U gudub tusmada ugu weyn
Tusmada Ugu Weyn

New Mexico Long-Term Services and Supports (LTSS)

Medicaid

Our New Mexico Long Term Services and Supports (LTSS) is a health coverage program for New Mexico residents who meet requirements and who are eligible for Medicaid. LTSS is designed to improve quality of life for members of any age who have functional limitations and/or chronic illnesses. LTSS helps support the member to live or work in the setting of their choice, which may include the person's home, a worksite, provider-owned or controlled residential setting, a nursing facility, or other institutional setting. LTSS provides in-home counseling sessions that focus on solving problems and becoming socially and physically active.

  • New Mexico Long-Term Services and Supports (LTSS) Steps to Enroll
  • Check Eligibility (opens modal window)

Hel Bixiyeyaasha iyo Caymiska loogu talagalay Qorshahan.

Hel Bixiye Daryeel

Hel dhakhaatiir, isbitaallo, caafimaadka dabeecadda, iyo khabiiro kale.

Eeg Liiska Daawooyinka

Hel daawooyinka lagu daboolo caymiskan.

Hel Taageerada Habdhaqanka Caafimaadka

Baarbaar bixiyeyaasha daryeelka caafimaadka handhaqanka iyo dhigaallo.

Hel farmashiye

Hel farmashiye kuu dhow.

Hel dhakhtarka ilkaha

Hel Dhartarka Ilkaha oo kuu dhow.

Macaashyada & Sifooyinka

Fur Dhammaan

Hearing & Vision care

Dacwad-dhageysiga

Hearing Aid is limited to one aid per four-year period. Binaural aids are covered under specific circumstances. 

Hearing aid batteries, insurance and ear molds are also covered. 

If you are experiencing hearing loss or hearing aid difficulties, please contact Member Services at 1-877-236-0826, TTY 711. Certain services are available if you do have a hearing impairment and need a special telephone. Contact your Care Coordinator who will help you get special equipment if you need it.

Aragga

Baaritaannada indhaha oo joogto ah ayaa muhiim ah. Xubnuhu waxay u qalmaan baarista joogtada ah ee indhaha iyo muraayadaha indhaha ee dhakhtarku qoray. Wac dhakhtarkaaga si aad u ballansato baaritaanka indhaha ee joogtada ah. Waxaad ballan ka qabsan kartaa bixiye kasta oo daryeelka aragga ka qayb qaadanaya. 

Adeegyada soo socda ee aragga waxa loo caymiyay xubnaha da'doodu ka yar tahay 21: 

  • Hal baaris oo indha oo joogta ah sanadkiiba — gudbin looma baahna 
  • Laba iyo tobankii biloodba hal muraayad oo indhood oo dhakhtar qoray 

Adeegyada aragga ee soo socda ayaa lagu daboolay xubnaha da'da 21 iyo wixii ka weyn: 

  • Hal baaris oo indha oo joogta ah labadii sano ba —gudbin looma baahna 
  • Hal muraayad oo muraayadaha indho ah 5 sano kasta 

Haddii aad u baahan tahay gaadiid, macaashyadaada waxaa ka mid ah gaadiid-raac. Waxaan daboolnaa safarrada lagu aado:

  • Balamaha caafimaadka
  • Keydka cuntada
  • Farmashiyaha
  • Ballamaha u-qalmida Medicaid

Raacida sharciyadaan fudud ayaa kaa caawin doona inaad hesho gaadiid: 

  • Call 3+ business days ahead of time 
  • Call 1-877-236-0826, TTY 711 to set up your ride 
  • Haddii aad baajiso booqashadaada, wac 1-877-236-0826 si aad u baajiso gaadiid-raacaaga 
  • Hayso oo diyaar ka dhigo kaarkaaga aqoonsiga xubintaada 
  • Gaadiidka waxaa la raacaa marka la oggolaado oo keliya 
  • Ogow ciwaanka bixiyaha daryeelka caafimaadkaaga iyo taariikhda iyo waqtiga ballantaada 
  • Si gaar ah u sheeg halka aad u baahan tahay inaad gaadiidka u raacdo 
  • Booqashadaada kadib, wac si aad ugu raacdo guriga 
  • Haddii dhakhtarkaagu ku siiyo rijeeto, waxaad mari kartaa farmashiyaha si aad u hesho 
  • Nala soo socodsii haddii aad qabto baahiyo gaar ah sida gure-gure 
  • Gaadiid-raaca wuxuu koobnaan karaa bixiye adiga kuu dhow

