Medicaid Managed Care Client Information Booklet
This booklet contains important information regarding those that are interested in joining Medicaid Managed Care. This is the same information that is found in the booklet that can be obtained at our offices. In this booklet, you will find a printable Referral Form that you can fill out and mail into our office.
Just click on any of the titles below for further information.
TABLE OF CONTENTS
I. II. III. IV. V. VI. VII. VIII. IX. X. XI.
Managed Care Bill of Rights Dear Client Letter Medicaid Managed Care: Will You Need to Choose a Plan? Information About Enrollment In Managed Care Covered Services Now You Can Choose A Health Plan How To Choose Your Managed Care Plan Gives You The Right Fidelis Community Blue Referral Form
Managed Care Bill of Rights
Dear New Yorker: Managed care health plans offer many benefits to you and your family. When you join a managed care plan, you don’t have to wait in an emergency room for routine health care. Instead you have a “medical home,” and a primary care doctor who knows all about you and your health. If you need to see a specialist, your primary doctor will refer you to one. And each plan has a 24-hour hotline in case you need to talk with a health expert at times other than office hours. In order to get the most from your managed care health plan, make sure you know how it works. Learn what health care your plan must give you. We are proud that New York State is a national leader in keeping the rights of managed care patients safe. The basics of these laws are in the “Managed Care Bill of Rights” that follows. I hope you will find it helpful. Wishing the best of health to you and your family. George E. Pataki, Governor
Managed Care Bill of Rights
You have a right to know what health care must be given to you by the plan, as well as any limits on care, and which types of health care are not covered. You have a right to know about any treatments or health care which your plan needs to approve in advance. You have a right to know what steps you can take if the plan will not cover a service. This includes the toll-free phone number of the person who will review the plan’s action, how long it will take until the review is done, and how to appeal the plan’s action. You also have a right to have someone speak for you in any disputes with the plan. You have a right to know, each year, how the plan decides on how much it will pay to doctors and health providers who belong to the plan. You have a right to know about any fees you will have to pay, any amount you have to pay yourself before the plan will start paying, and any caps (maximums) or yearly limits on plan payments. You also have a right to know what you will have to pay for health care not covered by the plan.
You have a right to know about what you will have to pay if you go to a doctor who is not part of the plan, or if you go even though the plan has not approved this in advance. You have a right to file a grievance about any dispute between you and the plan, and you have a right to know just how a grievance should be made. You have a right to go to the emergency room 24 hours a day for any health problem that threatens your life. You do not need the plan to approve this in advance, but you must tell your plan as soon as you can. You have a right to a list of the plan’s doctors, as well as to learn which doctors are taking new patients. You have a right to know how you can change to a new doctor within the plan. You have a right to see a doctor outside the plan if the plan does not have a doctor who can meet your health needs, but your primary doctor must set this up for you. If you need to keep on seeing a special doctor (specialist), you can ask to be allowed to see that doctor as needed, without going through your primary doctor. Your plan must explain to you how you can do this. If you have a very bad health problem that requires you to be seen by a special doctor for a long time, you can ask to have your special doctor be your primary doctor. The plan must tell you how to make such a request. If you have a very bad health problem that requires you to be seen by a special health care center (for example, a hemodialysis center) for a long time, you can ask to go there when you need to, without going through your primary doctor. The plan must tell you how to make such a request. You have a right to know how you can have input in how the plan makes its rules. You have a right to know how the plan meets the needs of plan members who don’t speak or read English. You have a right to know the correct mailing address and phone number to be used by plan members who need to know something or who need the plan to approve a health service. You have a right to a list that the plan updates once a year, of the name, address and phone number of each health care provider who belongs to the plan. This includes special doctors (specialists). You also have a right to know the level of training that the plans’ doctors have, and which ones have advanced training so they can practice in special health areas (board certification).
