rights and responsibilities.
You have the right to:
Have information about Amerigroup; this includes all Amerigroup programs and services as well as our staff’s education and work eǆperience͖ it also includes contracts we have with other businesses or agencies Refuse to take part in or disenroll from programs and services we offer Refuse to take part in or disenroll from program and services we offer on religious grounds; in the case of a child, the parent or guardian can refuse Know which staff members arrange your health care services and who to ask for a change Have Amerigroup help you to make choices with your doctors about your health care Learn about all DMCCU-related treatments; these include anything stated in the clinical guidelines, whether covered by Amerigroup or not; you have the right to discuss all options with your doctors Have personal and medical information kept private under HIPAA; know who has access to your information; know what Amerigroup does to keep it private Be treated with courtesy and respect by Amerigroup staff File a complaint with Amerigroup and be told how to make a complaint; this includes knowing about the Amerigroup standards of timely response to complaints and resolving issues of quality Get information that you can understand Amerigroup covers all Louisiana state required Medicaid services. But, if you feel there are services not covered because of moral or religious objections, you may contact the enrollment broker for information. For information on how to get these services, call 1-855-229-6848 (TTY 1-855-526-3346).
If you have one of these conditions or would like to know more about our DMCCU, please call 1-888-830-4300, Monday through Friday from 8:30 a.m. to 5:30 p.m. Ask to speak with a DMCCU case manager. Or you can leave a private message for your case manager 24 hours a day.
You can also visit our website at www.myamerigroup.com/LA. You can call DMCCU if you would like a copy of DMCCU information you find online.
Medicines Amerigroup has a list of preferred drugs. Your PCP or specialist can choose from this list of drugs. This list is called a Wreferred Drug ist ;WDͿ. /t’s part of the Amerigroup formulary. This is available on our
member website. The covered medicines on the PDL include:
Prescriptions Certain over-the-counter medicines If you have questions about your drug coverage, call Member Services at 1-800-600-4441.
Copays A copay is the amount you pay for a drug if you have Amerigroup.
*There are no copays for children, pregnant women, family planning supplies, members in the hospital, or Native American or Alaska Native members.
Things to remember about the PDL:
You, your providers and your pharmacy have access to this drug list.
Your PCP or specialist should use this list when he or she writes a prescription.
Certain medicines on the PDL need prior approval.
Medicines that are not on the PDL need prior approval.
You can get prescriptions filled at any Amerigroup network pharmacy. Our network includes most major chains and many independent pharmacies.
For a complete list of Amerigroup network pharmacies, go to www.myamerigroup.com/LA. You may also call Member Services to request a copy of the pharmacy directory, which is updated at least annually. The online version is updated at least weekly.
To get a prescription filled, follow these steps:
1) Take the written prescription from your provider to the pharmacy, or your provider can call in the prescription. Certain medicines require a written prescription.
2) Show your Amerigroup member ID card and Medicaid ID card to the pharmacy.
3) If you use a new pharmacy, tell the pharmacist about all of the medicines you are taking; include over-the-counter medicines, too.
/t’s good to use the same pharmacy each time. This way͕ your pharmacist:
Will know all the medicines you are taking Can watch for problems that may occur
SPECIAL AMERIGROUP SERVICES FOR HEALTHY LIVINGHealth information Learning more about health and healthy living can help you stay healthy. Here are some ways to get
Ask your primary care provider (PCP).
Call us. Amerigroup On Call is available 24 hours a day, 7 days a week to answer your questions.
They can tell you:
- If you need to see your PCP
- How you can help take care of some health problems you may have Health education classes Amerigroup works to help keep you healthy with our health education programs. We can help you find classes near your home. You can call Member Services to find out where and when these classes are held.
Some of the classes include:
Our services and how to get them Childbirth Infant care Parenting Pregnancy Quitting cigarette smoking Protecting yourself from violence Other classes about health topics Some of the larger medical offices (like clinics) in our network show health videos. They talk about immunizations (shots), prenatal care and other important health topics. We hope you will learn more about staying healthy by watching these videos.