Waxa sidoo kale aad u qalmi kartaa kaarka baska ama lacag-celinta la raacida baabuur saaxiibada iyo qoyska. Wac Member Services si aad u ballansato gaadiid ama weydii su'aalo ku saabsan helitaanka adeegyada gaadiid-raaca.

Adeeggan waxaa loogu talagalay raacitaanka horay loo sii qorsheeyay. Haddii aad qabto xaalad degdeg ah oo nafta halis gelinaysa, wac 911. Ambalaas ayaa lagu siin doonaa haddii aad u baahan tahay in isbitaalka laguu diro.

Reimbursement to member or healer for Traditional Healing services performed are covered. Benefits include:

$300 per year for Traditional healing services. This benefit includes but is not limited to:

  • Native American Healing and Ceremonies
  • Curandismo Healing

Your provider will need to submit a form to get a reimbursement. Forms can be requested by calling Member Services at 1-877-236-0826. For hearing impaired: TTY 711.

Home-delivered, medically tailored, culturally appropriate meals to promote better health and support health care. Meals can be tailored for members with regular and specialty dietary needs, and can support puréed, gluten free and vegetarian. This program promotes healthy nutrition and addresses food insecurity or malnutrition. Focus supporting members through transitions of care, including:

  • Post-delivery, for member and up to four household members
  • Post-release meals for justice- involved members
  • Skilled nursing facility (SNF) transition, focused on LTSS members

Daryeel muddo dheer soconaaya ayaa la heli karaa. Xubnaha iyo dadka ayaga taageera ayaa la hadli kara Isu-duwaha Daryeelka si loo fahmo xulashooyinka la heli karo dhammaantood. Waxaanu ka shaqeyn doonaa dejinta yoolal u dhigma natiijooyinka uu jecelyahay qofka xubinta ah. Xubnaha dhammaantood waa in lagu sameeyo baaritaan oo loo ansixiyo daryeel muddo dheer soconaya.

Caafimaadka Guriga lagu Bixiyo

Caymiska ayaa loo heli karaa hayadaha caafimaadka guriga ka shaqeeya taasoo loogu talagalay adeegyada baxnaaninta ee xirfadeysan ee caafimaad ahaan habboon, oo ay bixinayso kalkaaliso aqoon leh oo u qalanta hawshaa, iyo waliba adeegyada kaaliyaha caafimaadka ee guriga. Ka eeg faahfaahin buuggayaraha xubnaha.

Qalabka iyo Saadadka Caafimaadka

Caymisbaa loo heli karaa saadka dawooyinka, qalabka, iyo aaladaha guriga lagu dhex isticmaali karo. Isu-duwe Daryeel ayaa gacan ka geysan kara diyaarinta qalabka iyo saadka loo baahan yahay.

Daryeelka Guriga Kalkaalinta

Daryeelka guriga kalkaalinta ayaa la heli karayaa. Xubnaha iyo dadka ayaga taageera ayaa la hadli kara Isu-duwaha Daryeelka si loo fahmo xulashooyinka la heli karo dhammaantood. Waxaanu ka shaqeyn doonaa dejinta yoolal u dhigma natiijooyinka uu jecelyahay qofka xubinta ah. Xubnaha dhammaantood waa in la baaro oo loo ansixiyo daryeelka guriga kalkaalinta. Arrinkaan waxaa loo ansixin karaa joogitaanka mudada gaaban iyo joogitaanka mudada dheer.