Dear Client Letter
Dear Client: Are you having difficulty trying to find a doctor who will accept Medicaid? Do you find limited health care visits and co-pays discouraging? You now have the opportunity to enhance your Medicaid coverage through our Medicaid Managed Care Program. There are two (2) Managed Care Plans available in our county:
Community Care ........………………………….. Fidelis Better Health..................................
1-866-231-0847 1-888-343-3547
This medical coverage is provided, at no cost to you, and eliminates limits on the number of visits to the doctor and co-pays. In order to be eligible for the Managed Care Program, you must be eligible for Medicaid. Certain categories, which include individuals with Medicare, a “spenddown”, other health insurance, or those in the Restricted Recipient Program, are not eligible for Managed Care. Enclosed are materials explaining the Managed Care Program and how it works. Be sure to check to see if your doctor and/or specialist participates in the Plan that you choose. Also, be sure to read the booklet "You Have 60 Days To Choose A Health Plan." This booklet contains important information. To enroll, or for more details from the Plans, you may call the Plan’s toll-free number listed above. You may also call the Department of Social Services Managed Care Office at (716) 373-8077 for more information. There is also a
Form that you can complete and email back to us.
Referral
Sincerely, Barbara J. Hastings, RN, BSN, MSN Assistant Medical Director
Will You Need To Choose A Health Plan
Most persons on Medicaid will need to choose a managed care plan Most people who have Medicaid will be changing to a new way of getting health care, called managed care. With Medicaid managed care you will not have to search for doctors who take Medicaid. You will choose your own Medicaid health insurance plan and choose a doctor or nurse practitioner who belongs to your plan. Your doctor or nurse practitioner will manage your care and make sure you get all the health care you need.
It is very important for you to read the New York State booklet: You Have 60 Days to Choose a Health Plan This booklet will help to explain if you need to choose a plan. It includes information on: Who is not required to join a health plan. How to choose a health plan. How health plans work. Health plan services. Problem solving. Frequently asked questions.
Information About Enrollment in Medicaid Managed Care in Cattaraugus County
MEDICAID MANAGED CARE… provides you with your own doctor, who is available 24 hours/day, 7 days/week. has no fees, co-pays or limits on visits to your doctor. allows you to stay on as long as you are eligible for Medicaid. does not replace Medicaid. It works with Medicaid. provides you with complete, quality health care.
TO BE ELIGIBLE FOR MEDICAID MANAGED CARE you must have an active Medicaid case here in Cattaraugus County through TANF or Medical Assistance. If you lose your Medicaid eligibility, you lose Managed Care eligibility. Remember to always recertify on time and let your caseworker know of any changes within your household. you cannot be on Medicare, the Restricted Recipient Program, have a “spenddown” or have other health insurance.
TO SIGN UP FOR MEDICAID MANAGED CARE OR TO GET MORE INFORMATION fill out the
Referral Form on our site.
call the Department of Social Services Managed Care office at (716) 3738077. talk to your Medicaid or TANF caseworker. use the Referral front desk.
Form on our website or obtain one at the Social Services
YOUR RESPONSIBILITIES AS A MANAGED CARE MEMBER As a member of a Managed Care Plan, you will have certain responsibilities that you must adhere to for the Managed Care Health Plan to provide the best quality care for you and other members of your household.
go to the emergency room only when it is an emergency. Do not use it for routine care. Your PCP can treat problems that are not emergencies. see a specialist, only when referred by your Primary Care Physician (PCP). choose a Primary Care Physician (PCP), who is part of your Managed Care Plan. keep all doctor/medical appointments, or call if you can’t make it. tell your Medicaid or TANF examiner, the Managed Care office and your doctor, if you have other health insurance coverage. notify the Managed Care office of newborns in your family, as soon as possible.
show your Managed Care ID card to health providers or whenever you need services. follow the rules of your Managed Care Plan, which are outlined in your Member Handbook. You will receive a Handbook when you enroll. recertify on time.
