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Amerigroup providers florida healthy kids program

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You may refill your prescriptions early in those counties. Contact your pharmacy for information. Members call any time to reach our hour Nurse Advice Line. Call the member services number above.

Press 1, then star to reach the Crisis Line. Please read the most up-to-date information on temporary flexibilities to our prior authorization processes that have been implemented to support our members and providers due to storm activity. A flu shot is the best way to protect yourself and those close to you from the flu.

Schedule yours today! Learn more about your flu shot benefit. Children's Medical Services Health Plan Operated by Sunshine Health is a plan for children and youth less than 21 years old with serious, chronic conditions. Learn more! One Plan. The overall rating is the weighted average of all measures, not the average of the three composites Consumer Satisfaction, Prevention, Treatment.

For more information about the ratings, including how they are calculated, visit our ratings page. Note: There were no Health Plan Ratings in See our Health Plan Ratings Marketing and Advertising Guidelines for more information regarding the continued usage of Health Plan Ratings for advertising and marketing purposes. Lower Performance Higher Performance. Private Commercial Medicaid Medicare.

Special Project: Managed Medical Assistance. Plan Name. NCQA Accreditation. Consumer Satisfaction. Coventry Health Care of Florida, Inc. Humana Medical Plan, Inc. Molina Healthcare of Florida, Inc.

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Cognizant dlf porur PROVIDERS Please read the most up-to-date information on temporary flexibilities to our prior authorization processes that have been implemented to support our members and providers due to storm activity. Partial Data Reported. Medication Refills: Gov. Call if you have a medical emergency. NCQA Accreditation.
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Contact amerigroup texas Molina Healthcare of Florida, Inc. Members call any time to reach our hour Nurse Advice Line. Press 1, then star to reach the Crisis Line. A flu shot is the best way to protect yourself and those close to you from the flu. Florida True Health, Inc. PROVIDERS Please read the most up-to-date information on temporary flexibilities to our prior authorization processes that have been implemented to support our members and providers due to storm activity. Yes Interim.

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Full Disclaimer. This site complies with the HONcode standard for trustworthy health information. Post your Comments Comments should be on the topic and should not be abusive. The editorial team reserves the right to review and moderate the comments posted on the site.

Post Comments. I agree to the terms and conditions. Your comments are automatically posted once they are submitted. All comments are however constantly reviewed for spam and irrelevant material such as product or personal advertisements, email addresses, telephone numbers and website address.

Such insertions do not conform to our policy and 'Terms of Use' and are either deleted or edited and republished. Please keep your comments brief and relevant. If this happens, we will call or send you a letter to tell you. Sometimes, your child may be able to keep seeing his or her PCP for care for up to six months if he or she is in a course of treatment. We can also help you pick a new PCP for your child. Look in the Amerigroup provider directory. Or call Member Services to ask for a printed version.

We can also help you pick a doctor. We can change your PCP on the same day you ask for the change. The change will begin right away. Call your provider if you want to make an appointment. If you need help, call Member Services. We can help you make the appointment. Usually, the PCP needs to give your child a referral. Please read the section Specialists to find out more. If your child goes to a provider that the PCP has not referred him or her to, the care your child gets may not be paid for by Amerigroup.

These services include:. To speak with a registered nurse, call Amerigroup On Call at Click on Find. But your child may also need care from other kinds of doctors. Amerigroup offers services from many kinds of doctors.

These doctors provide other medically needed care. They are called specialists because they have training in a special area of medicine. Examples of specialists are:. In most cases, your child will need to have a referral from his or her PCP to see another doctor.

The referral form tells you and the specialist what kind of health care your child needs. Be sure to take the referral form with you when you take your child to the specialist.

This is done through a standing referral or an approved number of visits. Members with special health care needs are children who face daily physical, mental or environmental challenges. If you believe your child has special health care needs, please call Member Services. You will not pay any more than if you were getting the service from us.