Farmashiyaha

Daawooyinka lasoo qoray ayaa caymiska kujira. All health plans follow the same rules about the medications that are covered as part of the New Mexico Long Term Services and Supports (LTSS). Isla liiska daawooyinka la ansixiyay ayaa la isticmaalaa. Waxaa arrinkaan loogu yeeraa Liiska Daawooyinka Ladoor Bidayo, ama PDL.

Caafimaadka Dabeecadda

If you are currently receiving behavioral health services, please let your UnitedHealthcare Community Plan Care Coordinator know. It is important for them to be aware of all the services you are receiving or need. 

Also, please let your behavioral health provider know that you are enrolled in UnitedHealthcare Community Plan’s LTSS program. They may have questions about the services you are receiving through LTSS and how we can work together to help you get the care you need. 

Behavioral Health screenings are performed as medically necessary for diagnosis and treatment. Waxaan daboolnaa:

Adeegyada Caafimaadka Dabeecadda 

  • Daaweyn shaqsiyeed, kooxeed iyo qoyseed 
  • Adeegyada caafimaadka dabeecadda ee bukaan-socodka 
  • Adeegyada caafimaadka dabeecadda ee bukaan-jiifka 
  • Adeegyada caafimaadka dabeecadda ee gaarka ah ee carruurta qabta dhimanaanta

Adeegyada Cilladaha Isticmaalka Maandooraha 

  • Daaweynta bukaan-socodka opioid (daawoyinka xanuunka). 
  • Ku Daaweynta Guriga
  • Maareynta kiiska bartilmaameedsan

Additional health resources can be found at myuhc.com/CommunityPlan. Hel dheelitirnaanta, taageerada, iyo daryeelka aad u baahan tahay si aad ugu noolaato nolosha ugu caafimaadka badan ee suurtogalka ah.

Haddii aad aaminsan tahay in aad u baahan tahay inaad hesho adeegyada caafimaadka habdaqanka, la hadal PMP-gaaga ama wac Member Services si aad u hesho caawin.

Community benefit

What is the Community benefit?

The Community Benefit (CB) is Turquoise Care’s name for the home and community-based services (HCBS) benefit package. 

  • The Personal Care Services benefit is also part of CB 
  • Community Benefits are services that allow eligible members to receive care in their home or community as an alternative to being placed in a long-term care facility 
  • Community Benefits are intended to supplement natural supports and support community living 

Goals of Community Benefits. 

  • Allow New Mexicans who require long-term care to remain in their homes and in their communities 
  • Reduce the number of unnecessary nursing home admissions 

Community Benefit eligibility. 

  • All members must have a full Medicaid category or have Waiver category of eligibility 
  • All members must meet the nursing facility level-of-care criteria
  • All members must be a resident of New Mexico

Ka caawin luqad

If you speak a language other than Ingiriisi, we can provide translated printed materials. Or we can provide an interpreter who can help you understand these materials. You’ll find more information about Interpretive Services and Language Assistance in the section called Other Plan Details. Or call Member Services at 1-877-236-0826, TTY 711. 

Si usted habla un idioma que no sea inglés, podemos proporcionar materiales impresos traducidos. O podemos proporcionar un intérprete que puede ayudar a entender estos materiales. Encontrará más información acerca de servicios de interpretación y asistencia lingüística en la sección Otros detalles del plan. O llame a Servicios para Miembros al 1-877-236-0826, TTY 711.

Preferred Drug List

UnitedHealthcare Community Plan covers hundreds of prescription drugs from hundreds of pharmacies. The full list of covered drugs is included in the Preferred Drug List. You can fill your prescription at any in-network pharmacy. All you have to do is show your member ID card.

Click the link below to download the complete list, or download online at myuhc.com/communityplan/nm.

New Mexico Preferred Drug List

Daryeelka Kalagoysyada Lafaha

Daryeelka chiropractic ee loo saamaxo jirku inuu iskii u buskoodo ayaa caymiska lgu bixiyaa ilaa xad waxoogaa. Ka eeg faahfaahin buuggayaraha xubnaha.