IMPORTANT PHONE NUMBERS Community Care Fidelis Care Managed Care Office: NYS Department of Health Complaint Line: 1-866-231-0847 1-888-343-3547 1-716-373-8077 1-800-206-8125
SPECIAL NOTE When you join a new health plan, you will choose a doctor to be your Primary Care Physician (PCP). Your PCP will provide your health care and refer you to other doctors if you need them. If you like the PCP you have now, or you have chosen a new PCP to see, you may want to pick a plan that includes that PCP. You should call your PCP, or the new PCP you have chosen, to see what health plans they are in. If you are choosing a new PCP, call to make sure that PCP is taking new patients. This call will make sure that you have the PCP you want.
Covered Services
There has been a big change in the way many New Yorkers will get health care using Medicaid. Before, you had to find a doctor or hospital that would take Medicaid as payment. Now you can choose your own Managed Care Health Plan. Most people will be able to choose from several plans. The plan you choose must give you the care and services that you need.
ALL Managed Care Health Plans Provide You With a Benefit Card That You Will Use For:
Doctor/Primary Care Physician (PCP) Visits Hospital Care Immunizations Care During Pregnancy Regular Check-Ups and Other Preventative Services Emergency Room Services Specialists – Need Referral From PCP Medically Necessary Foot Care (Podiatry) – Need Referral From PCP Eye Care/Glasses/Contracts – Only use Plan Approved Providers Mental Health Services (SSI Clients Use Their Medicaid Benefit Card) Inpatient Alcohol & Substance Abuse Services (SSI Clients Use Their Medicaid Benefit Card) Well Baby Care Hearing Aids Homecare Services Durable Medical Equipment (DME) Laboratory Tests Physical, Respiratory, Occupational and Speech Therapies – Need Referral from PCP Family Planning/HIV Testing and Counseling From Your PCP or Any Medical Provider Without A Referral Court Ordered Services X-Rays
You MUST Use Your Medicaid Benefit Card For These Services:
Dental Care Methadone Maintenance Treatment Program (MMTP) Personal Care Services Prescription & Non Prescription Drugs (No Co-Pay) Medical Transportation Medical Supplies and Eternal Formula Hospice Program OMRDD: Day Treatment, Medicaid Service Coordination (MSC), Care At Home Programs Family Planning/HIV Testing and Counseling From Any Medicaid Provider Other Than Your PCP Carved Out Mental Health Services: Day Treatment, Continuing Day Treatment, Intensive Psychiatric Rehabilitation Programs, Intensive Case Management, HCB Waiver Services Outpatient Alcohol & Substance Abuse Services – Outpatient & Residential Rehabilitation
Now You Can Choose A Health Plan! (Information About Medicaid Managed Care) What health care services can you receive?
ALL managed care plans will offer: visits to doctors care during pregnancy emergency room services private duty nursing short-term home health care a 24-hour health questions hotline regular check-ups and other preventative services hospital care specialists eye care and glasses hearing aids private duty nursing mental health services medical equipment (crutches prostheses, orthotics) immunizations foot care (podiatry) laboratory tests x-rays
Is transportation to medical care covered?
Yes. Use your Medicaid card. Your local Department of Social Services will help you. The Cattaraugus County Medical Travel number is 716-373-8074.
Is dental care covered?
Yes. You can get dental care using your Medicaid card.
Are there any services that WON’T be covered?
Yes. For example, plans will not offer long-term nursing care. BUT Medicaid will pay for almost any medical service not covered by the plan IF your doctor says you need it.
How does a managed care health plan work?
After you sign up for a plan, you will choose one doctor who belongs to the plan, to manage your care. This doctor, who will be your primary care doctor, will know all about your health care needs. In order to see a specialist, or to receive special services such as x-rays or lab tests, you MUST be referred by your primary care doctor. Otherwise, the plan will not pay. You will be referred only to health professionals who belong to your plan. Women can also choose an ob/gyn practitioner within the plan, along with a primary care doctor.
Will I still be able to go to the emergency room?
