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Frequently Asked Questions (FAQs)

 

What do I do if I have a question about a claim or an Explanation of Benefits (EOB) statement?

For questions about claims and EOB statements you should call your claims payor. Check your health plan card for the claims payor customer service telephone number. You can also locate this information on the Member Tab, under the Claims and Benefits Information link on the left, and selecting your employer. Or just click on this link and select your employer: Claims and Benefits Information

What do I do if I have a question about my prescription coverage?

Prescription questions should be directed to the Pharmacy Benefit Manager (PBM). Check your health plan card for the PBM customer service telephone number. You can also locate this information on the Member Tab, under the Claims and Benefits Information link on the left, and selecting your employer. Or just click on this link and select your employer: Claims and Benefits Information

Who do I call when I need a new health plan card?

You should call your claims payor to request a new health plan card. Check your health plan card for the claims payor customer service telephone number. You can also locate this information on the Member Tab, under the Claims and Benefits Information link on the left, and selecting your employer. Or just click on this link and select your employer: Claims and Benefits Information

Will my procedure or service be covered by my insurance?

This information can be obtained from your claims payor. Check your health plan card for the claims payor customer service telephone number. You can also locate this information on the Member Tab, under the Claims and Benefits Information link on the left, and selecting your employer. Or just click on this link and select your employer: Claims and Benefits Information

What is precertification and why do I have to use it?

Your employer uses precertification as a part of medical management to make sure that you receive suitable care. Trained nurses act as advocates for you and your employer to ensure that your care is appropriate and cost effective. The back of your health plan card notes the precertification requirements of your health plan and provides you with a toll free number to call when you need to receive any of the listed services. Many plans have a financial penalty applied to the patient if you do not follow the precertification process. Information on this program is also contained in your health plan document, which is available from your employer. Please read this information carefully so that you understand your health plan, and its rules, in order to avoid any penalties.

Do I need a referral authorization to see a doctor or specialist?

If your plan design is a Preferred Provider Organization (PPO), then you do not need a referral to see a specialist. If you have a Point of Service (POS) plan design, you will need referral authorization from your primary care physician to see a specialist. You can also check your health plan booklet to verify the plan requirements regarding referral authorizations.

Who do I need to notify if I'm going to have a baby?

Cigna, and SC Johnson

You should call the number listed on the back of your health plan card, which identifies the company that does medical management for your plan. Medical management may be a function performed by your claims payor or it may be an independent provider of these services. Or just click on this link and select your employer: Claims and Benefits Information

 

MidMichigan Health and Northwood

As soon as you find out you are pregnant, please contact ConnectCare's customer service at 888-646-2429 (option 3) to precertify your pregnancy and to be enrolled in our Healthy Pregnancy Program.

Is my baby automatically covered by my insurance once it's born?

Your baby's charges at birth are usually submitted as part of the mother's bill for the delivery. Most insurance plans require that you go to your Human Resources or Personnel department and register your newborn within 31 days of birth. You should check the health plan booklet provided by your employer for the exact requirements for this situation.

I am married, how do we know whose insurance to use?

Each plan has different requirements on how families access their insurance benefits. You should check the health plan booklet provided by your employer to see how your coverage works under this situation.

Which physicians and providers participate with the ConnectCare network?

All the physicians and facilities listed under your employer's pages on our Web site are part of your provider network. The Web site listings are updated frequently; however, as this information may also change frequently, it is wise to ask whether the provider is still participating with your employer's ConnectCare plan.

What if I want to see a doctor who doesn't participate with the ConnectCare network?

If you choose a provider who is not part of your ConnectCare PPO, you can expect to pay a larger portion of the costs. You must follow your provider's procedure for payment when they do not participate with or bill your claims payor. Typically you will be asked to pay for the services you received and you will be given a receipt to submit to your claims payor for reimbursement. All providers participating in ConnectCare will bill your claims payor and they will accept the amount paid as payment in full, with the exception of your copayments, coinsurance, or deductible amounts.

What happens if I am out of town/state and have an emergency?

It is always important that you seek the medical care you need. Often, health plans cover emergency care at a benefit level that does not vary based on where your emergency occurs. Please check the health plan booklet provided by your employer for the coverage levels applied to emergency care.

Who do I contact if I have a concern about a provider?

ConnectCare uses a process to confirm the quality of our network providers. Any concerns you have about your experiences with our providers are important to us and we want to hear from you. Our complaint officer is available to discuss your concerns. You can contact us toll free at (888) 646-2429 and ask to speak to the complaint officer or send an email to the complaint officer at privacy@connectcare.com.

MidMichigan Health ONLY: How does the tier system work under the MidMichigan Health plan?

MidMichigan Health ONLY

A Tier 1 PPO provider is an in network provider owned and operated by MidMichigan Health. A Tier 2 provider is an in network provider not owned and operated by MidMichigan Health. Tier 3 providers are all out of network providers. A directory of providers in the PPO network can be obtained online, or by contacting Human Resources.

What do I do if my pharmacy won't fill my prescription?

MidMichigan Health and Northwood University

Call one of the nurse case managers at 989-839-1629, option 3.  If it is after hours, weekend, or holiday, call the member services number on the front of your card under the MagellanRx box.  Also in the MagellanRx box is a Pharmacy Provider Support number that your pharmacist can call for assistance.

ConnectCare

Customer Service

ConnectCare's Customer Service Staff is available to assist you with general questions and to verify your provider's participation in the ConnectCare network.

Toll Free: 888-646-2429
Local: 989-839-1629
Fax: 989-839-1626
 
Hours of Operation
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 5:00 p.m.
Monday - Friday (Eastern Time)

After normal business hours, inbound communications and information may be relayed via fax, confidential voice mail or electronic mail. All precertification requests and/or communications received after normal business hours are returned on the next business day and communications received after midnight on Monday through Friday are responded to on the same business day.

Certified by NCQA since 2007

NCQA Certified Utilization Management"Achieving Utilization Management Certification from NCQA demonstrates that ConnectCare has the systems, process and personnel in place to conduct utilization management in accordance with the strictest quality standards." -- Margaret E. O'Kane, President, NCQA

NCQA has reviewed and certified ConnectCare's Utilization Management functions only. For complete details on the scope of this review, visit www.ncqa.org.