Daryeelka ilkaha

Helitaanka baarista ilkaha ee sannadkiiba waxay muhiim u tahay caafimaadkaaga. Caymiska waxaa ku jira: 

  • Laba baritaano iyo nadiifin sannadkii ba 
  • Raajada qaniinyada hal mar 12 bilood ba iyo hal raajo oo dhamaystiran saddexdii sanaba 
  • Soo celinta yaryar sida buuxinta 
  • Soo celinta waaweyn sida taajajka iyo kanaalka xididka (mid kasta 12 bilood kasta) 
  • Nadiifin qoto dheer iyo daawaynta qaliinka ee cudurka ciridka 
  • Ilkaha qayb ka mid ah ama dhamaan, iyo hagaajinta qaybo ama ilko dhamaan 
  • Suuxinta iyo nitrous oxide (oo loo yaqaan gaasta qosolka) haddii caafimaad ahaan loo baahdo

Daryeelka degdegga ah

Hospital emergency rooms are there to offer emergency treatment for trauma, serious injury and life-threatening symptoms. Some reasons to go to the ER include:

  • Serious illness
  • Broken bones
  • Heart attack
  • Poisoning
  • Severe cuts or burns

UnitedHealthcare Community Plan covers any emergency care you need throughout the United States and its territories. Within 24 hours after your visit, call Member Services at 1-877-236-0826, TTY 711.

 

Daryeelka Cagaha (daryeelka cagaha)

Ilaa 6 ah daryeelka joogtada ah ee cagaha booqashooyinkiisa ayaa caymiska lagu bixiyaa sanad kasta. Adeegyada qaarkood ayaa u baahan oggolaansho hore. Fadlan ka eeg faahfaahin buugyaraha xubnaha.

Xasilinta Guriyeynta

Waxaanu dooneynaa in xubnaha iyo qoysaskoodu ku naaloodaan guriyeyn badbaado leh oo qiime jaban. Waxaanu kugu caawin karnaa qorshe lagu horumarinaayo guriga aad hadda daggan tahay ama inaan kula qorsheyno inaad guri kale u guurto. Isu-duwaha Daryeelka ayaa ka shaqeyn doona soo uruurinta yoolasha oo kula wadaagi doono xulashooyin wax ka qabanaya baahiyaha xubnaheena. 

Large provider network

You can choose any PCP from our large network of providers. Our network also includes specialists, hospitals and pharmacies — giving you many options for your health care. Find a complete list of network providers at myuhc.com/communityplan/nm.

Qalabka iyo Saadadka Caafimaadka

Caymisbaa loo heli karaa saadka dawooyinka, qalabka, iyo aaladaha guriga lagu dhex isticmaali karo. Isu-duwe Daryeel ayaa gacan ka geysan kara diyaarinta qalabka iyo saadka loo baahan yahay.

Daaweynta Isticmaalka Maandooriyaha

Xubnaha ayaa heli karaya daaweynta dadka meesha daggan la siiyo haddii ay helaan caawimaad khamri ama isticmaalka daroogada aawadood. Waxaa arrinkaa kujira xarunta in habeenkii la joogo. Isu-duwaha Daryeelka ee qofka xubinta ah ayaa gacan ka geysan kara ka jawaabida suaalaha ama sharraxaad ka bixin kara wixii xadad ah ama ansixin hore oo loo baahan yahay.

Dhigaalada Xubinta

Ilaha Xubinta (fur daaqada modeelka)

Individual & Family ACA Marketplace Plans Disclaimer
(ku dhex wad bogoskan si aad u aragto)