Yes. Go to the emergency room if you have a life-threatening emergency – such as trouble breathing, seizures, bleeding that won’t stop or unconsciousness. Call your plan as soon as you can after your visit to the emergency room. If you’re not sure whether you should go to the emergency room, call your plan’s 800 telephone number. You will no longer need to use the emergency room for routine illnesses or minor accidents, because you will have your own doctor to take care of you.
Do I have to use the plan for pregnancy tests and birth control?
No. You can go to any health care provider that offers these services and use your Medicaid card. You don’t need a referral from your primary care doctor.
Will all people with Medicaid be joining a managed care plan?
No. Check with your caseworker to learn if you can join a plan.
Will I have to pay any fees or co-pays?
No.
Will I get all my health care at one location, like an all-purpose clinic?
Some of the managed care plans are set up like clinics. Others use neighborhood clinics. Still others use a network of private doctors and hospital clinics and other health care providers.
Should I tell someone if my care is not good?
Yes! If you feel your care is not good, or if you have problems getting care, you can complain to the plan. The plan’s member handbook MUST tell you how to complain. You can also call the New York State Department of Health complaint line:1-800206-8125: Monday – Friday - 8:30 a.m. to 4:30 p.m.
How To Choose A Medicaid Managed Care Health Insurance Plan
To make the best choice for you and your family, you must be informed. Read the information you receive about each plan. Find out whether your present doctors, your friends and family have opinions about the plans. If you have questions, call your local Department of Social Services. Then answer each question with a YES or NO. Take a good look at the plan with the most YES answers. It might be a good choice for you. Fidelis Care Would you like to keep your present doctor and does he or she belong to the plan? Does your children’s doctor belong to the plan? If you are now seeing a specialist or counselor, is he/she part of the plan? Is there a primary care doctor (who would be in charge of your care) close to where you live? Does the hospital that you now use belong to the plan? Does the plan have a doctor who speaks your language, or a translator/interpreter to help you? Does the plan have a doctor who speaks your language, or a translator/interpreter to help you? Community Care
There are two Managed Care Plans that are available in Cattaraugus County. They are Community Care and Fidelis Care. We have included information about each Plan on the following pages. Be sure to read about each Plan, before you make your choic
COMMUNITY BLUE - MEDICAID MANAGED CARE PROGRAM OFFERS YOU MORE
Your own doctor Annual eye exam Alive & Lively programs 24-hour Helpline Frames and lenses Well child care
What if you had your own doctor? Have you ever sat in a hospital emergency room for an hour or two, waiting to see a doctor you didn’t know to ask for some medicine because you or your child had a fever? That wasn’t good for you or your child. It also wasn’t good for the hospital or other patients with serious emergencies. But you went to the hospital because you didn’t have a doctor of your own to call upon. Now you can have your own doctor, a doctor you can call 24 hours a day whenever you or someone in your family is ill. Now you can have your own doctor who will give you an appointment or tell you when you should go to the hospital. Now you can join Community Blue, from Blue Cross & Blue Shield of Western New York. Community Blue’s Medicaid Managed Care program was designed for people eligible for Medicaid health coverage.
Medicaid or Community Blue? The choice is yours. If you choose Community Blue you won’t lose any benefits you have through Medicaid. You won’t have to find a doctor who accepts Medicaid or go to the hospital whenever you need medical care. You will have your own doctor who will give you all the care you need or arrange for you to get that care from another doctor who belongs to the Community Blue program. Most of the services you now receive through Medicaid are covered by Community Blue at no cost to you. For those few services not covered by Community Blue, you can still obtain care in the same way as any other Medicaid recipient.
