New Mexico LTSS - Frequently Asked Questions

Your member ID card holds a lot of important information. It gives you access to your covered benefits. 

Take your member ID card to your appointments:

• Show it when you fill a prescription
• Have it ready when you call Member Services; this helps us serve you better
• Do not let someone else use your card(s). It is against the law.

You should have received your member ID card in the mail within 20 days of joining UnitedHealthcare Community Plan.

UnitedHealthcare Community Plan LTSS gives you health care that is medically necessary. The amount, duration, and scope of benefits you can get are based on your needs and approved services, as determined by the State of New Mexico. Some benefits and services require preauthorization. Preauthorization determines whether the services or benefits are necessary.

If you have a chronic health condition, like asthma or diabetes, you may benefit from our Care Coordinator program. We can help with a number of things, like scheduling doctor appointments and keeping your providers informed about the care you get. To learn more, call 1-877-236-0826, TTY 711.

You’ll get a Health Assessment over the phone. If we see that you could use extra assistance, you will be assigned a Care Coordinator. They will contact you by phone. If they are unable to reach you, you will receive a letter from your care coordinator. 

Contact your Care Coordinator at 1-877-236-0826. Once you are assigned a Care Coordinator, you can contact him or her directly as often as you need to.

Yog tias koj xav caij tsheb, koj cov kev pab suav nrog kev muab tsheb thauj mus los. Peb pab them cov kev taug kev mus rau:

• Cov sij hawm teem mus ntsib kws kho mob
• Chaw rau khoom noj
• Tsev muag tshuaj
• Cov kev teem caij kev muaj cai tsim nyog tau txais Medicaid
  

Kev ua raws li cov cai yoj yim nod yuav pab rau koj tau caij tsheb: 

• Call 3+ business days ahead of time 
• Call 1-877-236-0826, TTY 711 to set up your ride 
• Yog tias koj thim koj qhov kev mus ntsib kws kho mob, hu rau 1-877-236-0826 kom thim koj qhov kev teem caij tsheb 
• Npaj kom muaj koj daim npav ID ua tswv cuab 
• Kev caij tsheb tsuas yog rau cov laj thawj uas tau txais kev pom zoo nkaus xwb 
• Paub txog qhov chaw nyob ntawm koj tus kws kho mob thiab hnub tim thiab lub sij hawm teem caij mus ntsib 
• Qhia meej txog qhov chaw uas koj xav caij tsheb mus rau 
• Tom qab koj mus ntsib kws kho mob, hu xov tooj txhawm rau caij tsheb rov qab mus tsev 
• Yog tias koj tus kws kho mob muab ib daim ntawv sau yuav tshuaj rau koj, koj tuaj yeem nres ntawm lub tsev muag tshuaj txhawm rau yuav tshuaj tso mam mus tsev 
• Qhia rau peb paub yog hais tias koj muaj cov kev xav tau tshwj xeeb xws li ib lub laub zaum muaj log 
• Kev muab tsheb thauj mus los tej zaum yuav raug txwv rau ib tus kws kho mob uas nyob ze koj
  

Tej zaum koj kuj tseem tsim nyog tau txais daim npav them nqi caij tsheb npav los sis cov phooj ywg thiab tsev neeg cov nyiaj them rov qab. Hu xov tooj rau Lub Chaw Pab Cuam Tswv Cuab txhawm rau teem lub sij hawm caij tsheb los sis nug cov nqe lus nug txog cov kev pab muab tsheb thauj mus los.

Qhov kev pab cuam no yog rau cov kev caij tsheb uas tau npaj tseg ua ntej. Yog tias koj muaj xwm txheej ceev uas yuav txo txoj sia, ces hu rau 911. Lub tsheb thauj neeg mob yuav tau muab yog tias koj xav kom xa mus rau tom tsev kho mob.

You must call at least 3 business days before your appointment. Three business days does not include weekends, holidays, or the day of the call. You can call for a ride up to two weeks before your appointment. You must have your medical or behavioral health appointment date, time and address available. 

• Open Monday through Friday 8:00 a.m. to 5:00 p.m. Mountain Time 
• Closed Saturdays and Sundays
• Closed on national holidays 
• Calls for trips for urgent/same-day appointments/facility discharges and Ride Assist are handled 24/7, 365 days at 1-877-236-0826 Reservation: 1-877-236-0826 
• Ride Assist (Where’s My Ride?): 1-877-236-0826 
• Hearing impaired (TTY): 1-877-236-0826 

Yes, but you must speak with a representative from UnitedHealthcare Community Plan before your appointment. They will send you a voucher form with instructions. To obtain reimbursement: 

• The provider you are seeing must fill out the form or attach a doctor note 
• You are responsible for sending the paperwork back to UnitedHealthcare Community Plan for payment 
• If you have receipts for reimbursement, make copies and include them with your paperwork back to UnitedHealthcare Community Plan 

You may need to see a provider in another city or state because there is not one in your city or town. Work with your Care Coordinator to arrange the transportation and/or lodging through UnitedHealthcare Community Plan. The services must be medically necessary and prior approval must be obtained before seeing a provider out of the UnitedHealthcare Community Plan network.

The appointment must be at least 4 hours away from your primary residence and it must be medically necessary. Please work with your Care Coordinator to arrange lodging and make sure UnitedHealthcare Community Plan is given advance notice. UnitedHealthcare Community Plan will send you a voucher form with instructions for reimbursement of meal expenses.

