How we help take care of you
Our members are our neighbors and our family. That’s why we work every day to make sure you and all our members are getting the care you need.
It all starts with you and your doctor
Nothing is more important to your health than having a good relationship with your primary care doctor (PCP). Doctors know what their patients need. We’re here to help them.
ConnectiCare’s staff includes nurses, pharmacists, social workers and health navigators. Working hand in hand with primary care doctors, we extend our help to you if you:
- Are recovering from illness or an accident,
- Visited an emergency room,
- Are being discharged from a hospital or skilled nursing facility,
- Have a chronic health condition, such as diabetes or heart disease,
- May not be following your doctors’ orders for follow-up care or prescription medicines,
- Appear to be behind in your annual check-ups, immunizations and cancer screenings
How you may hear from us
We’ll often start with a phone call or a letter to you introducing ourselves. We’ll ask questions to find out:
- Are you taking prescription medicines your doctor has prescribed?
- Do you have the help at home that you need? Is your home safe?
- Are you making and keeping doctors’ appointments?
- Are you making changes in your lifestyle, such as diet or exercise, that will help you get and stay healthy?
- Are you depressed or anxious about your health – or other things?
- Do you rely on someone else – family, neighbor or friend – to be a caregiver?
- Is there anything that is hurting your ability to get and stay healthy? Do you need language translation services? Transportation? Help paying your bills?
In other cases, we may send you reminders by mail if it looks like you’re overdue for important screenings, immunizations or doctor’s visits to keep an eye on your health.
Together, we go to work
We work with you to help you get services or help that you need. That may mean:
Talking to you about health conditions and how to manage those conditions – diabetes, coronary artery disease, heart failure, asthma and chronic obstructive lung disease
Connecting you to social services in your community
Suggesting ways you can remember to take medicines and get your checkups
Sending you reminders when it looks like you’re not getting the doctor’s care that you need
Having phone calls with family members or other caregivers you want us to talk with (we don’t do this without your permission)
Contacting your doctors about your treatment and progress
Enrolling you in our QuitCare smoking cessation program
You can tell us not to contact you
If you don’t want the extra help that’s described above, you can tell us not to get in touch with you again. You can do that when we call or by calling us yourself. Our phone number is 1-800-390-3522 (TTY users: 1-800-842-9710). We’re open Monday-Friday, from 8 a.m. to 4 p.m.
We also evaluate some requests for treatment
Sometimes we need to review a medical service, treatment or medicine before we will cover it. We call this process “preauthorization.” Only certain medical services or drugs require preauthorization. You can find lists in your plan documents. Find yours by logging into the secure member service section of this website. Preauthorization helps see that you receive:
Drugs that are cost-effective and appropriate, following safe prescription limits set by the Food and Drug Administration
Medical or surgical services that are necessary, following national standards of care and input from local doctors
Referrals to out-of-network providers only when needed
Care in the most appropriate setting
We’ll send both you and your doctor letters with our decisions. The letter will include instructions on how to appeal a decision you don’t agree with.
We adapt to do what we feel is best in every situation
In some cases, we find it’s best if our nurses, social workers or health navigators visit you in your home. We let your primary care doctor know we are doing that and report back to him/her.
In every case, we adjust to meet your needs. How we help – and for how long – depends on your situation. For example, helping someone in good health recover from a knee replacement surgery is different than helping someone who is living with diabetes.
In professional terms, we call what’s described above “total population health management.” In everyday terms, it’s doing the right thing to live up to our promise to make it easy for our members get the care they need.