Services Covered In Full by Community Blue
When you join Community Blue, you will choose a Primary Care Physician (PCP) for yourself and your children as your doctor. The following services are covered at no cost to you when you receive them from your PCP or from another Community Blue doctor with a referral from your PCP: Doctor Care Office visits and hospital visits, health exams, well-child care, shots, x-rays, lab, surgery, anesthesia, radiation therapy and chemotherapy. Hospital When your PCP admits you to the hospital, or approves your admission after an emergency, all charges are covered for a semiprivate room and all other medicallynecessary services (not a TV or phone). Family Planning and Reproductive Health Services – Free Access You can get birth control advice, birth control prescriptions, a pregnancy test, sterilization, or a full range of family planning services from a Community Blue participating doctor or clinic that accepts Medicaid. During your doctor visit for any of these services, you can also get tests for sexually transmitted diseases. You do not need a referral from your PCP to get these services. You can use your Medicaid card for these services if you go to a doctor or clinic that does not participate with Community Blue. Obstetric and Gynecology Care In addition to visiting her PCP a woman may seek care from any OB/GYN who participates with Community Blue. She can see her OB/GYN for routine gynecology services such as pap smears and breast cancer exams without a referral from her PCP. A woman can also receive care from a different participating OB/GYN during pregnancy without a referral from her PCP. Maternity We cover the full range of maternity services including prenatal and postnatal care and hospital services. HIV Counseling & Testing – Free Access You can be counseled and tested for HIV by your PCP or by any Medicaid doctor as part of a family planning visit. You do not need a referral from your PCP to be tested for HIV when you have it done as part of a family planning visit. Eye Care Members may self-refer to any participating optometrist or ophthalmologist for one routine refractive eye exam every year. Lenses, frames and contact lenses can be obtained at participating locations.
Emergencies Go to the emergency room only when you think it is a real emergency. Do not use the emergency room for routine care. Your PCP can treat problems that are not emergencies. If you go to the emergency room, call your PCP as soon as possible afterwards. Transportation Use your Medicaid card for transportation. The Cattaraugus County Department of Social Services Medical Travel phone number is 373-8074. Please call your Department of Social Services for further information. Response Link 24 Hour Help Line Response Link 24 is Community Blue’s free medical help line at 1-800-359-5465, available 24 hours a day, 7 days a week. Response Link 24 is the perfect place to call if you don’t know exactly how serious your symptoms are. It’s just another way Community Blue makes sure that you get the best health care possible at the greatest convenience to you. Other Services With a referral from your PCP, and our advance approval, we also cover durable medical equipment like wheelchairs, medical devices put inside your body, home health care, private duty nursing and hospice care. With just a referral, we will cover medically necessary physical therapy. Alive & Lively In addition to covered medical services, Community Blue also gives you entry to our free “Alive & Lively” programs. These programs give you training on such topics as prenatal care, stopping smoking, alcohol and drugs, stress, diabetes, arthritis, high blood pressure, cancer, back care, healthy eating, and first aid.
Services Not Covered by Community Blue
Community Blue also does not cover prescriptions, blood, dental services, routine foot care, transportation, methadone treatment or cosmetic surgery to make you look better. Medicaid still pays for all the services in this paragraph except cosmetic surgery. Use your regular Medicaid card to obtain these services. This booklet cannot list all the services covered by Community Blue or everything which won’t be covered. You should always call your PCP before having any service and you can call Community Blue whenever there is a question about coverage at (toll free) 1-866-231-0847.
How to Enroll With the permission of county officials Community Blue staff will visit the Department of Social Services regularly to answer your questions and to help you fill out an application form if you want them to do so. Other times you can call Community Blue at 1-866-231-0847 to ask any questions you have about the Community Blue program. Once you decide to join Community Blue, you just return the application form. Be sure to list yourself and any of your children you wish to enroll. You should also tell us if you are pregnant and when you expect your baby so we can pre-enroll that child. If you are in a non-mandatory county and you later want to leave Community Blue and go back to regular Medicaid, you can do so by contacting us. FOR INFORMATION, PLEASE CALL: TOLL FREE 1-866-231-0847.
Your Managed Care Plan Gives You The Right...
