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What is a ConnectCare Primary Care Physician or PCP?
A ConnectCare Primary Care Physician or “PCP,” is your family “doctor” who will take care of all your healthcare needs.
Your ConnectCare doctor has your medical records and will give you medical advice based on your medical needs. Your doctor can handle your basic medical needs, refer you for special care, and admit you into the hospital, if needed.
You may contact your doctor 24 hours a day, seven days a week, including holidays. When attempting to contact your doctor, you may talk to your doctor directly, another doctor, or staff person based on the availability of your doctor.
Your doctor can:
- Provide preventive healthcare services, basic healthcare services, or refer you to a special doctor when needed.
- Examine your medical condition, provide care or refer you for further healthcare services or therapy when needed.
- Evaluate the medical or rehabilitative care prescribed to ensure you are improving.
Do
I have to have a doctor?
Medicaid will not pay for services until you have selected a doctor. However, there are certain situations or categories that allow you to not have a doctor. You are not required to have a doctor if:
- You have Medicare as your primary insurance (you present a red, white, and blue card to receive medical care).
- You are living in a nursing home.
- You are living in an intermediate care facility for the mentally retarded.
- You are in a “spend-down” eligibility category: your eligibility has expired or is only good for 3 months or less, at a time.
- You are briefly outside the state of Arkansas for treatment.
- You have Family Planning Medicaid ONLY.
Who
can I select for my ConnectCare doctor?
You must select from a list of doctors who have agreed to work with the Medicaid program. When you go to a DHS office to select a doctor, they will have a Doctor Directory, or you can visit the ConnectCare website at www.seeyourdoc.org for a list of ConnectCare doctors by county. You must select 3 doctors you would like to have in order of preference. You can select from the following types of doctors.
- Family practitioners
- General practitioners
- Internal medicine
- Obstetrician/Gynecologist
- Pediatricians and Adolescent Medicine specialists
- Or certain health clinics:
- Area Health Education Centers (AHEC)
- Federally Qualified Health Centers (FQHC) (Community Health Centers and Migrant Health Centers)
- Family Practice and Internal Medicine Clinics at the University of Arkansas Medical Sciences (UAMS) campus in Little Rock
You can select a doctor from other counties close to where you live. For example: Pulaski County residents may select a doctor in Lonoke County (bordering county) or Prairie County (next to border county).
If the first doctor you select has a full caseload, you may receive your next choice. If that doctor has a full caseload, you may receive your third choice. If your third choice has a full caseload, you may be referred back to the directory for another choice in your area.
How
do I get a ConnectCare doctor?
- Your Medicaid caseworker should ask you to complete a ConnectCare Primary Care Physician enrollment form when applying for a Medicaid card.
- If you are a SSI (Supplemental Security Income) recipient, you may go to the DHS office to select a ConnectCare doctor once you have become Medicaid eligible, or call ConnectCare Toll-Free at 1-800-275-1131 (1-800-285-1131 TDD), or if you are in the Central Arkansas area, call 614-4689.
- You may select your doctor at his or her office. Your choice is valid from the date the office calls it into Medicaid.
- You may call the ConnectCare Toll-Free Help Line 1-800-275-1131 (1-800-285-1131 TDD), or if you are in the Central Arkansas area, call 614-4689, 24 hours from 11 p.m. Sunday through midnight Friday.
- You may also request a doctor using the online assign/change form on our website at www.seeyourdoc.org. Please note that using this method DOES NOT guarantee your request. If you need a doctor immediately, please call the Toll-Free Help Line.
Do
all Medicaid eligible family members have to have the
same doctor?
No. Each Medicaid eligible family member may have a different doctor based on his or her preference and the type of doctor appropriate for him or her.
Will
other providers know who my ConnectCare doctor is?
Yes. Arkansas Medicaid doctors are identified by your Medicaid number. Please remember to take your Medicaid card with you to every doctor appointment. Your ConnectCare doctor can identify your beginning date of service, any benefit limits you may have reached, and if you have received well child check ups or shots.
