Read full article. Tesla dropped a bomb on the auto market with huge price cuts last week, and now Wall Street is catching up with post-game mmis conduent, if you will. The Company may collect https://forbiddenplateauroadassociation.com/amerigroup-merger-with-wellpoint/12459-cognizant-technical-interview-questions-for-cse.php of Personal Information listed in Cal. In preparation for the transition to a new Fiscal Agent system, including a new provider portal known as MESA, Provider Portal workshop webinars are available throughout October to help providers become familiar with navigating the cinduent system. We deliver real results we are proud of while condkent respectfultransparentand flexible.
Tools Authorization Lookup Clinical Guidelines. Corporate Information Company Overview Careers. Newsroom Newsroom. Who are you? Go to Login. Register for an Account. Providers We partner with providers to develop and deliver high-quality, cost-effective health care solutions. Getting Started Non-Wellcare Providers. 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 and stress. You and your family can play games and win prizes. 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. Disease management Amerigroup has disease management programs to help you better know and manage your chronic health problem. Your PCP and our team will help you with your health care needs. Licensed nurses or social workers called Disease Management Care Managers support you over the phone.
They help teach you how to deal with chronic conditions. Care managers also help you better know your condition and will work with you to set up a plan to address your health care needs. Earning NCQA accreditation for disease management shows our continued commitment to help you get quality health care coverage.
As an Amerigroup member enrolled in disease management, you have certain rights and responsibilities. You have the right to: Have information about Amerigroup. This includes programs, services and our staff s education and work experience. It also includes contracts we have with other businesses or agencies. Refuse to take part in or disenroll from programs and services we offer. Know which staff members arrange your health care services and who to ask to change your assigned care manager.
Have Amerigroup help you to make choices with your doctors about your health care. These include anything stated in the clinical guidelines, whether covered by Amerigroup. 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 ensure privacy.
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. Have Amerigroup act as an advocate for you if needed. You have the responsibility to: Listen to and know the effects of accepting or rejecting health care advice.
Provide Amerigroup with information needed to carry out our services. Tell Amerigroup and your doctors if you decide to disenroll from the disease management program. If you have one of these conditions or would like to know more about our disease management programs, please call Monday through Friday a.
Eastern time. Ask to speak with a Disease Management care manager. You can also visit our website at Durable medical equipment Your durable medical equipment DME benefits are arranged through Amerigroup. Your PCP must get prior authorization for these benefits. Case management services Amerigroup has case managers to help you understand and care for your condition.
Your PCP will help you with your special condition, but it is also important that you learn to care for yourself. During our welcome call to you, we will find out if you or your child needs case management services.
If you need case management services, we will refer you to a case manager. Your case manager will work with you and your PCP to set up a plan of care for your condition.
If you think you need case management services, please call Member Services, and we will refer you to the Case Management Department. Our case managers may also call you if: Your PCP thinks you would benefit from the program You are discharged from the hospital and need some follow-up coordination of care We see that you are going to the ER frequently for nonurgent care that can be managed by your PCP You call our hour Nurse HelpLine and you need additional follow up for ongoing care Your case manager can help with: Setting up health care services Referrals and prior authorizations Reviewing your plan of care as needed We may also call you to participate in our Complex Case Management program.
Complex case management is for members with serious physical or mental health conditions that need more care coordination. We use data to determine which members are eligible for this program.
See the section Amerigroup Health Care Benefits for more information on case management services. We want to know what you like and do not like. Your ideas will help us make Amerigroup better. You can also ask for information about the program. Amerigroup also offers members a way to be aware of health care safety. You can get information on all of our network hospitals at This website will help you compare the care these hospitals offer.
Domestic violence Domestic violence is abuse. Abuse is unhealthy. Abuse is unsafe. It s never OK for someone to hit you. It s never OK for someone to make you afraid.
Domestic violence causes harm and hurts you 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 to deserve abuse.
Safety tips for your protection: If you are hurt, call your PCP. Call 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 or relative s home. Always keep a small bag packed.
