How to Find Important Information
Here is where to find information about the following topics:
- To get more information about a provider's professional qualifications and specialty, see the Provider, Hospital, and Clinic Search. If you want more information about our PCPs and specialists—such as medical school attended, residency completed, and board certification status—please contact Customer Service.
- Benefits and services included in and excluded from coverage. See the Evidence of Coverage for your Plan.
- How to get primary care services, including where to get services. See the Evidence of Coverage for your Plan.
- How to get emergency care, including our policy on when to directly access emergency care or use 911 services. See the Evidence of Coverage for your Plan.
- Benefit restrictions on services you get outside our system or service area. See the Evidence of Coverage for your Plan.
- How to get care and coverage when you are outside our service area. See the Evidence of Coverage for your Plan.
- Copayments and other charges to you, if any. See the Evidence of Coverage for your Plan.
- How to submit a claim for covered services, if needed. See the Evidence of Coverage for your Plan.
- Our statement of your rights and responsibilities. See the Member Rights & Responsibilities Policy Statement.
- Our confidentiality policies, including:
- What a "routine consent" is and how it allows us to use and disclose information about you. See the Notice of Privacy Practices.
- How we use authorizations and your right to approve the release of personal health information (PHI) not covered by the "routine consent." See the Notice of Privacy Practices.
- How to request restrictions on the use or disclosure of PHI, amendments to PHI, access to your PHI, or an accounting of disclosures of PHI. See the Notice of Privacy Practices.
- Our commitment to protect your privacy in all settings. See the Notice of Privacy Practices.
- Our policy on sharing PHI with plan sponsors and employers. See the Notice of Privacy Practices.
- Pharmaceutical management procedures, if they apply to your plan. See the Evidence of Coverage for your Plan.
- The independent external appeals process for our utilization management decisions. See the information about what to do if you have a problem or complaint in the Evidence of Coverage for your Plan.
- How to voice a complaint. See the information about what to do if you have a problem or complaint in the Evidence of Coverage for your Plan.
- How to appeal a decision that adversely affects coverage, benefits, or your relationship with Community Health Plan. See the information about what to do if you have a problem or complaint in the Evidence of Coverage for your Plan.
ALERT: Clicking on the links below will take you away from the Community HealthFirst Medicare web site to the Community Health Plan of Washington web site. The information contained in the links below applies to all products offered by Community Health Plan of Washington.
- How to get care after normal office hours.
- How to get specialty care and behavioral health services and hospital services.
- Our policy against financial incentives for utilization management decision-makers.
- How we evaluate new technology to include it as a covered benefit. Read about our practice here.
- Our Quality Improvement Program, including goals, processes, and outcomes as related to care and service. Read about our program here.
- Our Case Management Program and how to refer yourself to the program.
- Our Disease Management Program and how to refer yourself to the program.
- How to contact staff if you have questions about the utilization management process.
- The toll-free number to call to contact staff about utilization management issues.
If you want paper copies or if you want more information about these items, please call Member Services at 1-800-942-0247 (TTY Relay: 7-1-1). Hours are 8 a.m. to 8 p.m., 7 days a week, and calls to these numbers are free.