Member Services
The primary purpose of the Freedom Health Member Services Department is to answer questions and attempt to resolve issues, problems and concerns raised by Members.
Beginning March 1 through November 14, our office is open Monday through Friday from 8:00 a.m. until 7:00 p.m. EST. From November 15 through February 28, the office is open Monday through Sunday from 8:00 a.m. until 8:00 p.m.
The Member Services Department can be contacted at 1-800-401-2740; Members with hearing and/or speech impairments should call our toll-free TTY line at 1-800-955-8771. We also encourage the use of our website at www.freedomhealth.com.
Members and Physicians may contact Member Services to: x Change a Primary Care Physician;
x Receive educational materials;
x Learn about referrals and authorizations; x Disenroll from the Plan;
x Obtain a new identification card; x Find participating pharmacies; x Verify Member eligibility;
x Ask co-payment, co-insurance and deductible questions; x Inquire about claims payment;
x Learn more regarding Member benefits for all lines of business – Medicare Advantage & Medicaid;
x File a Member complaint/grievance;
x Notify the Plan of a change in information – new address, phone number or other personal information; and
x Receive Member assistance with the Appeals & Grievance process.
Staff Selection and Training
The Member Services Department is committed to hiring highly qualified individuals, providing top- notch training and monitoring activities to support attainment of Freedom Health’s service
commitments. Telephone calls are monitored to maintain standards regarding information accuracy, timely follow-up and Member service attitudes.
Service Standards
The Freedom Health Member Services Department is designed to address issues, solve problems, answer questions and listen to concerns from Members and Physicians or Providers. Our service commitments are to:
1. Answer calls within 30 seconds;
2. Respond to voice mail messages within 24 business hours; and 3. Respond to urgent calls within one (1) hour.
Freedom Health will track the types of issues that you and your staff bring to our attention so that we may correct any underlying problems.
The Plan also maintains written case management and continuity of care protocols that include appropriate referral and scheduling assistance of Members needing specialty health
care/transportation services, including those identified through Child Health Check-Up Program (CHCUP) Screenings.
Member Identification Card
Each Member will receive an identification card that allows them access to receive services from the Freedom Health network of participating Physicians/Providers. A sample of the Freedom Health identification card for each product is available in the Sample Forms section of this manual. Physicians/Providers should ask to see the Member identification card at each scheduled
appointment.
Some important points to remember:
x The practice should make a copy of both sides of the identification card for their Member medical record;
x For purposes of privacy, the identification card has a unique Member number used for most transactions;
x The identification card lists the most common co-payments, co-insurance, and deductible amounts - these are not applicable to Medicaid;
x The identification card lists the toll-free Member Service telephone number; x The identification card has the address to mail claims;
x The identification card does not reflect the effective date of the provider; it is the effective date the Member became effective with the Plan; and
x The Physician/Provider can always verify eligibility by requesting to see the Member
identification card each time the Member has an appointment. The Member should also be asked if there have been any changes since their previous appointment.
Member Transfers
The following guidelines apply to the transfer of a Member, upon his/her request, from one Primary Care office to another:
x The Member’s decision to transfer should be strictly voluntary;
x The Member must not have been directly recruited by phone or in person by anyone involved with the Primary Care office;
x The Member must not have been influenced to transfer to or out of the office due to improper/incorrect information or for medical reasons; and
x Upon the Member’s request and completion of a Medical Record Release Form, the office is required to send his/her medical records to the newly selected Primary Care office.
Methods of Eligibility Verification
Providers will have up to four (4) methods to verify Member eligibility:
1. Member Services – Member Services Department staff are available to verify Member eligibility toll free at 1-800-401-2740, from March 1 through November 14, Monday through Friday from 8:00 a.m. until 7:00 p.m. EST and from November 15 through February 28, Monday through Sunday from 8:00 a.m. until 8:00 p.m. EST.
2. Monthly Roster – The Primary Care Physician will receive a “Monthly Roster” of Members assigned to their practice for each line-of-business with which they have agreed to
participate. However, the Plan cannot guarantee that a Member who appears on the
Monthly Roster will not be “retroactively” terminated due to failure to pay their premium, loss of eligibility (Medicaid), or termination (Medicare).
3. Application Form – For new Members who have not yet received their identification card with the New Member Packet, a copy of their application form will suffice as a form of eligibility verification. We do encourage that network Physicians/Providers use a second form of verification under these circumstances for “non-urgent” medical services. This is only applicable to Medicare members.
4. Provider Portal – Freedom Health has a Web portal to verify Member eligibility, benefits and claims status quickly and efficiently. You can go to www.freedomhealth.com to register/ log on to the Provider Portal. Please be aware that the confirmation e-mail containing the log on ID could be in your spam folder. Online Member information is available to Physicians/ Providers in “real-time” and will meet current Federal privacy guidelines. We encourage Physicians to verify Member eligibility prior to the appointment and ensure that the Member is eligible for covered benefits with the Plan. Eligibility can be gained or lost within a
month’s time frame.
For questions regarding the Web Portal, please refer to your Provider Portal User Manual. A copy is available for download on the registration page of the website, or contact your local Provider Representative to have the document sent to you.