Give your bag to a friend to keep for you until you need it. If you have questions or need help, please call our Nurse HelpLine at or call the National Domestic Violence hotline number at MINORS For most Amerigroup members under age 18, the Amerigroup network of doctors and hospitals cannot give care without their parent s or legal guardian s consent. This does not apply if emergency care is needed. Parents or legal guardians also have the right to know what is in their child s medical records.
Members under age 18 can ask their doctor not to tell their parents about their medical records unless the parents ask the doctor to see the medical records. These rules do not apply to emancipated minors. Members under age 18 may be emancipated minors if they: Are married Are declared emancipated by a court order Emancipated minors may make their own decisions about their medical care and the medical care of their children. Parents do not have the right to see the medical records of emancipated minors.
Emancipated minors can sign a paper called a durable power of attorney, too. This paper will let him or her name a person to make decisions when he or she cannot make them. Ask your PCP about these forms.
T Making a living will advance directive Emancipated minors and members over 18 years old have rights under the Georgia Advance Directive for Health Care Act. You have the right to: Control all aspects of your care and treatment Refuse the treatment you don t want Get the care you want Ask for medical treatment to be withdrawn There are three parts to the Georgia Advance Directive for Health Care Act: Part one lets you choose a person to make decisions for you when you cannot make them yourself; this person is called a health care agent.
Part two lets you make choices about getting the care you want if you are too sick to decide for yourself. Part three lets you choose someone you appointed as your guardian if a court says this is necessary. You can change your mind at any time. If you do, call your PCP to remove the form from your medical record. Fill out and sign a new form if you wish to make changes.
Remember to: Give a copy of the completed form to your health care agency, your family and your physician Keep a copy at home in a place where it can be easily found if needed Look at the form regularly to make sure it says what you want You can get a copy of the Georgia Advance Directive for Health Care Act by going online to You can ask for a copy of this form and its instructions at no cost by writing to the Georgia Division of Aging Services at: Georgia Division of Aging Services 2 Peachtree St.
NW Suite Atlanta, GA If you have questions or need more information, call the Division s Information and Referral Specialist at If you signed an advance directive and believe that a doctor or hospital has not followed the instructions in it, you can file a complaint.
Possible subjects for grievances include: Quality of care or services provided Rudeness of a provider or employee Failure to respect your rights All levels of grievances must be completed within 90 calendar days. You will receive a notice for failure to act within the required time frame. Complaints or grievances do not relate to decisions to deny or limit services. Please call Member Services if you have questions or concerns about services or network providers.
Level 1 Grievance Amerigroup will try to solve your complaint on the phone. If we cannot take care of the problem during your call, you can file a Level 1 grievance. You must send written approval to have a representative file a grievance for you. To file a grievance, you or your representative can call, fax or send us a letter. You may call Member Services for help with writing a letter. Amerigroup will look into your grievance when we get it. We will send you a letter within 30 calendar days of when you told us about your grievance or sooner if your health condition calls for it.
This letter will tell you the decision Amerigroup makes and the reasons for our decision. We will include information on how to file a Level 2 grievance. You must write or call us with this request within 10 business days of receiving the answer to your first grievance answer.
A person who was involved in the first decision may present information to the committee or answer questions. Amerigroup will send you a letter within 10 working days to let you know we got your grievance.
We will try to find a day and time for the meeting so you can be there. We will tell you the date, time and place of the meeting at least seven calendar days ahead of time. You can bring someone to the meeting if you want to. You do not have to come to the meeting. We will send you a letter within 30 calendar days or sooner if your health condition calls for it of the meeting request to tell you what the committee decides about your grievance and the reasons for the decision.
The total time for Amerigroup to complete the total grievance process with written notification will be completed within 90 calendar days from the filing date. This is our final decision. If you, your parent, legal guardian or authorized representative file or make a complaint or grievance, Amerigroup will not hold it against you. We will still be here to help you get quality health care. Medical administrative reviews There may be times when Amerigroup says we will not pay for care that has been recommended by your doctor.
