AmeriHealth Caritas Pennsylvania

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  • Hng dn C nhn ca Qu v c Sc khe Tt hn

    S tay Thnh vin

    www.amerihealthcaritaspa.com

  • S tay Thnh vin

    Lin h vi b phn Dch v Thnh vin theo s 1-888-991-7200.

    www.amerihealthcaritaspa.com

    Cn bn dch? Hy gi 1-888-991-7200

    i vi TTY, vui lng gi 1-888-987-5704.

  • AmeriHealth Caritas Pennsylvania | 1

    Mc lc

    Cho mng Qu v n vi Chng trnh Bo him Y t Amerihealth Caritas Pennsylvania ......................................2

    Ly thng tin ..........................................................................4

    Bt u ....................................................................................5

    Phc li v dch v ................................................................7

    Cc dch v ca nh thuc .................................................15

    Chm sc nha khoa ............................................................18

    Cc dch v nha khoa .........................................................19

    Chm sc nhn khoa ..........................................................21

    Nhn dch v chm sc dnh cho gia nh qu v ..........23

    Cc chng trnh c bit ca Amerihealth Caritas ......27

    n v ph trch Nhu cu c bit/Nhn dch v chm sc khi qu v xa nh ...........................................................31

    S chm sc c cht lng dnh cho qu v ....................32

    Giy gii thiu ......................................................................33

    S cho php trc ...............................................................34

    Cc dch v khng c chi tr .........................................36

    Nhn cc phc li v dch v khc ...................................37

    Cc gii hn v ngoi l ......................................................39

    Thng tin v khon ng thanh ton ...............................40

    Bo him v ha n khc .................................................41

    Rt tn ...................................................................................42

    Quyn li v trch nhim ca thnh vin ........................43

    Thng bo Tm tt v cc Thng l Quyn ring t .......45

    Giy ch th trc .................................................................46

    Khi qu v cn gip ........................................................47

    Khiu ni, khiu kin v iu trn cng bng .................48

    S dng qu mc v lm dng ..........................................60

    Cc trng hp c bit .....................................................61

    Nht k y t c nhn ca ti ...............................................64

    Ghi ch .................................................................................66

    Danh sch cc s in thoi hu ch ................................67

    Chng trnh chm sc c qun l ny c th khng chi tr tt c cc chi ph ca qu v. Hy c k hp ng v S tay Thnh vin ca qu v bit nhng dch v chm sc sc khe no c chi tr.

  • 2 | S tay Thnh vin Dch v Thnh vin: 1-888-991-7200 hoc TTY 1-888-987-5704

    Cho mng Qu v n vi Chng trnh Bo him Y t AmeriHealth Caritas Pennsylvania

    Gii thiu v chng tiChng trnh Bo him Y t AmeriHealth Caritas Pennsylvania chuyn tm cung cp dch v chm sc sc khe c cht lng trong cng ng ca qu v trong hn 30 nm.

    AmeriHealth Caritas l mt t chc chm sc c qun l, thc hin b tr cc dch v chm sc sc khe m qu v v cc thnh vin c bo him ca gia nh qu v cn. Chng ti mun gip m bo qu v v cc thnh vin gia nh ca mnh c khe mnh.

    Chng ti mun m bo qu v v gia nh qu v c i x tn trng v m bo rng cc dch v chm sc sc khe ca qu v c cung cp theo cch ring t v bo mt.

    Nhim v ca chng tiNhim v ca chng ti ti Chng trnh Bo him Y t AmeriHealth Caritas l gip mi ngi:

    Nhn c s chm sc.

    Duy tr khe mnh.

    Xy dng cc cng ng khe mnh.

    Chng ti c bit quan tm n ngi ngho.

    Cch chng ti c th gip qu vNu cn gip hoc c thc mc, qu v c th:

    Gi s 1-888-991-7200 ni chuyn vi i din ca b phn Dch v Thnh vin, 24 gi mi ngy, 7 ngy trong tun.

    Truy cp trang Trung tm Thnh vin ti a ch www.amerihealthcaritaspa.com.