As a member of a Managed Care Plan, you will have certain rights to which you are entitled. To quality care. To access to your Primary Care Physician (PCP) 24 hours/ day, 7 days/week. To choose your Primary Care Physician (PCP). To call the Department of Social Services Managed Care Office, if you have any questions about your Managed Care Plan. To call your Managed Care Plan, the New York State Department of Health, or your county’s Department of Social Services Managed Care Office, if you have a problem with your Managed Care Plan. To be told about all of the benefits and medical services in your health plan. To file a grievance, if you are not getting quality care. To ask your Primary Care Physician (PCP) any questions about your medical care. To get medical services, when you need them. To call your Managed Care Plan to discuss any benefits of the Plan. To receive the following services either from your Primary Care Physician (PCP) or from any other provider of these services: o o Family Planning & Reproductive Health Care Services HIV Counseling & Testing, when provided as part of a family planning visit.
FIDELIS – Everyone Covered with Care
Who is FIDELIS? Fidelis Care New York is a non-profit insurance plan that works only with programs like Medicaid Managed Care, Child Health Plus and now, Family Health Plus. We also have selected trial programs funded by New York State for special health care needs. We are not a commercial, for-profit company. Our mission statement reflects that commitment - to promote health through quality, accessible care and service for all and a health policy that accords true dignify and respect for all persons. You deserve this personal caring approach to your healthcare needs. Fidelis has provided Managed Care to Medicaid patients since the very start of such services and has become the largest pre-paid health services plan in New York with over 140,000 members and 20,000 healthcare providers statewide.
What are the benefits? As a Fidelis Medicaid Managed Care member, you select your own Primary Care Provider (PCP) from a list of participating doctors and nurse practitioners for your primary healthcare needs. You will not be turned away from medical services that you need because you can't find a doctor that "takes Medicaid". You can select different PCPs for other members of your family. Your PCP will be familiar with your health situation and can arrange for any other health services or hospitalization that you need. Your Primary, Care Provider will be available to you 24 hours a day to take care of your needs so you will not have to go to the Emergency Room to get routine medical help. There will not be a limit on the number of visits to your PCP like there is with Medicaid. To find out if the Doctor or Nurse Practitioner you want is part of the Fidelis plan, call 373-1234.
Does Fidelis pay for Specialist Visits? Yes ! - In fact you will have access to many more specialists through Fidelis Managed Care coverage to provide you with expert care. There are local specialists available as well as at larger medical centers. Your PCP will arrange for participating Fidelis specialists help you get the high quality care that you need.
What about eye exams and glasses? Fidelis coverage provides you with a eye exam once every two years or more often if medically needed. You just choose one of our participating providers. New eyeglasses are usually provided once every two years. New lenses may be ordered more often, if, for example, your vision changes more than one-half diopter. If you break your glasses, they can be repaired. Lost eyeglasss or broken eyeglasses that cannot be repaired will be replaced with the same prescription and style of frames. If you need to see a specialist for care of an eye disease or defect, your PCP will refer you.
Will my prescriptions be covered? You will get prescriptions filled at any pharmacy that accepts Medicaid - your Medicaid card will pay for the medication, but show your Fidelis card and you will not
be charged a cash co-pay.
How much will Fidelis Medicaid Managed Care cost me? There is no cost to you, the member, to get the extra coverage or for any covered service. There is never any cost to join our any of our wellness programs like BabyCare, AsthmaCare or DiabetesCare either. In fact we save you money because your Fidelis coverage cancels any co-pays.
What about maternity care? Medical services for pre-natal visits, hospital birth expenses and follow-up care are included for Fidelis members. Well baby visits for your newborn are covered as well. Fidelis offers the BabyCare program as a free added service. Prenatal assistance for mom and follow-up for the next two years are part of this program - we want you to enjoy this part of your new life experience with the confidence that you are getting the best possible care and guidance.