Your child should see his or her primary care provider PCP for a well-child visit a general checkup within 90 days of enrolling in Amerigroup. Call Member Services if you want our help. If your child has already been seeing the provider who is now your Amerigroup network provider, call that office. Is it time for a checkup? Make an appointment for your child to see the provider as soon as you can. Just call the office. We will help you make the appointment.

When you call to make an appointment, let the person you talk to know what your child needs for example, a checkup or a follow-up visit. Also, tell the office if your child is not feeling well. This will let them know how soon your child needs to be seen. We want your child to be able to get care at any time. When the office is closed, an answering service will take your call. See the chart below:. Tell the office to cancel the visit. Make a new appointment when you call. Try to call at least 24 hours before the visit.

This will let someone else see the provider during that time. If you want us to cancel the appointment, call. Member Services. If your child has an emergency and needs transportation, call for an ambulance. Be sure to tell. The PCP can arrange treatment and help your child get needed hospital care. The Amerigroup network of doctors and hospitals help members with disabilities get needed care. Members who use wheelchairs, walkers or other aids may need help getting into an office.

An HMO is a health plan that pays for most types of medical care without large out-of-pocket costs for you. Amerigroup pays for treatment when your child is sick or injured. We also pay for services that can help your child stay healthy. This includes annual checkups and immunizations shots. Amerigroup is easy to use. When your child gets covered services, you pay a small copay, if needed. Amerigroup pays for the rest without any paperwork. Premium payments are due 30 days in advance to Healthy Kids.

You will get a coupon book to help remind you to make your payments. You can pay your premium online or by phone with Healthy Kids.

Services will not be paid for by Amerigroup during this time. Monthly premiums can be paid by mail or phone or over the Internet. Checks by phone and payments by debit or credit card are also OK. Payments by phone can be made 24 hours a day, 7 days a week. Payments can also be made online at www. A small fee will be charged for payments made over the phone and online.

Every family must renew Healthy Kids coverage once a year. It will have a form with most of your current information already filled in. You may also review your information online at www. If you have any questions, please contact Florida Healthy Kids. The toll-free number for the Customer Service department is. This is a list of the health care services that the Healthy Kids program and Amerigroup will cover when your child needs them.

For some special benefits, members have to be a certain age or have a certain kind of health problem. If you have a question or are not sure whether we offer a certain benefit, call Member Services. If you have an emergency, call or go to the nearest hospital emergency room right away. Some services may need precertification before you can get them. Please have your doctor call Member Services at If you want your child to get hospice care, services which do not treat the terminal condition will not be covered.

To better meet all your needs, Amerigroup offers extra benefits called value-added services. These extra benefits include:. Call toll free at TTY Utilization Management UM. All UM decisions are based on medical needs and current benefits only.

We do this for the best possible health results for our members. Some services and benefits need prior authorization approval. This means your provider must ask Amerigroup to approve the services first. Amerigroup has a utilization review team that looks at. Amerigroup will let you and your doctor know after we get the request. If you get dental benefits, they are provided through a different company. You can pick from several local pharmacies drugstores and major drugstore chains to get the drugs.

Look in the provider directory for a list of network drugstores. The formulary is a list of drugs we pay for. Certain drugs may require approval before they are covered as a benefit. When this happens, it is called a prior authorization approval. An Amerigroup network pharmacist may need to get information from your doctor to make sure the medicine is the best one for you.

Amerigroup will talk with your doctor about prior treatments to help make these decisions. The pharmacist will use a generic instead of brand-name drug if one is available. A brand-name drug is only covered if a generic drug is not available or when your physician says a brand name is. You must get the item at an Amerigroup network drugstore that takes part in this benefit.

Choose the item. Show the pharmacist your Amerigroup ID card. Routine Care. Your child will go to see the doctor. This will be good for most minor illnesses, injuries and regular checkups. This care is called routine care. This is called wellness care. See the Wellness. Services in this handbook. Your child should be able to see his or her PCP within one week for. The second type of care is urgent care. But they can turn into an emergency if not treated within 24 hours.

