Medi-Cal | Wellpoint SSB | My Health | 2014 - page 10

10 ·
My Health
Sometimes we need to make decisions about how
we cover care and services. This is called Utilization
Management (UM). Our UM process is based
on the standards of the National Committee for
Quality Assurance (NCQA). All UM decisions are
based on medical needs and current benefits only.
We do this for the best possible health outcomes
for our members. We also don’t tell or encourage
providers to underuse services. And we don’t create
barriers to getting health care. Providers do not get
any reward for limiting or denying care. And when
we decide to hire, promote or fire providers or staff,
we don’t base it on if they might, or we think they
might, deny or would be likely to deny benefits.
Our Notice of Privacy Practices
has changed
The privacy regulations set by the Health Insurance
Portability and Accountability Act (HIPAA) recently
changed, and we have updated our Notice of Privacy
Practices. This type of notice explains how medical
information about you may be used and disclosed
by Anthem Blue Cross. It also tells you how to access
this information.
If you would like a copy of our Notice of Privacy Practices
or your Rights and Responsibilities as an Anthem
Blue Cross member, please call
1-800-407-4627
(TTY
1-888-757-6034
) or view them online at
anthem.com/ca
.
New treatments and procedures
Helping you get care that is
safe and right for you
When it comes to the latest information about
medical care, we work to review it quickly. We have
teams of health care experts who review medical,
mental health and drug policies on an ongoing basis.
We look at a variety of resources, including:
Medical journals.
Government policies and procedures.
Studies that show the effects of the new
technology on long-term health.
Doctors and other health care experts.
We update our health policies and even create new
ones to address many new treatments. Helping you
stay healthy is our No. 1 goal.
Making decisions on care and services
To learn more about UM or a case, call us toll-free
from 8 a.m. to 5 p.m. weekdays, except holidays, at
1-800-407-4627
. If you call at any other time, you
can leave a private message. Our staff will return
your call on the next business day during the hours
above. Or you can ask that someone call you back
at a different time. Any staff members who call you
about a UM issue will give you their name and title
and the name of the company.
If you would like to talk to someone in a language
other than English, ask for an interpreter in your
language. If you have a hearing or speech loss, call
the TTY line at
1-888-757-6034
.
How to get a paper copy of our latest notices
If you want a paper copy of the updates in this newsletter or the latest Member Services Guide, call us at
1-800-407-4627
.
If you have hearing or speech loss, call the TTY line at
1-888-757-6034
.
See the back page of the newsletter for languages that some written materials like your handbook, claims and benefits
letters come in.
1,2,3,4,5,6,7,8,9 11,12
Powered by FlippingBook