Can I get other services like medical equipment home health visits or therapy if my doctor requests it? Yes! Durable Medical Equipment is covered – your PCP can request things like glucometers, back braces or hearing aides. Also, if your PCP wants you to have short term Physical, Occupational or Speech Therapy or visits from Home Health Care, these are also part of the Fidelis plan coverage. Will Fidelis pay for Emergency Room Services? Yes. Go to the Emergency Room when you think there is a real emergency. Do not use it for routine care. You PCP can treat problems that are not emergencies. We will even pay for out of state emergencies. If your health problem seems urgent but is not a true emergency, call the number for your PCP. Now that you have a personal doctor available to you, your PCP or the doctor who is on-call for your PCP will tell you what to do for urgent health concerns. What if I need counseling or a mental health service? Services for mental health are covered. If you have SSI Medicaid, then your Medicaid coverage will pay for these services. If you have regular Medicaid coverage, then Fidelis will pay for counseling services. Medicaid will also pay for outpatient Alcohol and Substance Abuse services. Either way, you get the services you need. Will I still get Dental coverage? Yes, your dental health visits remain as Medicaid paid services regardless of which plan you join. You can continue to get these services from any Medicaid participating dentist.
Will I still have access to Medical Transportation? Medical travel is also a service that continues to be paid by Medicaid for both plans. Remember that you do not lose any services when you become a Fidelis member. Things like dental care and transportation remain available to you as Medicaid paid services. After one year, how do I renew my Fidelis coverage? Whenever you are asked to re-certify for Medicaid, be sure to do it promptly. If you keep continuous eligibility with Medicaid coverage, your Fidelis Managed Care membership will automatically go on each year. You don't need to renew it unless you lose Medicaid eligibility for a period of time.
What if someone on my Medicaid case "outgrows" Medicaid eligibility? At times people may lose eligibility for Medicaid because the household income increases or the person's age changes their eligibility status. There are other programs that you may be eligible for - CHILD HEALTH PLUS or FAMILY HEALTH PLUS for example. Call your Fidelis marketing representative (373-1234) to see if you qualify for a different program so that you can continue to maintain your health.
And if I have questions later or a problem with my Fidelis coverage? You can call Fidelis Member Services toll free to request a new card, update your information if you change your address or phone, ask about a billing claim, find out about services that are covered costs, request a different doctor - lots of informational things. You also have access to a Registered Nurse 24 hours a day if you have an important medical question through this same toll free number. The number is 1-888-343-3547 (1-888-FIDELIS).
And for our final words . . . Fidelis Care New York will be very pleased if you choose to trust us with your healthcare needs. We know that making this choice between plans is not an easy decision. Both plans are required by New York State regulations to offer the same coverage so your choice is basically between the extra services that you truly feel that you will use. Thank you for taking the time to learn more about us and we wish you good health! TOLL FREE MEMBER SERVICES 1-888-343-3547 (1-888-FIDELIS) On the Web at www.fideliscarny.org Marketing Voice Mail: (716) 373-1234
REFERRAL FORM FOR CATTARAUGUS COUNTY MEDICAID MANAGED CARE
There is a printable form on the next page that you can print out and mail in to us. OR You can use the electronic form on our web page to fill out and send in automatically
REFERRAL FORM
FOR CATTARAUGUS COUNTY MEDICAID MANAGED CARE
Please return completed form to:
Office of Managed Care Cattaraugus County DSS 1701 Lincoln Avenue Olean, NY 14760 (716) 373-8077
Special Note: The Referral Form is intended to give Managed Care Plans permission to contact you at your home. It does not enroll you in the Managed Care Program. Name: _______________________________________Date: _____________________ Address: _______________________________________________________________ City: _________________________________ State: NY Zip Code: _______________ Phone: _________________________________________________________________
Client Request For Medicaid Managed Care Information
I wish to have the opportunity to discuss my options with regards to enrolling myself and/or my family in the Medicaid Managed Care Program. I understand that this is a voluntary program and I give my permission for a Managed Care Representative to contact me at: I am interested in learning more about the following Managed Care Plan(s):
You may choose one plan or both plans.
►
________________ Fidelis Care New York ________________ Community Blue/Community Care
Signature: __________________________________________________________
Please fill in the following information on yourself and/or the family members you wish to enroll:
Last Name
First Name
Middle Initial
Date of Birth
Sex M/F
Social Security #
Your Primary Doctor