No out-of-network coverage unless preauthorized in writing by ConnectiCare. Also, this information is not intended to imply that services or treatments described in the information are covered benefits under yourplan. Use our online Provider Portal or call 1-800-950-7040. You have the right to be treated with dignity, respect, and fairness at all times. Our goal is to be the best healthcare sharing program on the planet and to providean AWESOME*experience, every time! Solutions. (SeeOther Benefit Information). Emergency care and out-of-area urgently needed services are covered under the Prime and Custom Plans, anytime, anywhere (worldwide). 1-1/2 times your annual salary paid to your beneficiary in the event of your death. drug, biological or venom sensitivity. Most plans exclude purely dental services, including oral surgery, but benefits vary by employer. The admitting physician is responsible for preauthorizing elective admissions five (5) working days in advance. If there are unusual and extraordinary circumstances, or the enrollees PCP is unavailable or inaccessible, the enrollee may seek urgent care treatment at the nearest facility. By contracting with this network, our members benefit from pre-negotiated rates and payment processes that lead to a much smoother . To verify eligibility for services, request to see the member's current ID card. You have the right to get a summary of information about the appeals and grievances that members have filed against our plan in the past. Answer 4. Go > Check provider status Research practitioners and facilities to view their participation status in our provider networks. This includes information about our financial condition, about our plan health care providers and their qualifications, about information on our network pharmacies, and how our plan compares to other health plans. Simply call (888) 371-7427 Monday through Friday from 8 a.m. to 8 p.m. (Eastern Standard Time) and identify yourself as a health plan participant accessing PHCS Network for Limited Benefit plans. PROVIDER PORTAL LOGIN REGISTER NOW Electronic Options: EDI # 59355 Eligibility (270/271) Bill Status (276) Bill Submission (837) For technical assistance with EDI transactions, please contact Change Healthcare at 1-800-845-6592. When scheduling your appointment, specify that you have access to the PHCS Network throughthe HD Protection Plus Plan, confirm the providers current participation in the PHCS Network, their address and thatthey are accepting new patients. Admission to a SNF for rehabilitation, in the absence of a hospitalization or acute episode of illness, requires preauthorization and is subject to medical necessity review. The following is a description of all product types offered by ConnectiCare, Inc. and its affiliates. Remember you will only need your registration code this one time to set up your account. Follow the plans and instructions for care that they have agreed on with practitioners. Coverage for medical emergencies without preauthorization. Optional Life Insurance *. Use the My Plan tab on the main website page to register for online access to your claims, plan document, EOBs and additional items. ThriveHealth STM - Health Depot Association Thank you, UHSM, for the excellent customer service experience and the great attitude that is always maintained during calls. Information is protected as stated in ConnectiCares policies. No referrals needed for network specialists. Members under 12 years of age call PHC's Care Coordination Department at (800) 809- 1350. How do I know if I qualify for PHCS insurance? Be treated with respect and recognition of your dignity and right to privacy. What insurance carrier is PHCS? - InsuredAndMore.com For Medicaid managed The plan will release your information, including your prescription drug event data, to Medicare, which may release it for research and other purposes that follow all applicable Federal statutes and regulations. You have the right to ask someone such as a family member or friend to help you with decisions about your health care. (SeeOther Benefit Information). To get this information, call Member Services. Minimal hold time Fast Claim Processing and Payment Clear Explanation of Benefits Clear Benefit Descriptions Eligibility and Benefits | ConnectiCare ConnectiCare eligible members shall not be discriminated against with respect to the availability or provision of health services based on an enrollee's race, sex, age, religion, place of residence, HIV status, source of payment, ConnectiCare membership, color, sexual orientation, marital status, or any factor related to an enrollee's health status. (SeeOther Benefit Information). No prior authorization requirements. You can sometimes get advance directive forms from organizations that give people information about Medicare. Performance Health Out of network benefits will apply when receiving care from non-participating providers. The PHCS Network includes nearly 4,400 hospitals, 79,000 ancillary care facilities and more than 700,000 healthcare professionals nationwide. Our plan must obey laws that protect you from discrimination or unfair treatment. At a minimum, this statement must: Clarify any differences between institution-wide conscientious objections and those that may be raised by the individual physician; PHCS PPO Network - Health Depot Association It is not medical advice and should not be substituted for regular consultation with your health care provider. Describe the range or medical conditions or procedures affected by the conscience objection; For benefit-related questions, call Provider Services at 877-224-8230. If you are a PCP, please discuss your provisions for after-hours care with your patients, especially for in-area, urgent care. Delays and failures to render services due to a major disaster or epidemic affecting our facilities or personnel. The legal documents that you can use to give your directions in advance in these situations are called "advance directives." You will now leave the AvMed web site once you click the "I agree" button. PHCS www.multiplan.com (Please select the provider network listed on your ID card) Our contract with you for participation in the ConnectiCare program requires you to provide coverage 24-hours, seven days a week, including weekends and holidays. To begin the precertification process, your provider(s) should contact Services or supplies that are new or recently emerged uses of existing services and supplies, are not covered benefits, unless and until we determine to cover them. You can reference your plan document for the complete list. You must be told in advance if any proposed medical care or treatment is part of a research experiment, and be given the choice of refusing experimental treatments. Please refer to your Membership Agreement, Certificate of Coverage, Benefit Summary, or other plan documents for specific information about your benefits coverage. For the PHCS Network, 1-800-922-4362 For PHCS Healthy Directions, 1-800-678-7427 For the MultiPlan Network, 1-888-342-7427 For the HealthEOS Network, 1-800-279-9776 For language assistance, please call 1-866-981-7427 For TTY/TTD service, please call 1-866-918-7427 Search for a provider > Advance directives are written instructions, such as living will, durable power of attorney for health care, health care proxy, or do not resuscitate (DNR) request, recognized under state law and relating to the provision of health care when the individual is incapacitated and unable to communicate his/her desires.