I am unhappy with my medical treatment. What do I need to do?
If you are unhappy with your medical treatment, discuss the problem with your ConnectCare doctor. Your doctor will work with you to provide the best care possible. It is important that you visit your doctor BEFORE you become sick or need medical care. This provides you the opportunity to meet the staff, complete a medical history form, ask questions, and confirm your doctor’s after hours policy.
If you have a problem that you are unable to resolve, please call the Toll-Free ConnectCare Help Line 1-800-275-1131 (1-800-285-1131 TDD), or if you are in the Central Arkansas area, call 614-4689. We will forward your complaint to the Medicaid Grievance Help Line for assistance in resolving the problem.
What services do I need a referral for?
You must have a referral from your ConnectCare doctor for most Medicaid covered services when receiving care from anyone other than your doctor, or you will be responsible for the bill.
The Medicaid services below require a referral from your ConnectCare doctor.
- Federally Qualified Health Center (FQHC) Services
- Home Heath services
- Inpatient hospital services
- Laboratory and X-ray services
- Nurse Practitioner services
- Outpatient hospital services
- Physician services
- Rural Heath Clinic services
- Ambulatory Surgical Center services
- Targeted Case management for Pregnant Women, adults with a developmental disability, recipients age 60 and over
- Durable Medical Equipment
- End-Stage Renal Disease (ESRD) facility services
- Hyperalimentation services
- Inpatient Rehabilitative Hospital services
- Medical supplies
- Personal Care services
- Podiatrist’s services
- Portable X-Ray services
- Private Duty Nursing services for ventilator dependent
- Ventilator equipment
Services for Children and Young People under age 21:
- Hearing Aid services
- Medical clearance
- Audiological Exam
- Purchase of Hearing Aid
- Allergy/Desensitization Injections and Antigens
- Cochlear Implantation
- Durable Medical Equipment (DME), e.g., specialized wheelchairs
- Chiropractic services
- Occupational, Physical, Speech Therapy services
The following services are available when determined to be medically necessary because of a Child Health Services (EPSDT) screening referral. These services include, but are not limited to:
- Hospice services
- Targeted Case Management Services for Recipients under age 21
- Orthotic appliances
- Prosthetic devices
- Respiratory services
Why
do I need a referral?
Having your ConnectCare doctor refer you to a specialist or hospital will help your doctor monitor the care you are receiving, to ensure it is adequate and that you are improving.
If you do not get a referral from your doctor BEFORE receiving healthcare services from other doctors, clinics, or hospitals, you must pay the bill.
Can
I change my ConnectCare doctor?
Yes,
you may change your doctor for the following conditions:
Your doctor moves to another county, closes the office, or no longer accepts Medicaid as payment for services.
You move to another county.
You or your child needs a doctor that speaks another language, such as Spanish.
However, ConnectCare enrollees may transfer their PCP enrollment at any time, for any stated reason.
To request a change to your ConnectCare doctor, call the Toll-Free ConnectCare Help Line 1-800-275-1131 (1-800-285-1131 TDD), or if you are in the Central Arkansas area, call 614-4689 or go online to www.seeyourdoc.org. Please have your Medicaid or ArKids First number available when calling. You may also visit your local DHS office to request a change.
What
if I cannot contact my ConnectCare doctor after hours?
At your first visit with your new ConnectCare doctor, you should ask him or her about their after hours policy for getting non-emergent healthcare services. Your doctor can tell you what to do if you get sick at night or on the weekend, and feel you cannot wait to get medical help.
Generally, you are asked to contact your doctor or the doctor on call. He or she will tell you what to do. If you receive routine healthcare services in the emergency room without your doctor’s approval, you will be charged for these services.
How
can I get my baby on Medicaid?
As soon as your baby is born, contact your county DHS office and they will tell you what you need to do to find out if your baby is eligible for Medicaid.
