1. Know your rights and learn about the health plan’s quality program.
To review your rights and responsibilities as a health plan member and to learn about the health plan’s quality program and goals, please visit your health plan’s website. If you would like a written copy of our quality program or a copy of your Rights and Responsibilities, please call Member Services. You may also find a written copy of the Rights and Responsibilities document in the Quality section of your health plan’s website.
2. Read your Member Handbook.
Your Member Handbook is a good source of information. The documents help you understand the benefits and services you have; the benefits and services you don’t have (exclusions); how to get your prescription drugs and what drugs are covered; how to select a primary care provider (PCP); what to do if you need care when you are out of town; how and when to get routine, after-hours, specialty and emergency care; how to voice a complaint or appeal a coverage decision; and how to get care from specialists, hospitals and mental health providers. If you need another copy of this information, please call Member Services at 1-800-962-8074. You may also find a written copy of general benefit information on your health plan’s website.
3. Know what to do if you have an issue.
We strive to meet your needs. If you are unhappy with services or care, or with the health plan in general, please call Member Services or write a letter to Health Plan of Nevada. Either way, we will respond to your issue.
4. Know how to get information at your fingertips.
Did you know your health plan has online tools to help you? You can search our online provider directory and review the drugs covered on our drug list. As a member, you also get information on our programs and services, such as health education and wellness classes and value added services. As always, if you have questions about your plan, call Member Services.
5. Know that we research new medical technology.
For safety reasons, we formally evaluate new and emerging medical discoveries before including them in our member benefit package. Led by a highly skilled staff that includes physicians, our review process compares new technology to medical standards and clinical research to measure the effectiveness and safety of new medical procedures, drugs and devices. We also research new applications of existing technologies. If you, your providers or other interested parties would like to submit a request for the review of new medical technology, please contact Member Services.
6. Ask for help if you speak another language.
If you need help with communication, such as the services of a language interpreter, please call Member Services.
7. Know that the health plan does not offer incentives for prior authorization denials.
Health Plan of Nevada prohibits the compensation of physicians, other health care professionals or staff to be based upon or used as an incentive for the denial of benefits. All decisions regarding your benefits are given special consideration based on your medical needs and the appropriateness of the care and service. Health Plan of Nevada employees who perform utilization review duties do not receive any incentives, financial or otherwise, to encourage denial of benefits. That is, we provide no incentive for anyone on our team to restrict benefits for our members. For more information, please call Member Services.
8. Learn about internal and external review for denial of benefits.
If a benefit is denied, we provide internal review to help ensure member satisfaction. Additionally, a review is provided by a panel of medical professionals from outside of Health Plan of Nevada for eligible denials that have already undergone internal review. Expedited (rush) appeals are available when decisions are needed quickly. For additional information, please refer to your Member Handbook.
9. Know that we have special programs available for members.
Are you looking for extra help? You may be eligible for additional benefits from one of these programs.
Disease Management: If you have diabetes, chronic obstructive pulmonary disease, heart failure or asthma, you may be eligible to receive educational materials and calls from a Registered Nurse Health Coach. For more information, call the Disease Management Program at 1-877-692-2059, TTY 711 on weekdays between 8 a.m. and 5 p.m. PST.
Case Management: This program provides additional assistance for members with extra special needs. For more information, contact Member Services.
10. Know that we evaluate the care you receive.
If you are admitted to a non contracted facility or get care or services outside of the Health Plan of Nevada service areas, we may look at your medical records (after care was received) to evaluate the appropriateness of the medical care, services, treatments and procedures you received.
11. We want to hear from you.
You may get a survey in the mail about your health plan. We need your help so we can monitor our plan and make improvements for our members. Surveys you may get include the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcomes Survey (HOS) for Medicare members, Patient Satisfaction Survey, Health Management Program Satisfaction Survey, Complex Case Management Program Satisfaction Survey and Telephone Advice Nurse Program Satisfaction Survey.
Members are randomly selected for these surveys. If you get one, please fill it out. Your input is valuable to us.
12. Make an investment in your future.
It’s one that pays solid dividends, too. Keeping up with well visits and annual exams helps your primary care physician take care of the little things — before they become more serious. At your next appointment, please talk to your primary care physician about screenings and recommendations. Depending on your medical history, your provider may have additional medical advice. You can find the preventive guidelines on your plan’s website.
Call Member Services at 1-800-962-8074.