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| Q. What is VHP CommunityCare? |
A. VHP CommunityCare is a managed care organization (MCO) participating in the TennCare program. MCOs offer preventive health care screenings and complete well-baby care for your children. MCOs want you to maintain your health rather than providing health benefits only when you are sick or injured. |
| Q. Who will be in charge of my health care? |
| A. The primary care provider (PCP) you choose will coordinate your health care. |
| Q. What is a primary care provider (PCP)? |
| A. A PCP is usually an M.D. Some other providers of care may be Nurse Practitioners. A PCP is licensed in general practice, family practice, internal medicine or pediatrics. |
| Q. May I select my OB/GYN as my PCP? |
A. No. Although an OB/GYN is not considered a PCP, women may see any OB/GYN in our network for their well-woman check-up each year without an authorization from a PCP. |
| Q. Does everyone in my family have to have the same PCP? |
| A. No. Each member of your family can have a different PCP. For example, you may choose an internist for yourself and a pediatrician for your child(ren). |
| Q. May I change my PCP? |
| A. Yes. You may change your PCP once in any month, up to a total of three times in a calendar year. Our Member Services representatives will help you do this. |
| Q. What do I pay when I see my PCP? |
A. Depending on your eligibility category, each time you see your PCP for an office visit, you may be asked to pay a co-payment. The co-payment is paid to the PCP at the time of your visit. All services provided during that office visit will then be covered at 100% by VHP. |
| Q. How do I see a specialist? |
A. Whenever necessary, your PCP will give you an authorization for specialist services. This may include specialist visits, home health care, tests and treatment that cannot be performed in your PCP's office |
| Q. What do I pay the specialist? |
| A. You pay the same co-payment when you see a specialist that you pay to see your PCP. |
| Q. What do I do if I need hospitalization? |
| A. All non-emergency hospital admissions must be authorized by your PCP and precertified by VHP. |
| Q. What do I do if I have a medical emergency? |
A. For medically necessary emergency services, go to the nearest emergency facility for immediate attention and call your PCP within 24 hours. Medically necessary emergency services are services for symptoms of sufficient severity, including severe pain, such that a prudent lay person with an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in serious medical complications, loss of life, serious impairment to bodily functions or serious dysfunction of a bodily organ or part. If you are hospitalized as a result of your emergency services, you must notify and receive authorization from VHP within one business day or as soon as reasonably possible. |
| Q. How do I file a claim? |
| A. You don't. One of the advantages of joining an MCO is that there is virtually no paperwork. |
| Q. What should I do if I receive a bill? |
A. You should not receive any bills from participating providers. Some doctors use computers to send statements that are not bills. We recommend you call the provider to make sure they know you are a member of VHP. If you continue to receive bills, please call our Member Services Department. |
| Q. How do I reach my PCP if the office is closed? |
A. All contracted PCP's are required to have 24-hour-phone coverage. If you need to contact your PCP when the office is closed, call the number on your identification card. The answering service will get you in touch with your PCP or the physician taking calls for your PCP. |
| Q. How do I get my medicine or prescriptions? |
A. All medicines prescribed by participating physicians can be filled at your local pharmacy. To be sure you get your prescriptions filled at a pharmacy that participates with VHP, please refer to the pharmacy section in this directory. |
|
Member
Services Department |
| If you have any other questions or need information, our Member Services Department hours are 8:00am to 5:00pm CST, Monday through Friday. |
|
(615) 782-7878 |
| or |
|
(800) 316-CARE |
