Important Information for all Health
Limits for Emergency Services
All plans have limits on when you use emergency room and
ambulance services. These services can only be used in an emergency
situation. This will allow Medicaid and BadgerCare Plus providers to be
able to provide services to more people. It also helps to keep Medicaid
and BadgerCare Plus costs down.
Emergencies require medical attention right away to
prevent death or serious damage to your health. Non-emergencies are
illnesses, injuries or medical needs that are usually taken care of at a
Examples of non-emergency conditions are (but not limited to):
Minor cuts or burns
Sprains or strains
Cold or flu symptoms
Pregnancy test, medical or other lab tests
An ongoing condition that has not suddenly changed or worsened
Please Note: You cannot use the emergency room or ambulance rides because it is easier for you to use these services. To avoid using emergency rooms and ambulance services:
Have a regular doctor,
Keep your appointments, and
Call your doctor or nurse help line about your medical needs, if one is available to you.
Prior Authorization for Services
Some services must be approved by ForwardHealth before you can get them. This is called “Prior Authorization.”
Your provider asks for the approval for these services
from ForwardHealth. If your provider does not get the services approved,
ForwardHealth will not pay for the service. The provider will then be
responsible for the cost of care provided. If you choose to get a
service after you know the approval was denied, the provider can bill
you for the service.
If You Get A Bill
ForwardHealth pays your provider for covered services. A
provider should not ask you, your family or others to pay anything other
than a copay for covered services. If you get something that looks like
a bill, contact the provider who is billing you.
Providers know the ForwardHealth coverage limits. The
provider must tell you if ForwardHealth does not cover a service before
the service is provided.
If you are not enrolled in an HMO, you should check with
your health care provider to see if your provider takes Medicaid and/or
BadgerCare Plus. If not, call Member Services and ask for help finding a
provider who does take Medicaid and/or BadgerCare Plus. All services
must be provided by your HMO or a Medicaid/BadgerCare Plus provider. If
you get services from someone who is not, you will be responsible for
paying the cost of the service.
If there is an emergency and you do not have your card
with you when you get services, give your ForwardHealth card number to
all providers as soon as possible.
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February 06, 2013