    Chng ti c th gip qu v gii p nhng thc mc nh:

    Ti c th nhn c s chm sc y t bng cch no?

    Ti c th chn bc s chm sc chnh (PCP v tm mt c s y t bng cch no?

    Ti c th nhn h s y t ca mnh bng cch no?

    Cc dch v v phc li no c chi tr?

    Ti c th tm hiu v cc dch v nhu cu c bit bng cch no?

    Ti phi lm g nu nhn c ha n?

    Ti c th np n khiu ni hoc khiu kin bng cch no?

    Ti c th nhn danh sch cc nh cung cp ca AmeriHealth Caritas bng cch no?

  • AmeriHealth Caritas Pennsylvania | 3Thng tin sn c 24/7 ti a ch www.amerihealthcaritaspa.com

    Cho mng Qu v n vi Chng trnh Bo him Y t AmeriHealth Caritas Pennsylvania

    Cch qu v c th gip chng tiChng ti cn qu v gip chng ti. iu quan trng l phi nh:

    Thng bo cho AmeriHealth Caritas v cc nh cung cp dch v chm sc sc khe ca qu v bit bt k thay i no c th nh hng n t cch thnh vin, nhu cu chm sc sc khe hoc phc li ca qu v. Mt s v d bao gm, nhng khng gii hn cc trng hp sau:

    Qu v mang thai. Qu v sinh con. a ch hoc s in thoi ca qu v c

    thay i. Qu v hoc mt trong cc con ca qu v c bo

    him y t khc. Qu v c mt bnh trng c bit. Quy m gia nh ca qu v c thay i. Qu v chuyn ra khi ht hoc tiu bang.

    Hy cp nht thng tin v phc li ca qu v vi cn s x hi ca qu v ti Phng H tr ca Ht (CAO). Tm hiu khi no phc li ca qu v chm dt. m bo tt c thng tin ca qu v c cp nht qu v c th duy tr cc khon phc li ca mnh.

    Hp tc vi AmeriHealth Caritas v cc nh cung cp dch v chm sc sc khe ca chng ti. iu ny c ngha l tun th cc quy nh c cung cp cho qu v v AmeriHealth Caritas v tun theo hng dn ca nh cung cp dch v chm sc sc khe ca qu v v vic chm sc ca qu v. iu ny bao gm:

    C mt ti cc bui hn vi nh cung cp dch v chm sc sc khe ca qu v.

    Hy hn khi qu v khng th c mt ti bui hn.

    Gi cho AmeriHealth Caritas khi qu v c thc mc.

    i x tn trng vi cc nh cung cp dch v chm sc sc khe ca qu v v nhn vin ca h.

    Trao i vi nh cung cp dch v chm sc sc khe nht tr v cc mc tiu iu tr ca qu v, mc qu v c th thc hin.

    Trao i vi nh cung cp dch v chm sc sc khe qu v c th hiu c cc vn sc khe ca mnh, mc qu v c th thc hin.

    Nu qu v c bt k thc mc no v trch nhim ca mnh, hoc bit thm thng tin, vui lng gi cho b phn Dch v Thnh vin.

    Hy nh: Qu v cng phi gi cho Phng H tr ca Ht (County Assistance Office, CAO) hoc Trung tm Dch v Khch hng qua s 1-877-395-8930 thng bo cho h bit nhng thay i ca qu v.

  • 4 | S tay Thnh vin Dch v Thnh vin: 1-888-991-7200 hoc TTY 1-888-987-5704

    Ly thng tin

    Trn WebChng ti ci tin qu v c th d dng tm thy ni dung mnh ang tm kim trn website ca chng ti. Hy truy cp www.amerihealthcaritaspa.com tm hiu:

    Danh b Nh cung cp Trc tuyn ca AmeriHealth Caritas Pennsylvania gip tm nh cung cp, bao gm nh cung cp dch v chm sc sc khe hnh vi.

    Phc li v dch v y t, nha khoa v nhn khoa. Phc li nh thuc v danh mc thuc. Th thng bo dnh cho thnh vin. Cc chng trnh sc khe. Thng tin gio dc sc khe trn Lin kt ca

    Qu v vi Gio dc Sc khe (Your Link to Health Education).

