Senior Whole Health Member Services
- Overview of Senior Whole Health Member Services
- Eligibility and Enrollment Process
- Primary Care Providers and Specialist Referrals
- Prescription Drug Coverage
- Transportation Services
- Medical Equipment and Supplies
- Behavioral Health Services
- Dental, Vision, and Hearing Benefits
- Wellness Programs and Preventive Care
- Complaints and Grievances Procedure
Overview of Senior Whole Health Member Services
Senior Whole Health is a healthcare program that provides integrated care and support services to seniors who are eligible for both Medicare and Medicaid. The program offers an extensive range of services to its members, including medical, behavioral health, dental, vision, and hearing care. Additionally, Senior Whole Health also helps its members with transportation services, medical equipment, and supplies, prescription drug coverage, wellness programs, and preventive care.
Eligibility and Enrollment Process
To be eligible for Senior Whole Health, individuals must be 65 years or older, live in Massachusetts, and qualify for both Medicare and Medicaid. To enroll in the program, eligible individuals can call Senior Whole Health's Member Services department, and a representative will guide them through the enrollment process. Members can also request enrollment forms from their primary care providers or fill out the forms online on the Senior Whole Health website. Once enrolled, members receive a welcome packet containing information about their benefits and services.
Primary Care Providers and Specialist Referrals
Each member of Senior Whole Health has a primary care provider (PCP) who oversees their medical care. Members can choose their PCP from a list of participating providers, and if they want to change their PCP, they can do so by calling Member Services. If members need specialty care, their PCP will make referrals to specialists within the Senior Whole Health network. Members can also choose to see specialists outside the network, but they may have to pay additional costs.
Prescription Drug Coverage
Senior Whole Health provides comprehensive prescription drug coverage to its members. Members can get their prescriptions filled at participating pharmacies or through mail-order delivery. The program covers a wide range of medications, including generic and brand-name drugs. Members may have to pay copayments for their medications, depending on their income level.
Transportation Services
Senior Whole Health offers transportation services to its members who need help getting to and from medical appointments. Members can schedule rides with transportation providers in advance, and the program covers the cost of the rides. The program also provides reimbursement for members who use their own vehicles to go to medical appointments.
Medical Equipment and Supplies
Senior Whole Health provides medical equipment and supplies to its members, such as wheelchairs, walkers, and diabetic supplies. Members can get these items through participating providers or by calling Member Services. The program covers the cost of the equipment and supplies, but members may have to pay copayments, depending on their income level.
Behavioral Health Services
Senior Whole Health provides integrated behavioral health services to its members. The program offers counseling, therapy, and medication management to members who need help with mental health issues. Members can see mental health providers within the Senior Whole Health network or choose to see providers outside the network. The program covers the cost of behavioral health services, but members may have to pay copayments, depending on their income level.
Dental, Vision, and Hearing Benefits
Senior Whole Health provides dental, vision, and hearing benefits to its members. The program covers routine dental exams, cleanings, fillings, and dentures. Members can also receive annual eye exams, eyeglasses, and contact lenses. Additionally, the program covers hearing exams and hearing aids. Members may have to pay copayments for these services, depending on their income level.
Wellness Programs and Preventive Care
Senior Whole Health offers wellness programs and preventive care services to its members. The program provides health education classes, nutrition counseling, and exercise programs to help members stay healthy. Additionally, the program covers preventive care services such as mammograms, colonoscopies, and flu shots. Members can also receive annual wellness visits with their PCPs to assess their health status and develop personalized care plans.
Complaints and Grievances Procedure
Senior Whole Health has a complaints and grievances procedure in place for members who have concerns about their care or services. Members can file a complaint or grievance with Member Services, and the program will investigate and address the issue promptly. If members are not satisfied with the program's response, they can file an appeal with the Senior Whole Health Appeals Department. The program is committed to resolving issues and ensuring that its members receive high-quality care and services.
People Also Ask About Senior Whole Health Member Services:
What services do Senior Whole Health members have access to?
Senior Whole Health members have access to a variety of services, including doctor visits, hospital stays, prescription drugs, dental care, vision care, and more. Members can also receive care coordination and support from a dedicated care manager.
How do I enroll in Senior Whole Health?
To enroll in Senior Whole Health, you must be eligible for both Medicare and Medicaid, and live in a service area where the plan is offered. You can enroll by calling Senior Whole Health directly or through a licensed insurance agent.
Are there any extra costs for Senior Whole Health members?
Senior Whole Health members generally do not have any extra costs beyond their Medicare and Medicaid premiums. However, some services may require copayments or coinsurance. Members should check their plan documents for specific information about costs.
What if I need help with my Senior Whole Health plan?
Senior Whole Health members can contact customer service for assistance with their plan. They can also speak with their care manager for help with care coordination and other support services.