If we do this, a letter will be mailed to you and your provider for services that are not approved. This letter is called a proposed action. A proposed action is the denial or limited authorization of a requested service and includes: The type or level of service The reduction, suspension or termination of a previously authorized service The proposed action will explain how you or your doctor with your consent or a legal representative of a deceased member s estate can ask for an administrative review of the decision.
An administrative review is when you ask Amerigroup to look again at the care your doctor asked for and we said we would not pay for. You must ask for an administrative review within 30 calendar days of receiving your notice of proposed action. You may ask for the administrative review by calling Member Services toll free at. You must also send in a written request. One of our Member Services representatives can help you with your written request.
We will start working on your request when you first tell us you want an administrative review. We will send you the administrative review results within 30 calendar days from when we get your preservice administrative review request and within 45 calendar days from when we get your postservice administrative review request.
If you need a quick review because of a severe physical or mental health condition, we will respond within three calendar days. If your condition does not meet the requirements for a quick review, it will be reviewed as a standard administrative review.
We will send you our decision within 45 calendar days. The administrative review can be extended up to 14 calendar days if you or Amerigroup needs more time. We will let you know if we need more time to complete the review. You will receive a notice for failure to act within the required time frames noted above.
At any time during the administrative review process, you or your representative may: Obtain and examine a copy of the documents that will be used for review Provide additional information or facts to Amerigroup in person or in writing If you need a verbal translation, please call Member Services at TTY toll free.
Administrative reviews You, an authorized representative a person you prefer to help you , your PCP or the doctor taking care of you at the time, with your written consent, or a legal representative for a deceased member s estate can file an administrative review.
If you use a representative including your doctor , you must write a letter or complete the authorized representative form that was provided to you, telling us this person is allowed to represent you. You must file an administrative review within 30 calendar days from the date of the first letter from Amerigroup that says we will not pay for the service.
You can ask for a continuation of benefits during the administrative review process. See the Continuation of Benefits section for help. You can file an administrative review orally, but you must follow an oral filing with a written and signed Administrative Review Form. If Amerigroup does not receive a written request within 30 calendar days from the date of your oral request, the request will be closed.
You can call Member Services, and we will send you an administrative review form. Fill out the entire form, and mail it back to us at the address below. Have your doctor send us your medical information about this service.
You can send us a letter to the address below. Include information such as the care you are looking for and the people involved. This letter will let you know we got your administrative review. A doctor who has not seen your case before will look at your administrative review. He or she will decide how Amerigroup should handle your administrative review.
We will send you and your doctor a letter with the answer to your administrative review. The letter will tell you the reasons for our decision.
We will do this within 30 calendar days from when we get your preservice administrative review request and within 45 calendar days from when we get your postservice administrative review request. If there is a delay Amerigroup cannot control, more information is needed or you request a delay, we will send you a letter. The letter will tell you we need 14 more calendar days to review your administrative review. We have a process to answer your administrative review quickly if the care your doctor says you need is urgent.
Please see the section Expedited Administrative Reviews for help. If you, an authorized representative a person you prefer to help you , your PCP or the doctor taking care of you at the time, with your written consent, or a legal representative for a deceased member s estate files a medical administrative review or an appeal, Amerigroup will not hold it against you, your authorized representative or your doctor.
We will be here to help you get quality health care. At any time during the administrative review process, you or your representative may: Obtain and examine a copy of the documents used in the administrative review Provide additional information or facts to Amerigroup in person or in writing Expedited administrative reviews You, your PCP, the doctor taking care of you at the time, the person you ask to file an administrative review for you or a legal representative of a deceased member s estate can request an expedited administrative review.
You can request an expedited administrative review if you or your doctor feels that taking the time for the standard administrative review process could seriously harm your life or your health.
You can request an expedited administrative review in two ways: You can call Member Services toll free at Fax Quality Management at. We will do this within 72 hours after we get your administrative review request or sooner if your health condition calls for it. If we do not agree that your request for an administrative review should be expedited, we will call you right away.