What
if I cannot remember who my ConnectCare doctor is?
You can call ConnectCare Toll-Free 1-800-275-1131 (1-800-285-1131 TDD), or if you are in the Central Arkansas area, call 614-4689 and we will assist you. Please remember to have your Medicaid or ARKids number when calling.
Can
I keep my current doctor as my ConnectCare doctor?
Yes,
if…
- Your current doctor accepts Medicaid payment and is one of the following:
- Family Practitioner
- General Practitioner
- Internal Medicine
- Obstetrician/Gynecologist
- Pediatrician
- Or is part of certain clinics:
- Area Health Education Centers (AHEC)
- Federally Qualified Health Centers (FQHC) (Community Health Centers and Migrant Health Centers)
- Family Practice and Internal Medicine Clinics at the University of Arkansas
- Medical Sciences (UAMS) campus in Little Rock.
- Your doctor’s Medicaid caseload is not full.
Be sure your doctor is listed as your first choice when completing the PCP Enrollment Form at your local DHS office or call ConnectCare Toll-Free 1-800-275-1131 (1-800-285-1131 TDD), or when you are in the Central Arkansas area, call 614-4689. You may also request a doctor online at www.seeyourdoc.org.
Can
a ConnectCare doctor refuse to take me as a patient?
Yes,
if…
- The doctor is not accepting new patients.
- A pediatrician may refuse to take a child older than 16 years of age.
- An obstetrician/gynecologist may refuse to take a male or a female patient younger than 2 years of age.
- An internal medicine doctor may refuse to take anyone 6 years of age or younger.
- A doctor can refuse to take you when your relationship with the doctor does not work out. For example:
- You miss two or more appointments without calling ahead of time.
- You are abusive to the doctor or staff.
- You fail to follow the doctor’s medical instructions.
What if I get sick when I am out of town?
If you are not in the state of Arkansas and cannot wait until you get home to get medical help, you should call your doctor. If you have a true emergency, you should go to the emergency room immediately.
When should I go to my ConnectCare doctor, and when should I go to the Emergency Room?
You should only go to the emergency room when you have a true emergency. If you do not have a true emergency, you should go to your doctor during office hours. Your doctor has your medical history and knows best how to treat you.
Good reasons to go to the Emergency Room:
- Danger of losing life or limb
- Very bad or sudden chest pains
- Poisoning or overdose of medicine
- Choking or having a hard time breathing
- Possible broken bones
- Heavy bleeding
- Fainting or shock
- Suddenly not able to move (paralysis)
- Head or eye injury
- Violent attack (rape, mugging, stab, or gunshot wound)
- Fever above 103 degrees
Good reasons to go to your ConnectCare doctor:
- Earache
- Toothache or baby teething
- Rash
- Colds, cough, sore throat, flu, or sinus problems
- Minor sunburn
- Minor headache
- Broken cast
- Stitches needing to be removed
- Medicine refills
If you go to the Emergency Room when it is not an emergency, you may:
- Wait a long time
- Receive limited healthcare services
- Be sent to your ConnectCare doctor anyway, and
- Be responsible for the bill
How
do I get a referral to see a specialist?
Your ConnectCare PCP will treat you in their office then refer you to a specialist, if you need additional care.
If you get healthcare services through the ConnectCare Primary Care Physician program without getting a referral from your ConnectCare PCP, you will have to pay for those services.
My
ConnectCare PCP will not take me as a patient anymore.
You may be asked to select a new PCP, if your PCP moves to another county, closes their office, or withdraws from the Arkansas Medicaid program.
Your PCP must give you a 30-day written notice before they dismiss you as a patient.
How do I get a prescription?
Always talk to your doctor about any medicine you are currently taking or that you think you need.
If you need a medicine refill, call your doctor’s office. If your doctor has sent you to another doctor or clinic for healthcare, you should talk to that doctor about medicine he or she has prescribed, or call your pharmacist.
