How to Use Your Benefits

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Getting Help
Member Services can answer questions about your health care benefits, Member ID cards and PCPs. You can also call them to get help with problems about your health care. Member Services can be reached at 1-855-300-5528 (TTY users dial 711/TDD users dial 1-800-627-4702.)

24-Hour Care
Your PCP is your medical home who takes care of all of your health needs, 24 hours a day, 7 days a week, including weekends and holidays. When your PCP is not available, there is another provider scheduled to take his/her place. For routine and urgent care, call your PCP. If you have an emergency, call 911 or go to the closest emergency room.

To see your PCP, call the provider’s office and schedule an appointment. You should call your PCP, even it is after office hours. Your PCP or someone from his/her office will call you back.

If you have not chosen or been assigned a PCP, you may go to any PCP in the CoventryCares of Kentucky network to receive care. Once you have a PCP you should receive your care from your chosen PCP.

24-Hour Nurse Line
We encourage you to work with your PCP for all your health care needs. But, if you have a medical question and are not sure what to do, call our 24-Hour Nurse Line. The nurses can help answer health questions. They can also tell you what to do when you need health care, such as, call your PCP for an appointment or going immediately to the emergency room. Call the 24-Hour Nurse Line at 1-855-620-3924. This number is also on the back of your CoventryCares of Kentucky Member ID card.

CoventryCares of Kentucky does not require a referral from your PCP or OB/Gyn before you see another CoventryCares of Kentucky provider. However, your PCP is your medical home and should coordinate your care. You should call your PCP to tell him/her you are going to the other provider.

Pre-Authorized Care
CoventryCares of Kentucky must approve some health care services and supplies before you get them. This is called pre-authorization. Services that need pre-authorization are in the following list. This list may change from time to time. Call Member Services at 1-855-300-5528 (TTY users dial 711/TDD users dial 1-800-627-4702) to request the most current list.

Second Medical Opinions
You may need a second opinion for an illness, surgery or treatment that your PCP says you need. Contact your PCP or Member Services at 1-855-300-5528 (TTY users dial 711/TDD user dial 1-800-627-4702) for help getting a second opinion. There is no cost to you for second opinions.

Financial Responsibility: Limits on Co-Pays
There is a limit on the total amount of co-pays you will have to pay.  You will not have to pay more than 5% of your family's income each quarter.  We keep track of the co-pays you pay.  If you pay a co-pay and your family has reached the maximum out-of-pocket amount, we will refund the co-pay amount to you or your provider.  If you have Medicare and Medicare pays for the service, you have no Medicaid co-pay.

Please see your Member Handbook for a full description of your benefits.

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