We will send you a letter within two calendar days to let you know how the decision was made and that your administrative review will be reviewed through the standard review process. You may file a grievance if you do not agree with this decision by calling Member Services. If the decision of your expedited administrative review agrees with our first decision, an Amerigroup representative will call you. Amerigroup will also send you a letter to let you know the decision that was made and that we will not pay for the service asked for.
The letter will tell you we need 14 more calendar days to review your expedited administrative review.! RING Medicaid eligible members You, your authorized representative or a legal representative of a deceased member s estate may ask for an administrative law hearing.
You must send a letter after you have gone through the Amerigroup grievance or administrative review process. You must send a letter for an administrative law hearing. Your provider cannot ask for an administrative law hearing for you unless you name him or her as your personal representative.
At any time during the administrative law hearing process, you or your representative may: Obtain and examine a copy of the documents that will used for review Provide additional information or facts to Amerigroup in person or in writing The decision reached by an administrative law hearing will be final. You must ask for the administrative law hearing within 30 calendar days from the day we send you the administrative review decision.
You can ask for a continuation of benefits during the administrative law hearing process. See the section Continuation of Benefits for help. Their address is listed below. An administrative law judge will hold the hearing. You may speak for yourself or let a friend or family member speak for you. You may get help from a lawyer. You may also be able to get free legal help. You or your authorized representative may ask for a formal appeal committee review in writing from the state after you have gone through all of the Amerigroup administrative review processes.
You must ask for a formal appeal committee review within 30 calendar days from the date of the administrative review decision letter. You can ask for a continuation of benefits during the formal appeal committee process.
The decision reached by a formal appeal committee will be final. If coverage of a service you are receiving is denied or reduced and you want to continue that service during your administrative review, administrative law hearing or formal appeal committee, you can call Member Services to request it.
You must call to ask us to continue your benefits within 10 calendar days of when we mailed you the notice that said we wouldn t cover or pay for a service. We must continue coverage of your benefits until: You withdraw the administrative review, administrative law hearing or formal appeal committee request Ten calendar days from the date of our first decision has passed and you have not made a request to continue benefits within the calendar-day time frame if you have not requested an appeal An administrative review, administrative law hearing or formal appeal committee decision is reached and is not in your favor If a decision is made in your favor as a result of your administrative review or appeal, Amerigroup will authorize and pay for the services we said we would not cover before.
Payment reviews If you receive a service from a provider and Amerigroup does not pay for that service, you may receive a notice from Amerigroup called an Explanation of Benefits EOB. This is not a bill. The EOB will tell you: The date you got the service The type of service it was The reason we cannot pay for the service The provider, health care place or person who gave you this service will get a notice called an Explanation of Payment. If you get an EOB, you do not need to call or do anything at that time.
You may call if you want to or if your provider disagrees with the decision. You can ask Amerigroup to look again at the service we said we would not pay for. You must ask for us to do this within 30 calendar days of getting the EOB. To do this, you or your doctor can call Member Services toll free at You or your doctor can also mail your request and medical information for the service to: Administrative Review and Grievance Department Amerigroup Community Care Perimeter Center N.
You have the right to ask for a grievance. See the section Complaints, Grievances and Administrative Reviews for help. You must call Amerigroup before you can get any services in your new area unless it is an emergency. If your family size changes You should call Department of Family and Children Services if your family size changes. Do not lose your health care benefits! You could lose your benefits even if you still qualify if you do not renew.
You must renew your eligibility for Medicaid every 12 months or your child s PeachCare for Kids every 12 months. It is important to follow the instructions in this letter. For help or to find out the date you need to renew your benefits, call your local DFCS office. We want you to keep getting your health care benefits from us if you still qualify.
Your family s health is very important to us. If you are no longer eligible for Medicaid based on income, your children may be eligible for PeachCare for Kids.
How to disenroll from Amerigroup If you do not like something about Amerigroup, please call Member Services. We will work with you to try and fix the problem. If you are still not happy, you may be able to change to another health plan. You can change health plans without cause during your first 90 days of enrollment. After that, you can change health plans every 12 months. Please call Member Services for disenrollment forms and assistance. If your disenrollment request is received in the mail between the first and the 15th of the month, your disenrollment will be effective on the first day of the following month.