    Cch thc nhn dch v chm sc sc khe hnh vi.

    Thng bo v cc Thng l Quyn ring t ca HIPAA.

    Quyn li v trch nhim ca thnh vin. Th tc khiu ni, khiu kin v iu trn

    cng bng. Thng tin v cc dch v cng ng. Cc ngun tr gip dnh cho thnh vin. Nhng cu hi thng gp. Thng tin lin lc. Bng ng thanh ton.

    Nu qu v khng c truy cp Internet, phn ln thng tin ny nm trong s tay ny. Nu qu v c thc mc, vui lng gi cho b phn Dch v Thnh vin.

    Trung tm Thnh vin trn website ca chng ti sn c bng ting Anh v ting Ty Ban Nha. Qu v cng s tm thy s tay ny trn website ca chng ti bng ting Anh, ting Ty Ban Nha, ting Nga, ting Trung Quc, ting Campuchia, ting Vit v nh dng ch in ln.

    Qu v cng c th quay s 711, PA Relay, nhn dch v TTY, dch v chuyn tip Internet v dch v chuyn tip video. Ph cc cuc gi chuyn tip a phng v ng di s ging nh ph gi in a phng hay ng di

    bnh thng.

    Cng thng tin an ton dnh cho thnh vinChng ti cng c mt cng thng tin an ton cho cc thnh vin ca mnh. Cng thng tin ny an ton v ch c th c truy cp bng ti khon ng nhp v mt khu c nhn m qu v thit lp khi ng k.

    Sau khi thit lp ti khon ng nhp v mt khu c nhn m ch mnh qu v bit, qu v c th tm:

    Danh sch cc loi thuc hin ti ca mnh v thi im qu v nhn chng.

    Danh sch cc ln khm bc s gn y nht ca mnh.

    Tin s bnh l ca qu v. Th nhc v cc cuc kim tra quan trng m

    qu v cn. Thng tin v bc s ca mnh. Danh sch bc s v nh cung cp.

    Sau khi ng nhp, qu v cng c th:

    t th ID. t S tay Thnh vin. Kim tra chc chn rng chng ti c a ch

    v s in thoi chnh xc cho qu v.Truy cp www.amerihealthcaritaspa.com ngay hm nay ng k.

    Bng cc ngn ng v nh dng khcAmeriHealth Caritas c cc ti liu bng vn bn dnh cho thnh vin bng cc ngn ng khng phi ting Anh v cc nh dng khc dnh cho ngi khim th. Cc nh dng khc bao gm ngn ng Braille, bng m thanh, ch in ln, a compact (CD), DVD, a mm my tnh, v/hoc truyn thng in t. Nhng ti liu ny c cung cp min ph cho qu v. Vui lng gi cho b phn Dch v Thnh vin ca AmeriHealth Caritas theo s 1-888-991-7200 yu cu cc ti liu dnh cho thnh vin bng mt ngn ng hoc nh dng khc. Nu qu v khng ni ting Anh, chng ti c cc i din ni cc ngn ng khc khng phi ting Anh. Chng ti cng c th s dng dch v Language Line Services gip qu v. Nu PCP hoc bc s chuyn khoa ca qu v khng th cung cp thng dch vin trong cc bui hn khm ca qu v, AmeriHealth Caritas s cung cp mt thng dch vin gip qu v.Nu qu v b khim thnh hoc nng tai, s TTY ca chng ti l 1-888-987-5704.

  • AmeriHealth Caritas Pennsylvania | 5Thng tin sn c 24/7 ti a ch www.amerihealthcaritaspa.com

    Bt u

    Ghi danhKhi qu v iu kin tham gia chng trnh H tr Y t, qu v cn phi chn mt chng trnh bo him y t HealthChoices. Phng Dch v Nhn sinh (Department of Human Sciences) c mt cng ty ring c cc chuyn vin ph trch ghi danh gip mi ngi chn mt chng trnh bo him y t HealthChoices.

    Cc chuyn vin ph trch ghi danh c th:

    G

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