What
services does Medicaid cover?
Arkansas Medicaid covers a wide range of services. Some services have limits on how often you can receive those services, and some services require prior approval from Medicaid. Sometimes, Medicaid adds or removes services, depending on the need for the service and the state’s ability to pay for the service. You can contact your local DHS office for more information on these limits and services.
The following services are available to both adults and children who are Medicaid eligible. Services marked by an asterisk (*) do not require a referral from your doctor. The other services require a referral from your doctor.
- Family planning*
- Federally Qualified Health Center (FQHC) Services
- Home Heath services
- Inpatient hospital services
- Laboratory and X-ray services
- Nurse-midwife services*
- Nurse Practitioner services
- Nursing Facility services*
- Outpatient hospital services
- Physician services
- Rural Heath Clinic services
- Ambulatory Surgical Center services
- Targeted Case management for Pregnant Women, adults with a developmental disability, recipients age 60 and over
- Certified Registered Nurse Anesthetist (CRNA) *
- Developmental Day Treatment Clinic services*
- Domiciliary Care services*
- Durable Medical Equipment
- End-Stage Renal Disease (ESRD) facility services
- Hyperalimentation services
- Inpatient Rehabilitative Hospital services
- Intermediate Care Facility Services for Mentally Retarded*
- Medical supplies
- Personal Care services
- Podiatrist’s services
- Portable X-Ray services
- Private Duty Nursing services for ventilator dependent
- Prescription drugs*
- Rehabilitative services for persons with Mental Illness*
- Transportation services (ambulance, public and private/Non-profit)*
- Ventilator equipment
- Visual services*
Services for Children and Young People under age 21:
- Eye prosthesis*
- Repairs and replacements of eyeglasses*
- Hearing Aid services
- Medical clearance
- Audiological Exam
- Purchase of Hearing Aid
- Immunization*
- Allergy/Desensitization Injections and Antigens
- Child Health Management services*
- Inpatient Psychiatric Care*
- Cochlear Implantation
- Durable Medical Equipment (DME), e.g., specialized wheelchairs
- Chiropractic services
- Occupational, Physical, Speech Therapy services
The following services are available when determined to be medically necessary because of a Child Health Services (EPSDT) screening referral. These services include, but are not limited to:
- Hospice services
- Targeted Case Management Services for Recipients under age 21
- Orthotic appliances
- Prosthetic devices
- Respiratory services
Can
I get eye care or dental care?
EYE CARE
All Medicaid recipients are eligible for an eye exam and one pair of glasses per year if needed. If someone under 21 has a special condition that requires them to need glasses more often, they can receive them. Medicaid will also cover repairs and replacement of broken glasses.
You can receive eye exams from any eye doctor who will accept Medicaid as payment, without a referral from your doctor.
DENTAL CARE
Children may receive a dental examination every 6 months beginning at age 1. Children may receive medically necessary preventive and restorative care including cleanings, fillings, crowns, root canals, medically necessary orthodontics, and prosthetics.
You can receive dental care from any dentist who will accept Medicaid as payment, without a referral from your doctor.
Certain doctors are approved for and do accept Medicaid patients. You must verify that your eye doctor or dentist does accept Medicaid.
Who do I call if I have a problem with Medicaid Billing or denial of a claim?
You may call Client Assistance/Medicaid Claims at 1-800-482-5431.
Where do I call if I have any other questions about Medicaid services, such as benefit limits, prior authorization, or covered services?
You may call Client Assistance/Medicaid Claims at 1-800-482-5431.
Where
do I call if I have a problem with Medicaid transportation?
You may call the Transportation Help Line at 1-888-987-1200 and follow the directions.
Who do I call to complain about my doctor?
You may call the Medicaid Beneficiary Complaint line at 1-888-987-1200 and follow the instructions.
Who do I call if I have a problem with Medicaid eligibilty, lost Medicaid card, or DHS problems?
You may call Client assistance at 1-800-482-8988.
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