If your disenrollment request is received in the mail between the 16th and the 31st of the month, your disenrollment will be effective on the first day of the second month after the request was received.
For example, if your disenrollment request is received on April 15, your disenrollment will be effective May 1. If your disenrollment request is received on April 16, your disenrollment will be effective June 1. Reasons why you can be disenrolled from Amerigroup There are several reasons you could be disenrolled from Amerigroup without asking to be disenrolled.
These are listed below. If you have done something that may lead to disenrollment, we will contact you. We will ask you to tell us what happened. You could be disenrolled immediately from Amerigroup if: You are no longer eligible for Medicaid You are disenrolled by the Georgia Department of Community Health DCH You let someone else use your Amerigroup ID card You move out of the service region You are sent to prison You are placed in a long-term nursing facility, Community-based Alternative for Youth CBAY , state institution or intermediate care facility for the mentally retarded If you have any questions about your enrollment, call our Member Services department for help at TTY.
Even if your doctor told you to go, you must show your Amerigroup ID card and current Medicaid or PeachCare for Kids card to make sure you are not sent a bill for services covered by Amerigroup. You do not have to show your Amerigroup ID card before you get emergency care.
If you do get a bill, send it to us with a letter saying that you have been sent a bill. If you need help understanding this or other information in this handbook, call our Member Services department at TTY. If you have other health insurance Coordination of benefits Please call Member Services if you or your children have other insurance.
The other insurance plan needs to be billed for your health care services before Amerigroup can be billed. Amerigroup will work with the other insurance plan on payment for these services. Changes in your Amerigroup coverage Sometimes, Amerigroup may have to make changes in the way it works, its covered services or its network doctors and hospitals.
We will mail you a letter when we make changes in the services that are covered. Your PCP s office may move, close or leave our network. If this happens, we will call or send you a letter to tell you about this. You can call Member Services if you have any questions. Member Services can also send you a current list of our network doctors. How to tell Amerigroup about changes you think we should make We want to know what you like and do not like about Amerigroup.
Please call Member Services to tell us your ideas. Member Services is available Monday through Friday 7 a. These meetings are called member advisory meetings. This is a chance for you to find out more about us, ask questions and give us suggestions for improvement.
If you would like to be part of this group, call Member Services. Amerigroup also sends surveys to some members. The surveys ask questions about how you like Amerigroup. If we send you a survey, please fill it out and send it back. Our staff may also call to ask how you like Amerigroup. Please tell them what you think. Your ideas can help us make Amerigroup better. Your provider may be paid each time he or she treats you fee-for-service. Or your provider may be paid a set fee each month for each member whether or not the member actually gets services capitation.
These kinds of pay may include ways to earn more money. This kind of pay is based on different things like member satisfaction, quality of care, accessibility and availability. If you want more information about how our contracted doctors or any other providers in our network are paid, please call Member Services or write us at: Amerigroup Community Care Perimeter Center N.
Get a Medicaid Fair Hearing if you disagree with a decision Amerigroup makes about your health care coverage. This includes the right to know how Amerigroup handles, uses and gives out your PHI.
PHI is defined by HIPAA Privacy Regulations as information that: - Identifies you or can be used to identify you - Either comes from you or has been created or received by a health care provider, a health plan, your employer or a health care clearinghouse - Has to do with your physical or mental health condition, providing health care to you or paying for providing health care to you Get a current directory of doctors within the Amerigroup network.
Get information about your Amerigroup doctors and other network providers; call Member Services at Choose any of our Amerigroup network specialists after getting a referral from your PCP. Be referred to specialists who are experienced in treating disabilities if you have any chronic disabilities. Call without getting permission from Amerigroup if you have an emergency situation. Have a doctor make the decision to deny or limit your coverage.
Have no gag rules, which means that doctors are free to discuss all medical treatment options, even if they are not covered services. Know how Amerigroup pays the doctors, so you know if there are financial incentives or disincentives tied to medical decisions. Know how to make a complaint to Amerigroup. Know how to ask for an administrative review of a decision to not pay for a service or limit coverage to Amerigroup.