Faaiidooyinka laga helo ayaa laga yaabaa inaan lagu bixin karin dhammaan qorsheyaasha aana laga bixin karin gobolada oo dhan. Qorsheyaasha qaarkood waxay u baahan karaan bixinta qiimeyaal goan, qarashaad la jarayo iyo/ama inta qarash kaga aaddan qofka caymiska kujira qarashka baxaya taasi oo loogu tala galay dadka faaiidooyinka caymiska hela. Qorshahaan wuxuu leeyahay waxyaabo aan kujirin, xadidaad, faaiidooyinka oo la dhimo, oo sharuudo soo hoos galaya siyaasada caymiska ayaa dhaqangal sii ahaan kara ama la joojin karaa. For costs and complete details of the coverage, review your plan documents, call or write your insurance agent or the company, whichever is applicable. Waxyaabaha qorshe caymis ugaar ah iyo faaiidooyinka caymiska ayaa kukala duwan waxa caymis kujira iyo qeybta qorshaha caymiska. Fadlan dib u eegid ku samee faahfaahinta qorshaha si aad wax badan uga ogaato.

UnitedHealthcare Individual & Family plans medical plan coverage offered by: UnitedHealthcare of Arizona, Inc.; Rocky Mountain Health Maintenance Organization oo Katirsan CO; UnitedHealthcare of Florida, Inc.; UnitedHealthcare of Georgia, Inc; UnitedHealthcare of Illinois, Inc.; UnitedHealthcare Insurance Company in AL, KS, LA, MO, NJ, and TN; Optimum Choice, Inc. in MD and VA; UnitedHealthcare Community Plan, Inc. in MI; UnitedHealthcare of Mississippi, Inc.; UnitedHealthcare of New Mexico, Inc.; UnitedHealthcare of North Carolina, Inc.; UnitedHealthcare of Ohio, Inc.; UnitedHealthcare of Oklahoma, Inc.; UnitedHealthcare of South Carolina, Inc.; UnitedHealthcare of Texas, Inc.; UnitedHealthcare of Oregon, Inc. in WA; and UnitedHealthcare of Wisconsin, Inc.  Administrative services provided by United HealthCare Services, Inc. or its affiliates.

This policy has exclusions, limitations, reduction of benefits, and terms under which the policy may be continued in force or discontinued. Qiimeyaasha iyo faahfaahinta buuxda ee caymiska haddii aad dooneyso inaad ogaato, soo wac ama warqad usoo qor wakiilka caymiska ama shirkada, kii hadba labadaas arrin la isticmaali karo. By responding to this offer, you agree that a representative may contact you.

1 Unless otherwise required, benefits are available only when services are delivered through a Designated Virtual Network Provider. Virtual visits are not intended to address emergency or life-threatening medical conditions and should not be used in those circumstances. Services may not be available at all times, or in all locations, or for all members. Check your benefit plan to determine if these services are available. Ascaarta internetka ayaa ku jiri kara. Certain prescriptions may not be available and other restrictions may apply.

2 Tier 2 prescriptions for $5 or less not available on all medications. 3-month fills apply to select maintenance medications only. Applicable formulary requirements such as prior authorization and quantity limits may apply to your pharmacy benefits. Qiime dhimista Walgreens waxay shaqeyneysaa ilaa 12/31/24. Discount valid only for in-store purchases of eligible Walgreens brand health and wellness products by current members eligible for the UnitedHealthcare discount program. Qiime dhimis onlayn laguma adeegsan karo. Si aad u hesho liiska dhammaystiran ee agabka caafimaadka iyo fayo-qabka ee leh summada shirkadda Walgreens iyo ka-dhaafitaanada, fadlan booqo www.walgreens.com/smartsavings.

Cusbooneysintii Ugu Dambeysay: 04.17.2024 at 11:35 gn. CDT

Macluumaadka afeefta
(ku dhex wad bogoskan si aad u aragto)

Ma waxaad raadinaysaa mareegta dawladda dhexe ee Medicaid? Halkan ka eeg Medicaid.gov.

