How To Obtain Care
Primary Care Services and Points of AccessYou are encouraged to select a primary care practitioner (PCP) to oversee and coordinate your care. Your PCP may be a general practitioner, family medicine practitioner, an internal medicine specialist, a pediatrician, an obstetrician/gynecologist, or a nurse practitioner. We encourage you to work closely with your PCP who will provide most of your care and coordinate services with other providers, if this is needed. Kentucky Health Cooperative has a large Provider Network. There are many different types of facilities and practitioners. We have a Provider Directory to help you select the practitioner and facility that meets your needs. There are standards for how many practitioners and facilities we need in our Network and standards for types of practitioners and facilities. We measure these at least annually to be sure we meet those standards. Our Provider Directory is available on our Website at www.mykyhc.org or you may call Member Services at 800-687-5942 to request a printed list of providers. Specialist
How to Obtain Hospital services, Specialty Care and Mental Health and Substance Use ServicesIn the event you require admission to a hospital, your provider may arrange hospital services for you. He or she is welcome to work with Kentucky Health Cooperative to arrange your hospitalization. You may choose where you receive care by using the “Provider Search” on your Member Portal or by calling our member services at 1-855-OUR-KYHC (1-855-687- 5942) to ensure choice of an in-network facility. Kentucky Health Cooperative does NOT require Members to utilize a Primary Care Physician (PCP) for access to medically necessary services and referrals are not required to specialists, OB/GYN in particular, nor to mental health/chemical dependency services. If you need mental health or chemical dependency services, you may contact MHNet at 1-855-309-2422 directly. You do not need a referral for mental health or chemical dependency services. After Normal Office Hours
How to Obtain Care After Normal Office HoursIf you have an injury or illness that is life threatening, always seek your closest Emergency Room or call 911. However, if you get sick or hurt when your provider’s office is closed, and it is not an emergency, there are other options. You can call your PCP’s office even after hours. Your call will either be answered by a health care provider or an answering service who can relay your concern to the providers “on-call” who will call you back and provide advice and guidance as to your level of need. As a member of KYHC you may also call our 24–Hour Nurse Line that is staffed by nurses who will be able to assist you in determining your particular level of health care need. Lastly, you can go to an urgent care center. Urgent care services can be obtained from a network or non-network provider. However, you must obtain urgent care services from a network provider to receive maximum benefits. Urgent care services received from a non-network provider will be covered as a non-network service and you will be responsible for the difference between the non-network provider’s charge and the Maximum Allowable Amount. To identify an urgent care center near you that is in our provider network, you may search the Provider Directory on our Website at
https://www.mykyhc.org, or call Member Services at 1-855-OUR-KYHC (1-855-687-5942) or, if Member Services has closed, call the 24–Hour Nurse Line at 1-855-348-9113. Emergency Room CareIf you are experiencing an Emergency, call 9-1-1 or go to the nearest hospital. Services which we determine to meet the definition of emergency care will be covered, whether the care is rendered by a Network provider or non-network provider. Emergency care rendered by a non-network provider will be covered as a Network service; however you may be responsible for the difference between the non-network provider’s charge and the Maximum Allowable Amount, in addition to any applicable Coinsurance, Copayment or Deductible. If you contact your physician and are referred to a hospital emergency room, benefits will be provided at the level for emergency care. Hospitals are open to treat an Emergency 24 hours a day, 7 days a week. Benefits are provided for treatment of emergency medical conditions and emergency screening and stabilization services without prior authorization for conditions that reasonably appear to a prudent layperson to constitute an emergency medical condition based upon the patient's presenting symptoms and conditions. Benefits for emergency care include facility costs, physician services, and supplies and prescriptions. For Inpatient admissions following emergency care, prior authorization/precertification is not required. However, you must notify us or verify that your physician has notified us of your admission within 24 hours or as soon as possible within a reasonable period of time. When we are contacted, you will be notified whether the Inpatient setting is appropriate, and if appropriate, the number of days considered Medically Necessary. Care and treatment provided once you are stabilized is not emergency care. Continuation of care from a non-network provider beyond that needed to evaluate or stabilize your condition in an emergency will be covered as non-network benefit unless we authorize the continuation of care and it is Medically Necessary. If you have to visit an emergency room while traveling, show your member ID card and ask the hospital staff to call us at 1-855-OUR-KYHC (1-855-687-5942). Out of Service Area
How to Obtain Care and Coverage When Out of the KYHC Service AreaIf you are not in KYHC’S service area and you need emergency care, go to the nearest hospital. If you are not able to call us, ask a person with you or the hospital staff to call Customer Services at 1-800-687-5942 and tell us about your condition. Show hospital staff your health insurance card. If you receive a bill have for emergency services or have to pay for emergency services at the time of services please send any bill, receipt for payments paid with any discharge paperwork form the hospital and KYCH will pay the bill or reimburse you have made payment. Please send all paperwork to: Kentucky Health Cooperative 9700 Ormsby Station Road, Suite 100 Louisville, KY 40223. If you are not in our service area and you need care and it is not an emergency, please call us at 800-687-5942. We will work with you to help you get the care and services you need. When KYHC helps to arrange non-emergency services for you outside its service area, we will cover the cost. KYHC does not cover care provided if you obtain out of service care without our help or when you are out of the country. Out of Network
Benefit Restrictions When Using Out of Network Providers
Except for Emergency Care and Urgent Care most services must be received from a Primary Care Physician (PCP), Specialty Care Physician (SCP) or another network provider to be a Covered Service. Services which are not received from a PCP, SCP or another network provider or approved as an authorized service, will be considered a non-network service. The amount payable for Covered services varies depending on whether you receive your care from a PCP, SCP or another network provider or a non-network provider, except for emergency care and urgent care. If you use a non-network provider, you are responsible for the difference between the non-network provider’s charge and the Maximum Allowable Amount, in addition to any applicable Coinsurance, Copayment or Deductible. We cannot prohibit non-network providers from billing you for the difference in the non-network provider’s charge and the Maximum Allowable Amount. | | Member Info Email
[email protected] Phone
(855) 687-5942 Mailing Address
9700 Ormsby Station Rd
Suite 100
Louisville, KY 40223
MEMBER ID CARDS
Please note that a number of 2015 KYHC Individual ID cards were mailed to our members without the Group ID on the card.
Your Group ID is
KHBE-I.
Kentucky Health Cooperative Inc. is reissuing Individual member ID cards to correct this issue.
ATTENTION ALL MEMBERS WHO LIVE IN BULLITT COUNTY!Below you will find a link (under TOPICS OF INTEREST) with information on different classes and workshops the Bullitt County Health Department is offering for the Spring of 2015. Many of the classes offered are FREE. Diabetes 101 for members who have been recently diagnosed with diabetes. A Living Well workshop for members who have other types of chronic conditions like high blood pressure, diabetes, arthritis, cancer and depression. Also, a smoking cessation program. You can also visit their website for more information at
www.bullittcountyhealthdept.com
BOARD VOTING
Board Voting Has Ended!
Kentucky Health Cooperative is a different kind of health plan - we are a Consumer Operated and Oriented Plan (CO-OP), which means you have a voice in how the health plan is run. At
Kentucky Health Cooperative, we are focused on our members. We are your voice, your health insurance, your choice. KYHC Nominating Committee Leon Mooneyhan, PhD, Chair
To learn more about the Member Director role, please click the
KYHC Board Member Duties and Responsibilities link.
FORMS
MEMBER RESOURCES
MEMBER NEWSLETTERS
TOPICS OF INTEREST |
