I received a letter stating that the plan I am in is going away, what is happening?
We have important news about your Healthy Connections benefits. The South Carolina Department of Health and Human Services (SCDHHS) is making changes to the Healthy Connections managed care program. Your health plan is currently a Medical Homes Network Plan (MHN) and SCDHHS will no longer offer this plan type. On January 1, 2014, your health plan, Palmetto Physician Connections (PPC), will become Advicare, a Managed Care Organization (MCO).
Advicare contracts with both primary care and specialty care providers, like heart doctors and hospitals. As a result, Advicare can provide greater access to all of your health care needs and will be able to provide better management of the health care services you receive. Advicare will provide the same basic services you were getting in your old plan but may also offer extra services.
If Advicare is participating in your county, you will be automatically enrolled in the new Advicare MCO plan on January 1, 2014. You will receive an Advicare ID card and new member kit that will include important information about Advicare.
How can I find a doctor in your network?
You can search our doctors by name, county or zip code from our website. Click here to search for a doctor in your area. You can also call our Member Services Department at 1.888.781.4371 and a representative will help you find a doctor in our network.
What is prior authorization and How do I get it?
Some prescriptions must be approved before you can get them filled. This is called a prior authorization. If a medicine needs prior authorization, your doctor must complete a form and return it to CVS Caremark before the prescription can be filled.
There are also medical services that may require prior authorization. Your provider has been given a list of these services. You may also contact Member Services at 1.888.781.4371 if you have questions about a service and if it requires authorization.
If the request is approved, a notice is sent to your doctor, and you can get your medicine or the requested service. If the request is denied, you will get a letter explaining why. If you don’t agree with the denial, you can appeal the decision. To file an appeal, call Member Services at 1.888.781.4371.
Can I change my primary care doctor?
Yes. Call Member Services at 1.888.781.4371, and a representative will help you change your primary care doctor. For most doctors, you can call anytime during the month, and the change will go into effect the 1st day of the next month.
What are your hours of operation? What phone number should I call?
Member Services is available to take your call Monday through Friday from 8 a.m. to 5 p.m. Advicare also offer after hours services through our 24 Hour Nurse line. The Nurse line can help you with any of your health care concerns when the office is closed. Please call toll free at 1.888.781.4371 to reach our Member Services and 24 Hour Nurse Line.
What is a well visit?
Childhood is a time of rapid growth and change. A well visit is a complete medical check-up from head to toe. At this exam, your PCP will check the infant or young child’s growth and development and try to find problems early. Preventive care is important to keep children healthy. Based on age, there are certain times that you (or your child) should have a well visit.
Get a Well Visit
|From Birth to age 2||Within 2 weeks of:1 month
|Age 3 through 21||Once per year|
|Adults||Every 2 years|
How do I become a member?
Enrollment is done through SC Healthy Connections Choices. If you would like to be enrolled in Medicaid please contact Healthy Connections Choices at: 1.877.552.4642. Healthy Connection Choices will help you apply for your Medicaid benefits.
How do I know if I am eligible?
You may be eligible for Advicare if you have Medicaid through:
- TANF (Temporary Assistance to Needy Families)
- OCWI (for Pregnant women)
- Social Security without Medicare
You are not eligible for Advicare if you:
- Have Medicare
- Are 65 or older
- Have another HMO plan
- Receive hospice care
- Live in a nursing home
If I can’t get my medicine, can I call Advicare while I am at the pharmacy?
Yes. If you have a problem getting your medicine, please call Member Services at1.888.781.4371 while you are still at the pharmacy. You can also call CVS Caremark at 1.855.383.9430.
Can I change my primary care doctor?
Yes. You may change your Primary Care Physician (PCP) at any time by calling our Member Services team at 1.888.781.4371 and a representative will help you. Once you change your PCP you will be issued a new Advicare ID card within 14 business days. When you get the new card, please destroy your old card.
What should I do if I get a bill?
If you get a medical bill, call Member Services at 1.888.781.4371 as soon as possible. Please have the bill in hand when you call, so that the representative can help you.
Why is Advicare asking for my race, ethnicity and language?
At Advicare, we’re here to serve you. We want to make sure that all of our members get the best care possible. The more we know about you, the better we can meet your needs. The next time you talk to an Advicare customer service representative or nurse; you may be asked to share your race, ethnicity (cultural background), and preferred written and spoken language. You do not have to answer these questions. But, if you do, your answers will help us make sure that you and your family gets good care.
Your information will stay private. We will only share it with your doctor and other healthcare providers. For more information about how your race, ethnicity (cultural background) and language information is protected and stays private, please contact Member Services at 1.888.781.4371.