UnitedHealthcare Dual Complete Plans

Qorsheyaasha waxaa la doolaa iyadoo loo sii marayo Shirkadda Caymiska UnitedHealthcare ama mid ka mid ah shirkadaheeda xiriirka la leh, Hay'adda Medicare Advantage ee haysata qandaraaska Medicare iyo qandaraaska kula jirto Barnaamijka Medicaid ee Gobolka. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waxaa heli kara qof kasta oo haysta Medical Assistance ee laga helo Gobolka iyo Medicare. Dheefaha, qaybaha iyo/ama aaladuhu waxay ku kala duwan yihiin qorshe/aagga. Xaddidaadyada, ka-dhaafitaanada iyo/ama xannibaadyada shabakadeed ayaa laga yaabaa in lagu soo dabaqo. Macaashyada, khidmadaha iyo/ama kharashka la wada bixiyo/qaybsiga caymiska ayaa laga yaabaa inay isbeddelaan markay tahay 1-da Janaayo ee sannad kasta.

Khidmadda afeefta billaha ah

Qorshayaasha Dual Special Needs waxay leeyihiin $0 khidmado bille ah oo loogu talagalay xubnaha haysta Caawimaada Dheeraadka ah (Kabka Dadka Dakhligoodu Hooseeyo).

Dheefaha afeefta

Dheefaha, sifooyinka, iyo/ama aaladaha way ku kala duwan yihiin qorshe/aag ahaan. Xaddidaadyada, ka-dhaafitaanada iyo/ama xannibaadyada shabakadeed ayaa laga yaabaa in lagu soo dabaqo.

Afeefta Khadka-furan ee Kalkaalisada

Adeegani waa inaan loo isticmaalin baahiyada gurmadka ama daryeelka ee degdegga ah. Marka ay jirto xaalad degdega ah, wac 911 ama tag qolka gurmadka ee kuugu dhow. Macluumaadka lagu bixiyay adeegan waxaa laga leeyahay ujeedooyin waxbixin oo keliya. Kalkaaliyeyaashu ma sheegi karaan dhibaatooyinka ama kuma talin karaan daaweyn mana u noqon karaan beddel daryeelka daryeel bixiyahaaga. Macluumaadkaaga caafimaad waxaa loo keydiyaa si qarsoodi ah oo waafaqsan sharciga. Adeeggu maaha barnaamij caymis waxaana laga yaabaa in la joojiyo wakhti kasta. Khadka Taleefanka ee Kalkaalisada looma isticmaalo xaaladaha degdegga ah, ujeeddooyin macluumaad oo keliya ayaa loo isticmaalaa.

UnitedHealthcare Connected® ee MyCare Ohio (Medicare-Medicaid Plan)

UnitedHealthcare Connected® ee MyCare Ohio (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo Medicaid Ohio si ay u siiso macaashyada labada barnaamij dadka ka diiwaangashan. 

UnitedHealthcare Connected® (Medicare-Medicaid Plan)

UnitedHealthcare Connected® UnitedHealthcare Connected® (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo Texas Medicaid si uu u siiyo dheefaha labada barnaamij dadka ka diiwaangashan.

UnitedHealthcare Connected® oo loogu tala galay One Care (Qorshaha Medicaid - Medicare)

UnitedHealthcare Connected® oo loogu talagalay One Care (Medicare-Medicaid Plan) waa qorshe caafimaad oo kunturaad la leh labadaba Medicare iyo MassHealth (Medicaid) si ay u siiso dheefaha labada barnaamij dadka ka diiwaangashan. 

Afeefta dheefaha guud UnitedHealthcare Connected®

Kani ma ahan liis dhammeystiran. Macluumaadka macaashka waa qoraal kooban, ma ahan sharraxaadda dhammeystiran ee macaashyada. Wixii macluumaad intaas ka badan la xiriira qorshaha mise akhri Buug-gacmeedka Xubinta. Xaddidaado, wada-bixinno, iyo xannibaado ayaa lagu dabaqi karaa. Wixii macluumad dheeraad ah, wac Adeegyada Xubnaha ee ku xiran UnitedHealthcare ama aqri Buugyaraha Xubnaha ee UnitedHealthcare Connected®. 

