Get the Most from Your Coverage
You deserve quality health care. You also need clear facts about your plan. Your health plan sets goals for quality care. It checks these goals to help you get the care you need.
This page is part of our Quality Program. The program helps make your care and services better. This page tells you about your plan and the help you can get. Contact Member Services at 1-866-595-8133 (TTY: 711) to learn more about the Quality Program. We’re here to help Monday – Friday, 7 a.m. to 7 p.m.
Know Your Rights
As a member, you can expect these things from your health plan:
- You can use all services that are open to members.
- You will be treated with care and respect.
- You can get a copy of your health record.
- Your health information will be kept private. We have rules to keep your records safe.
- You can get an interpreter or written translation at no cost to you.
- You have the right to understand how we use your contact information. We use your phone number, email and mailing addresses to send you important information about your health plan, such as eligibility updates, health reminders and ways to earn rewards. You can unsubscribe at any time.
You can also take these steps to get the most from your plan:
- Ask questions if you do not know your rights.
- Go to your scheduled appointments.
- Take your Member ID card to each visit.
- Tell your doctor if you got care in an emergency room.
See your Member Handbook for the full list of rights and responsibilities.
How We Keep Your Personal Details Safe
You may choose to share facts about yourself. These facts may include your race, ethnic group, language (REL), sexual orientation and gender identity (SOGI) or disability information. They may also include aids or other help you need. We work to keep these facts safe. We:
- Keep paper files in locked cabinets.
- Keep digital files on secure devices.
- Keep digital files in folders that need a password.
The law may let us use or share your REL and SOGI information. We may share them with your doctors, other care teams, or state and public health groups. We may use them to help plan your care, meet your language or access needs, make services better, study gaps in care and run the health plan. This work may include:
- Planning programs to help members.
- Planning and sending member messages.
- Telling your care team about your language needs.
- Studying gaps in health and care.
We will not use your race, ethnic group, or language (REL) facts, or your sexual orientation and gender identity (SOGI) facts, to set your rate, decide your benefits or approve you for coverage. We will not share these facts with people who are not allowed to see them.
Getting the Care You Need
Your PCP is the doctor you see for checkups and basic care. Your PCP can help you find other types of health care providers. You can also use the Find a Provider tool on your health plan website.
As children grow up, they should move from a child doctor to an adult doctor. Teens may need fewer checkups than young children. Still, they should see their PCP at least once a year. These visits help them stay up to date on shots. Teens with diabetes, asthma, or another health issue should not miss visits. Call your health plan if you need help finding an adult doctor.
You should be able to make a visit with your PCP and get care when you need it. You may wait longer to see some doctors, such as specialists. Call your health plan if you cannot get a visit soon enough.
Language assistance services are available for any language, free of charge. This help includes American Sign Language. You can get free interpreter help when you talk with your health plan or doctors. You can also get this help during a grievance (complaint) or appeal. It also includes live spoken help from trained medical interpreters. Our interpreters can speak English and the member’s other language well.
For real-time oral and American Sign Language interpretation, call 1-866-595-8133 (TTY: 711), 24 hours a day, 7 days per week. If you need an interpreter for a doctor visit, call Louisiana Healthcare Connections before the visit. We will set up an interpreter for you.
If you need written health materials translated into a language other than English, please ask Louisiana Healthcare Connections for help. You can also ask for help tied to a disability. This may include braille, large print, a trained reader or other aids. For help, call Member Services at 1-866-595-8133 (TTY: 711), Monday – Friday, 7 a.m. to 7 p.m.
You should get safe drugs and the right care for your health needs. Not all drugs are covered. Some need approval before your plan will pay for them.
A link to the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations)(PDF) is on your plan website. This PDL (preferred drug list) is kept up to date. It lists drugs that Louisiana Medicaid members can use if prescribed. The PDL is not a complete list of covered drugs. It lists the preferred medications in the most common drug categories. Ask your doctor or pharmacist to check the PDL and answer your drug questions.
The Utilization Management (UM) team checks your health records. The team may also talk with your doctor. This helps the team decide if your plan covers a service. Money does not guide this choice. Doctors and staff do not get a reward for saying no to care. Each UM choice is based on:
- Whether you need the service for your health.
- Whether the service works well.
- Whether the service is right for you.
New drugs, tests, and types of care come out each year. A team of doctors and other experts checks them. The team decides if your plan will cover them. Your plan covers care you need for your health. It may not cover each new service for every member.
If your plan says no to a service, you can appeal. We will send you a letter that tells you how. We review each appeal based on your request, health needs, and benefits.
Care Management helps members who need more support with their health. Some members have more than one health issue or see more than one doctor. Some need help getting services their doctor ordered. A care manager can help you learn about your health needs, work with your doctors, and get the care you need.
Get More Information
Your Member Handbook has facts about your plan and benefits. It also lists key phone numbers.
You can also contact Member Services at 1-866-595-8133 (TTY: 711), Monday – Friday, 7 a.m. to 7 p.m. You can get an interpreter or written translation if you need it. Call Member Services to get:
- A paper copy of your Member Handbook, Privacy Notice, or any item on your plan website. We will send it to you within five business days, at no charge.
- Help finding a doctor or making an appointment.
- Help talking with a care manager.
- Help with an appeal when a service is denied.
- Help getting a ride to your appointment, if you don’t have your own transportation.
Your health plan website also has helpful facts and tools. You can find your Member Handbook, the Find a Provider tool, and the Preferred Drug List. You can also use free resources on the site to help manage your health.
It's free and easy to make an online member account. With your account, you can:
- Find or change your PCP
- Ask for a new Member ID card or print a temporary card
- View or change your personal details
You can also send a secure message to your health plan from your account.