Know you or your doctor cannot be penalized for filing a complaint or administrative review. Be treated with respect and dignity by health care providers, their staff and all individuals employed by our company. Have information about Amerigroup, its services, policies and procedures, providers, member rights and responsibilities, and any changes made.
Talk about your medical record with your PCP; you can ask for a summary of that record. Refuse treatment to the extent of the law and be aware of the results. This includes the right to refuse to be part of research. Decide ahead of time the kind of care you want if you become sick, injured or seriously ill by making a living will. Expect that your records and communications will be treated confidentially and not released without your permission; parents of members who are over 18 cannot have access to records when care is for OB-GYN services.
If you are over 18, expect that you will be able to participate in and make decisions about your own and your child s health care. Have your medical information given to a person you choose to coordinate care when you are unable to or have it given to a person who is legally authorized when concern for your health makes it inadvisable to give such information to you.
Have medical services available to you under your Amerigroup plan in accordance with 42 CFR through Be free from liability and receiving bills from providers for medically needed or covered services that were authorized or covered by Amerigroup in which the provider was not paid.
Only be responsible for copays as described in this member handbook. Be free from any Amerigroup debts in the event of insolvency and liability for covered services in which the state does not pay to Amerigroup. Be free from payment for covered services in which the payment exceeds the amount you would be responsible for if Amerigroup provided the service. Continue as a member of Amerigroup despite your health status or need for care.
Call our Nurse HelpLine 24 hours a day, 7 days a week toll free at Call our Member Services department toll free at from 7 a. Receive information on available treatment options and alternatives, regardless of cost or benefit coverage.
Ask for and receive a copy of your medical records and ask to amend or correct the record, and not be restrained or secluded if doing so is to punish you or: - For someone else s convenience - Meant to force you to do something you do not want to do Take part in making decisions about your health care with your doctor.
Make suggestions about the Amerigroup member rights and responsibilities policy. Discuss questions you may have about your medical care or services with Amerigroup; call Member Services at. Go to the emergency room when you have an emergency. Call Amerigroup if you have a problem and need help. Tell your PCP about symptoms or problems and ask questions. Read this member handbook to understand how Amerigroup works.
Notify Amerigroup if a family member who is in Amerigroup has died. Someone must also notify Amerigroup if you die. Give Amerigroup proper identification when you enroll. Treat your doctors, their staff and Amerigroup employees with respect and dignity. Not be disruptive in your doctor s office. Respect the rights and property of all providers.
Cooperate with people providing your health care. Get information about treatment and consider this treatment before it is done. Discuss any problems in following your doctor s directions. Consider the results of refusing treatment recommended by a doctor.
Help your PCP get your medical records from the doctor you had before; you should also help your PCP fill out new medical records. Respect the privacy of other people waiting in the doctors offices. Get permission from your PCP or the PCP s associates before seeing a consultant or specialist; you should also get permission from your PCP before going to the emergency room unless you have an emergency medical condition.
Learn and follow the Amerigroup policies and procedures outlined in this handbook until you are disenrolled. Make and keep appointments and be on time. Always call the doctor s office if you need to cancel an appointment, change your appointment time or will be late. Discuss complaints, concerns and opinions in an appropriate and courteous way. Tell your doctor who you want to be told about your health.
Get medical services from your PCP. Know and get involved in your health care. You should talk with your doctor about recommended treatment.
You must then follow the plans and instructions for care agreed upon with your provider. Know how to take your medicines the right way. You should report any lost or stolen cards to Amerigroup quickly.
You should also contact Amerigroup if information on your ID card is wrong or if you have changes in name, address or marital status. Show your ID cards to each provider. Tell Amerigroup about any doctors you are currently seeing. Provide true and complete information about your circumstances.
Report change in your circumstances. Give Amerigroup and your doctor the information they need to take care of your medical needs. It also tells what rights you have to see and change your information. Information about your health and money is private. The law says we must keep this kind of information, called protected health information PHI , safe for our members.