UnitedHealthcare Senior Care Options (HMO SNP) Plan

Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO) waa qorshaha Daryeelka Isku Dubaridan ee la leh qandaraas Medicare iyo qandaraas kula jira barnaamijka Common Wealth Massachusetts of Medicaid. Iska diiwaangelinta qorshaha waxay ku xiran tahay heshiiska cusboonaysiinta qorshaha ee Medicare. Qorshahan waa barnaamij isxilqaan ah uu heli karo qof kasta oo jira 65 iyo ka weyn oo u-qalma MassHealth Standard iyo Original Medicare oo aan lahayn caymis caafimaad ee kale ee dhamaystiran, marka laga reebo Medicare. Haddii aad leedahay MassHealth Standard, balse aadan u-qalmin Original Medicare, waxaa laga yaabaa inaad weli u-qalanto inaad iska diiwaangeliso qorshaheena MassHealth Senior Care Option oo aad hesho macaashyadaada MassHealth oo dhan adoo u maraya barnaamijkeena Dookhyada Daryeelka Waayeeladda ee UnitedHealthcare (SCO).

Afeefta qiimeynta xidigeed

Sannad kasta, Medicare waxay qiimaysaa qorsheyaasha iyadoo ku salaysa nidaamka qiimeynta 5-ta Xiddig. Qiimeynta 5-ta Xiddig waxay khuseysaa qorshaha sannadka 2024.

Macluumaadka bixiyaha ee muhiimka ah

Go'aanka Adigaa Leh.

Waxaan ku siin doonaa macluumaad kaa caawin doona inaad gaarto go'aano wargal ah, sida aqoonsashada dhakhaatiirta iyo xirfadleyaasha daryeelka caafimaadka. Macluumaadkan, si kastaba ha ahaatee, ma ahan mid ayidaya dhakhtar gaar ah ama xirfadlaha daryeelka caafimaadka ee ku habboon baahidaada.

Bixiyeyaasha la heli karo iyadoo loo marayo codsigan ma ahan inay xaqiiqdii uga turjumayaan si buuxda shabakada UnitedHealthcare ee bixiyeyaasha qandaraaska lagula jiro. Waxaa laga yaabaa inay jiraan bixiyeyaal ama takhasusleyaal gaar ah oo aan lagu darin codsigan oo qayb ka ah shabakadeena. Haddii aadan helin bixiyaha aad raadinayso, waxaad si toos ah ula xiriiri kartaa bixiyaha si aad u xaqiijiso xaaladda kaqaybgalka ee shabakadda UnitedHealthcare, ama kala xiriir Mamber Services lambarka bilaashka ah ee ku qoran kaarkaaga aqoonsiga UnitedHealthcare. Waxaan sidoo kale kugula talineynaa, kahor inta aadan la kulmin dhakhtar kasta, oo ay ku jiraan takhasusleyaal kasta, inaad wacdo xafiiska dhakhtarka si aad u xaqiijiso xaaladda kaqaybgalka iyo helitaanka.

Qaar kamid ah shabakadda bixiyeyaasha ayaa laga yaabaa in lagu daray ama laga saaray shabakadeena kadib markii diiwaankan la cusbooneysiiyay. Ma dammaanad qaadi karno in bixiye kasta weli aqbalayo xubno cusub.

Bixiyeyaasha shabakadda ka baxsan/kuwa aan qandaraaska lahayn kuma khasbana inay daaweeyaan xubnaha kujira qorshaha UnitedHealthcare, marka laga reebo xaaladaha gurmadka dagdagga ah. Fadlan soo wac lambarkeena adeegga macmiilka ama ka eeg Caddayntaada Caymis wixii macluumaad dheeraad ah, oo ay ku jiraan kharash wadaagga khuseeya adeegyada shabakadda ka baxsan.

Ogeysiiska Xeerka Naafada Mareykanka

Sida waafaqsan shuruudaha Xeerka Naafada ee Dawladda Dhexe Maraykanka 1990 iyo Qeybta 504 Xeerka Baxnaaninta 1973 ("ADA"), Shirkadda Caymiska UnitedHealthcare waxay bixisa adeegyada la daboolay oo buuxa oo loo siman yahay mana takooraan shakhsiyaadka u-qalma ee naafada ah iyadoo lagu salaynayo naafanimada markay bixinayaan adeegyadooda, barnaamijyadooda, ama waxqabadooda.