Community events Amerigroup sponsors and participates in special community events and family fun days where you can
get health information and have a good time. You can learn about topics like:
Healthy eating Asthma Stress You and your family can play games and win prizes. People from Amerigroup will be there to answer your questions about your benefits, too. Call Member Services to find out when and where these events will be.
Domestic violence Domestic violence is abuse. Abuse is unhealthy. Abuse is unsafe. It is never OK for someone to hit you.
It is never OK for someone to make you afraid. Domestic violence causes harm and hurt on purpose.
Domestic violence in the home can affect your children, and it can affect you. If you feel you may be a victim of abuse, call or talk to your PCP. Your PCP can talk to you about domestic violence. He or she can help you understand you have done nothing wrong and do not deserve abuse.
Safety tips for your protection:
- If you are hurt, call your PCP.
- Call 911 or go to the nearest hospital if you need emergency care. Please see the section Emergency care for more information.
- Have a plan on how you can get to a safe place ;like a women’s shelter or a friend’s or relative’s home).
- Pack a small bag and give it to a friend to keep until you need it.
If you have questions or need help:
Call Amerigroup On Call at 1-866-864-2544.
Call the National Domestic Violence hotline number at 1-800-799-7233 (TTY 1-800-787-3224).
Minors For most Amerigroup members under age 18 (minors), our network doctors and hospitals cannot give them care without a parent’s or legal guardian’s consent. This does not apply if emergency care is needed.
Warents or legal guardians also have the right to know what is in their child’s medical records, except
for information about the following:
Birth control Sexually transmitted infections (STIs) Minors can ask their PCP not to tell their parents about their medical records, but the parents can still ask the PCP to see the medical records. /f the providing doctor feels it is in the minor’s best interest͕ he or she can decide to tell the parent or legal guardian about the minor’s treatment.
Emancipated minors may make their own decisions about their medical care and the medical care of their children. Parents no longer have the right to see the medical records of emancipated minors.
Parents or guardians have the right to refuse medical service, diagnoses or treatment for their child on moral or religious grounds.
MAKING A LIVING WILL (ADVANCE DIRECTIVES)Emancipated minors and members over 18 years old have rights under advance directive law.
It may be a hard subject to talk about, but its important to talk about the care you want with your family and provider. Then you can put your wishes in writing. This way, your family will not have to guess or make hard decisions about what care you want if you are unable to speak for yourself.
You may have serious concerns about the care you receive such as:
Your medical and spiritual needs will be by health care provider The quality of your medical care Spending long periods of time time on life support Emotional finalcial stress end-of-life can cause your family An advance directive will give you, your family and your provider the change to talk about your medical, physical and spiritual needs when it comes to end-of-life care.
There are two main types of advance directives:
A living will ʹ This lets you state what kind of care you want and don’t want A durable power of attorney ʹ This lets you name a person to make decisions for your when you can’t.
If you wish to sign a living will or durable power or attorney, you can:
Ask your primary care provider (PCP) for a living will or durable power of attorney form.
Fill out the form by yourself, or call us for help.
Take or mail the completed form to your PCP or specialist. Your PCP or specialist will then know what kind of care you want to get.
You can change your mind any time after you have signed a living will or durable power of attorney.
Call your PCP or specialist to remove the living will or durable power of attorney from your medical record.
Fill out and sign a new form if you wish to make changes in your living will or durable power of attorney.
ADVANCE DIRECTIVE FOR MENTAL HEALTH TREATMENTA mental health advance directive is a document that says what kind of medical care you want to get if you aren’t able to make a decision for yourself.
This will help your family or caregivers know what treatment you want or don’t want from psychiatrists or other mental health providers. This will also tell your providers and health plan who you chose to make care decisions for you.