That means if you re a member right now or if you used to be. We get information about you from state agencies for Medicaid and the hildren s Health Insurance Program after you become eligible and sign up for our health plan. We also get PHI from your doctors, clinics, labs and hospitals so we can OK and pay for your health care.
Federal law says we must tell you what the law says we have to do to protect PHI that s told to us, in writing or saved on a computer.
We also have to tell you how we keep it safe. To protect PHI: On paper called physical , we: Lock our offices and files Destroy paper with health information so others can t get it Saved on a computer called technical , we: Use passwords so only the right people can get in Use special programs to watch our systems We can share your PHI with your family or a person you choose who helps with or pays for your health care if you tell us it s OK.
Sometimes, we can use and share it without your OK: For your medical care To help doctors, hospitals and others get you the care you need For payment To share information with the doctors, clinics and others who bill us for your care When we say we ll pay for health care or services before you get them For health care business reasons To help with audits, fraud and abuse programs, planning, and everyday work To find ways to make our programs better For public health reasons To help public health officials keep people from getting sick or hurt With others who help with or pay for your care if you can t speak for yourself and it s best for you We must get your OK in writing before we use or share your PHI for anything but your care, payment, everyday business, research or other things not in this notice.
Other things could be selling it or using it to sell things to you. We have to get your written OK before we share psychotherapy notes from your doctor about you. You may tell us in writing that you want to take back your written OK. We can t take back what we used or shared when we had your OK.
But we will stop using or sharing your PHI in the future. Other ways we can or the law says we have to use your PHI: To help the police and other people who make sure others follow laws To report abuse and neglect To help the court when we re asked To answer legal documents To give information to health oversight agencies for things like audits or exams To help coroners, medical examiners or funeral directors find out your name and cause of death To help when you ve asked to give your body parts to science For research To keep you or others from getting sick or badly hurt To help people who work for the government with certain jobs To give information to Workers Compensation if you get sick or hurt at work What are your rights?
You can ask to look at your PHI and get a copy of it. We don t have your whole medical record, though. If you want a copy of your whole medical record, ask your doctor or health clinic. You can ask us to change the medical record we have for you if you think something is wrong or missing.
You can ask us to send PHI to a different address than the one we have for you or in another way. We can do this if sending it to the address we have for you may put you in danger. You can ask us to tell you all the times over the past six years we ve shared your PHI with someone else. This won t list the times we ve shared it because of health care, payment, everyday health care business or some other reasons we didn t list here. You can ask for a paper copy of this notice at any time, even if you asked for this one by.
If you pay the whole bill for a service, you can ask your doctor not to share the information about that service with us. What do we have to do? The law says we must keep your PHI private except as we ve said in this notice. We must tell you what the law says we have to do about privacy. We must do what we say we ll do in this notice.
We must send your PHI to another address or to send it in a way other than regular mail if you ask for reasons that make sense, like if you re in danger. We must tell you if we have to share your PHI after you ve asked us not to. If state laws say we have to do more than what we ve said here, we ll follow those laws.
We have to let you know if we think your PHI hasn t been kept private. What if you have questions? We re here to help. Nothing bad will happen to you if you complain. If that happens, we ll tell you about the changes in a newsletter. We ll also post them on the Web at This notice tells you about your rights and what the state laws say we have to do. Your Personal Information We may ask for, use and share personal information PI as we talked about in this notice.
Your PI is not public and tells us who you are. It s often taken for insurance reasons. We ll let you know before we do anything where we have to give you a chance to say no. We ll tell you how to let us know if you don t want us to use or share your PI. You have the right to see and change your PI. We make sure your PI is kept safe.
For all questions, please call. Dear Member: Welcome to Amerigroup! You can always ask for the latest handbook toll free at TTY. Please check the PP s name on your ID card. Our Member Intake Line is available 24 hours a day, 7 days a week. Georgia Population Projections Office of Planning and Budget March 12, Georgia Population Projections Over the next two decades, between and , the state s population is projected.
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