Gudbinta

Bixiyeyaasha shabakadda ayaa idin ka caawin doona adiga iyo xubnaha qoyskaaga ee caymiska leh inaad heshaan daryeelka aad u baahan tihiin. Helitaanka dhakhaatiirta takhasuska leh waxaa isku dubaridi kara dhakhtarkaaga daryeelka aasaasiga ah.

Codsiyada diiwaanka waraaqaha

Nuqullada warqadaha ee ku jira diiwaanka bixiyaha shabakadda waxay ku heli karaan xubnaha si bilaash ah iyagoo wacaya lambarka adeegga macmiilka ee ku yaala gadaasha kaarka aqoonsiga. Dadka aan xubinta ka ahayn waxay natiijooyinka ka soo dejisan karaan oo ka daabacan karaan diiwaanka onlaynka ah.

Macluumaadka khaldan

Si aad uga warbixiso xogta khaldan, u dir iimayl provider_directory_invalid_issues@uhc.com. Bogoskan iimaylka waxaa loogu talagalay xubnaha si ay uga warbixiyaan khaladaadka suurtagalka ah ee macluumaadka qofka (cinwaanka, telefoonka, iwm.) ee ku jira hagaha diiwaanka onlaynka ah ama waraaqaha. Ka warbixinta arrimaha iyadoo loo marayo bogoskan boostada waxay keeni doontaa in la gaaro xafiiska bixiyaha si loo xaqiijiyo dhammaan xogta dadka ee ku jira diiwaanka, taasoo qaadan karta qiyaastii 30 maalmood. Shakhsiyaadka sidoo kale waxay soo sheegi karaan khaladaadka suurtagalka ah iyagoo adeegsanaya telefoonka. Xubnaha UnitedHealthcare waa inay wacaan lambarka ku yaalla dhabarka dambe ee kaarkooda aqoonsiga, halka dadka aan xubinta ka ahayn UnitedHealthcare ay soo wici karaan 1-888-638-6613 TTY 711, ama waxay isticmaali karaan adeegga gudbinta ee ay doorbidayaan.

Ku Dhawaaqida Masiibo ama Xaalad Dagdag ah

Haddii ay ku saamayso ku dhawaaqida musiibo ama xaalad dagdag ah ee Madaxweynaha ama Gobarnatooraha, ama ogeysiiska xaalad caafimaadka dadweynaha ee dagdaga ah oo uu ku dhawaaqay Xoghayaha Caafimaadka iyo Adeegyada Aadanaha, waxa jira taageero dheeraad ah oo gaar ah oo adiga diyaar kuu ah.

  • Qaybta A, Qaybta B, iyo dheefaha qorshaha Qaybta C ee dheeraadka ah waa in lagu bixiyaa xarumo aan kunturaad lahayn oo gaar ah (ogsoonoow in dheefaha Qaybta A iyo Qaybta B ay tahay in laga helo xarumaha shahaadaysan ee Medicare);
  • Meeshii ay ku habboon tahay, shuruudaha loogu talagalay gudbinta albaab-ilaaliyaha si buuxda ayaa looga dhaafay;
  • Wadaagista kharashka shabakada ka baxsan ee qorshaha la ansixiyay ilaa qadarada wadaagista kharashka shabakada ayaa si ku meelgaar ah loo dhimay; iyo
  • Shuruudaha oggeysiiska ee 30-ka maalin ah ee ku aadan xubnaha waa la dhaafay, ilaa inta dhammaan isbeddellada dheefta (sida dhimista wadaagista kharashka iyo oggolaanshaha ka dhaafitaanka) ee xubinta.

Haddii CMS aysan bixin taariikhda dhammaadka ee loogu talagalay musiibada ama xaaladda degdegga ah, qorshooyinka ayaa dib u bilaabi doona maalmaha 30 shaqada ee caadiga ah ka dib ku dhawaaqista hore.

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