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1. How do I use my ID card?
Each month that you are eligible for Medicaid, you will receive a Medicaid card from the State of Michigan which shows that you are eligible for Medicaid coverage. When you get your Medicaid card, check to see if everything is right. At the time of enrollment with Priority Health you will receive a Priority Health ID card that lists the name and phone number of your primary care physician (PCP). This is the doctor you need to call when you have questions about your health or need a medical appointment. When you get your ID card, check to see if everything is right. If you lose your ID card or have a problem with it or want to change the doctor who is listed on the card, call our Customer Service Department at 1 888 975-8102. Each member of your family who has Medicaid will get a separate Priority Health ID card. You will not receive a new Priority Health card every month. Take your Priority Health ID card with you each time you visit your doctor or go to a medical appointment or get medical services. Here are some examples of when you need to show your Priority Health ID card:
2. I'm in the Plan, now what do I do? Here is what you need to do to get the most from the Plan:
3. How do I choose a doctor? The Find a Doctor directory lists all of the doctors you can choose from. We will help you find a doctor you like by asking you questions such as who you have seen before, where you live, and which hospital you want to use. It is important that you establish and maintain a good relationship with your PCP and other health professionals. If you cannot maintain a good relationship with your doctors, we can ask you to choose another PCP, select another PCP for you, and arrange for your PCP to refer you to another participating provider, or ask the State to disenroll you from Priority Health. For help in picking a doctor call Priority Health Customer Service at 888 975-8102 or e-mail our Customer Service department. 4. How do I change doctors? You can change your doctor by calling our Customer Service Department at 888 975-8102. You can also e-mail our Customer Service department. The Primary Care Physician change will take effect within 30 days of your request. If you are changing a child's PCP to a pediatrician, the change will take effect the day that we receive the request. Do not go to the new doctor until the change has been made. You will receive a new Priority Health ID card with the name of your new doctor. 5. How do I change health plans? If you find that Priority Health is not the right plan for you, you must follow these steps to change to a different health plan: If you have enrolled with Priority Health within the past 90 days:
If you have been enrolled with Priority Health for more than 90 days:
If you have Medicare or an HMO as your primary insurance:
6. How can I be sure about quality? We work hard to make sure you get the best service possible. Here are some examples of what we have done:
7. What if I need to see a specialist or have medical tests? Talk to your Primary Care Physician first. Your doctor will work hard to keep you healthy. If you need care or special tests that your doctor cannot give, your doctor will arrange for you to see a specialist who is a Priority Health doctor. Don't see a specialist without the okay of your doctor or you may have to pay the bill. Priority Health must also approve a referral to a provider such as a physical therapist who is outside our network. If you are a new Priority Health member and are seeing a specialist, call the doctor listed on your ID card for approval to keep seeing the specialist. You do not have to get your doctor's okay for these services:
8. What if I need a ride to my appointments? Priority Health will help you get a ride to your medical appointments. You can get help in getting a ride if:
The rides you need must be approved in advance. For routine appointments such as a doctor's appointment that is not an emergency, you must ask for a ride at least 5 days before your appointment date. If you need urgent medical care and must see a doctor sooner than that, we will also help you with this. First make your appointment and then call us. To use our transportation, you must have no other way to get to your medical appointment. Call toll-free 888 975-8102 or 616 464-8102 for more information or help to arrange a ride. You will be asked the following questions:
9. When should I go to the emergency room? For most problems, call your doctor, even at night or on weekends. Only go to the Emergency Room when it is an emergency. The Emergency Room is set up for problems that can seriously harm your health or problems that are a matter of life or death. Your doctor is the one who needs to see you when you need care that is not an emergency. Urgent care When you have a problem that is serious (but is not as bad as an emergency) such as cuts, bumps or sprains, call your doctor, even at night or on weekends or holidays. Your doctor will give you instructions on what to do, or where to go for treatment. Your doctor must approve a visit to an Urgent Care Center. If you go without your doctor's approval, the Urgent Care Center may refuse to see you or require that you pay for the visit. Emergency care An emergency is any condition that may cause death or injury if not treated right away. For an emergency, go right away to the emergency room or call 911 immediately. Examples of emergencies (call 911 or seek care immediately): Chest pain or heart attack Convulsions Drug overdose Severe burns Stroke Severe bleeding Unconsciousness Examples that are not emergencies (call your doctor): Sore throat Headache Colds or flu Earache Low back pain Stomachache Minor cuts or bruises Vaginal discharge Sprains or strains When the problem is not an emergency, call your doctor's office anytime day or night. When you need an ambulance In an emergency, dial 911 to reach an ambulance. An ambulance will be sent to take you to the hospital if you have a very serious illness or injury. 10. What if I am out of town when I get sick? When you are more than two hours from your doctor's office and you get sick:
11. What do I do if I move? If you move, call your local Family Independence Agency office so they can change the State's records. Also call our Customer Service Department at 1 888 975-8102. We want to know your new address. We will be happy to help you find a new doctor nearer to your house if necessary. 12. What if there are changes in my family? If the following changes apply to any member of your family enrolled with Priority Health please notify your FIA Caseworker and the Priority Health Customer Service Department at 888 975-8102.
13. What if my Medicaid coverage ends? Priority Health will no longer pay your bills. 14. What if I get a bill? You should not get a bill for services that your doctor and Priority Health have approved. If you get a bill, call or write us. We will ask you for your Medicaid number. Call: 888 975-8102 OR Write: Priority Health Government Programs, Inc. Customer Service Department MS 2105 PO Box 269 Grand Rapids, MI 49501-0269
Last modified
12/14/07
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