PA Medicaid Member Handbook

Member Handbook Download (PDF)

Table Of Contents

Services for members

• Member Services
• Gateway Health Plan^® Notice of Privacy Practices
• Hearing and Sight Problems
• Non-English Speaking Members
• Gateway Health Plan^® ID Card

Primary Care Doctors and specialty care

• Primary Care Doctor
• How Can I Change My Doctor?
• Specialty Care Referral
• How Can I Get a Second Opinion?
• Arranging Your Care
• Out of Network Care
• Other Medical Staff in Your Doctor's Office
• More Information About Your Doctor
• Hospital Care
• Emergency Services
• When Out of Town
• Transportation for Medical Services

Benefits and special services

• Covered Benefits
• Medicines
• Eye Exams and Eyeglasses
• Dental Care
• Special Needs
• Mental Health, Drug & Alcohol Services
• MOM Matters^® for Pregnant Women
• AIR Gateway^SM Asthma Program
• Help Your Heart Program
• Healthy Returns Diabetes Program
• Growing Up with Gateway^SM
• Early Intervention
• Family Planning
• Chiropractic Services
• Services Not Covered

• Adding New Members to Gateway
• When You Move
• Other Insurance
  • If You Have Medicare Benefits
• Claims-What Do I Do With a Bill?
• Changes in Benefits or Services
• Changing Health Plans
  • When You Stop Being a Gateway Member
• Involuntary Disenrollment
• Rights and Responsibilities
  • Member Rights
  • Member Responsibilities
• COMPLAINTS
  • What is a complaint?
  • What should I do if I have a complaint?
  • First Level Complaint
  • What if I don't like Gateway’s decision?
  • Second Level Complaint
  • What happens after I file a second level complaint?
  • External Complaint Review
• GRIEVANCES
  • What is a grievance?
  • What should I do if I have a grievance?
  • What if I don't like Gateway’s decision?
  • Second Level Grievance
  • What can I do if I still don’t like Gateway’s decision?
  • External Grievance Review
  • What can I do if my health is at immediate risk?
• Persons with Disabilities
• DEPARTMENT OF PUBLIC WELFARE FAIR HEARINGS
  • What happens after I ask for a fair hearing?
  • What can I do if my health is at immediate risk?
• Advance Directives
• HealthChoices Clinical Sentinel Hotline
• Suggestions for Changes
• Fraud and Abuse
• New Technology: Is it Covered?
• Other Information
• Eligibility
• Important Notice
• Important Phone Numbers for Mental Health, Drug, & Alcohol Services
• Medical Assistance Transportation

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