You may be told to go to another office for your child to get care right away. See the next section about emergency care to find out more. You can also call Amerigroup On Call, our hour nurse helpline, at TTY for questions about urgent care. Your child should be able to see his or her PCP within one day for an urgent care appointment.

The third type of care is emergency care. If your child has an emergency, you should call Or take your child to the nearest hospital emergency room right away. The most important part is to get medical care as soon as you can. Your child should be able to see a physician right away for emergency care.

When your child goes to the hospital, he or she will get a medical screening. Ask the hospital to call Amerigroup. The steps for providers to follow are on your ID card. The problem is so bad that a person with an average knowledge of health and medicine can tell the problem may cause death.

Or it may cause harm to any organ or part of the body. Or in the case of a pregnant child, it may cause harm to the health of the child or her unborn baby. An emergency behavioral health condition meets the standard above. Examples of an emergency behavioral health condition include:. Post-stabilization services are covered services your child gets after emergency medical care. Your child gets these services to help keep his or her condition stable. You can also call Amerigroup On Call 24 hours a day, seven days a week for help.

If you think your child needs emergency services see previous section , call Or go to the nearest emergency room right away. Or call If your child is placed in the hospital, have the hospital call Amerigroup. This call should be made within 24 hours of admission or as soon as possible to confirm coverage. Any nonemergency care your child gets outside the service area is not covered unless your child gets prior approval from Amerigroup. You may be told to get care for your child where he or she is if he or she needs it very quickly.

If your child needs routine care like a checkup or a prescription refill when he or she is out of town, call the PCP. Amerigroup will find a way to help take care of your child. We will put you in touch with a case manager who will help your child get the medical care he or she needs. Your child needs to have routine wellness visits with his or her primary care provider PCP.

Many health problems can be treated and handled, if found early. You need to make his or her first appointment within 90 days. Your child should have his or her teeth and gums checked by the PCP as a part of the routine well-child visits. It is important for your child to get immunizations shots on time. Take your child to the provider when the PCP says a shot is needed. Use the chart that follows to help keep track of the shots your child needs. If your child does not get a wellness care visit on time, make an appointment with his or her PCP as soon as you can.

If you need help to set up the appointment, call Member Services. If your child has not visited the PCP on time, Amerigroup will send you a postcard to remind you. This kind of care is called prenatal care. It can help your child have a healthy baby.

Prenatal care is always important even if your child has already had a baby. With our program, members receive health information and baby gifts for getting prenatal care and postpartum care. Our program also helps pregnant members with complex health care needs. Nurse case managers work closely with these members to help teach them about these needs. They give emotional support.

Our nurses also work with providers. They help with other services members may need. The goal is to promote better health for members and the birth of healthy babies. You must also call Amerigroup Member Services when you find out your child is pregnant. If she is a new Amerigroup member who is pregnant and has been seen by a non-Amerigroup provider for at least one complete prenatal checkup before she joined Amerigroup, then she may be able to keep seeing that provider throughout her pregnancy.

She may also keep seeing the provider through the delivery and up to two months after her baby is born. When your child is pregnant, Amerigroup will send her a pregnancy education package. It will include a:. The self-care book gives her information about her pregnancy.

She can also use the book to write down things that happen during her pregnancy. The Taking Care of Baby and Me brochure tells your child how to get her gift for getting prenatal care.

After she delivers her baby Get her postpartum checkup between days after she has her baby, even if she sees her doctor before three weeks have passed. While your child is pregnant, she needs to take good care of her health. She and her baby should stay in the hospital until her provider says they can leave. They can leave the hospital before the provider releases them.

But it is best not to do this. If she and her baby leave the hospital early, the provider may ask her to have an office or in-home nurse visit within 48 hours. After your child has her baby, you must call Amerigroup Member Services as soon as you can. You need to call us to let us know she had her baby. When your child has had her baby, Amerigroup will send her the Taking Care of Baby and Me postpartum education package. DMCCU care managers work with your child to create health goals.

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