Not all appointments qualify for this service 

You can reach our Member Services at 1-877-236-0826, TTY 711, 8:00 AM–5:00 PM MT., Monday–Friday.

If you speak a language other than Lus Askiv, 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.

Your Ombudsman: 

• Is a neutral party and a member advocate. The ombudsman will work directly with the member in order to research and address member concerns. 
• Is a resource for finding a solution 
• Will work with members to help them understand their rights and their responsibilities 
• Contact information for members: 
• The direct telephone number to the Ombudsman’s office is 1-877-236-0826, TTY 711.

If you have both Medicare and Medicaid, you have more than one insurance coverage:

• Medicare is considered your primary insurance
• LTSS (Medicaid) is your secondary insurance

Your benefits will not change your primary insurance benefits. Your Care Coordinator will assist you in working with your primary insurance to help set up your health care.

If you have both Medicare and LTSS, Medicare Part D will cover your medication (you will still have to pay Medicare Part D copays), unless you live in a nursing facility. If you have Medicare, you can use your current doctor. You can get Medicare specialty services without approval from Turquoise Care.

We will work with your doctor for the services you get through LTSS. We can help you pick a doctor if you do not have one. This doctor can set up your LTSS and Medicare services. If you are in a Medicare Advantage Plan, your primary care provider (PCP) is your Medicare Advantage doctor.

You do not have to pick another primary care provider for LTSS. Medicare or your Medicare Advantage Plan will pay for your services before LTSS. LTSS may cover some services that are not covered by Medicare.

If you have questions, call Member Services at 1-877-236-0826. For hearing impaired, dial 711 for TTY service.

Your plan covers a long list of medicines, or prescription drugs. Medicines that are covered are on the plan’s Preferred Drug List. Your doctor uses this list to make sure the medicines you need are covered by your plan. 

New Mexico Preferred Drug List

If your medicines are included on the Preferred Drug List, you’re all set. Be sure to show your pharmacist your new member ID card every time you get your prescriptions filled.

If your prescriptions are not on the Preferred Drug List, schedule an appointment with your doctor within the next 30 days. They may be able to help you switch to a drug that is on the Preferred Drug List. Your doctor can also ask for an exception if they think you need a medicine that is not on the list.

Yes, you have thirty (30) days from the date of the letter that you received to change your pharmacy. In special cases, you may be able to request a pharmacy change after thirty (30) days. You will still only be able to use one pharmacy. To change your pharmacy, call Member Services at the number below.

Search online at myuhc.com/communityplan/nm. 

Look through the Provider Directory. 

Call Member Services at 1-877-236-0826 and talk to a Member Advocate or your Care Coordinator. 

UnitedHealthcare Community Plan of New Mexico LTSS Medicaid Dental manages your dental benefits. You may call Member Services at 1-877-236-0826 to find a dentist in the UnitedHealthcare Community Plan New Mexico network.

March Vision manages your vision benefit. You may call Member Services at 1-877-236-0826 or visit their website at www.marchvisioncare.com to find a vision provider.

The Community Benefit (CB) is LTSS’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.

Most services are covered by LTSS. Copays apply in some instances. The only time you pay is when a service is not covered by LTSS or when you get non-emergency service without meeting rules on prior authorization. In these cases, the provider must talk to you first about payment. Even if you fail to pay, you can keep your Medicaid eligibility. 

If a member has been incorrectly overcharged copayments, the member has a right to be repaid by the provider. The HSD Income Support Division (ISD) determines eligibility for most categories of Medicaid. If the member household disagrees with the household income calculation, then the household may request a HSD fair hearing. 

Members have a right to request from UnitedHealthcare Community Plan at any time, an accounting of his or her household’s accrued copayment total(s). If the member disagrees with the MCO’s accounting of accrued copayments, the member may file an appeal directly with UnitedHealthcare Community Plan Member Services. 

If you get a bill from a provider: 

• Ask why they are billing you 
• Give them your health plan information 
• You do not have to pay bills that UnitedHealthcare Community Plan should pay.

If you get a bill: 

• Hu rau Lub Chaw Pab Cuam Tswv Cuab ntawm 1-877-236-0826. 
• Be sure you have your bill when you call. 

You must report other health insurance to your local Income Support Division office. If your private insurance is canceled, you have new coverage, or have questions, call Member Services or your Care Coordinator. Having other insurance does not affect whether you qualify for LTSS.

If you suspect fraud or abuse by a caregiver, medical provider, behavioral health provider, another member or anyone else, you can report it safely without providing your name or identity to the State or to UnitedHealthcare. There are email addresses and websites provided below that you can use to report suspected fraud or abuse 24 hours a day 7 days a week. 

You can report to UnitedHealthcare Community Plan. You can do this by calling your Care Coordinator, by telephone or through our website at: UnitedHealthcare Fraud Hotline: 1-844-359-7736. 

Website: uhc.com/fraud

You can first talk to your doctor or provider if you have questions or concerns about your care. They can work with you on fixing the problem. If the problem isn’t fixed, you can call us. 

You may file a grievance over the phone with Member Services at 1-877-236-0826, TTY 711. 

You may file grievances online at member.uhc.com/CommunityPlan. 

You can send your written grievance to: 

UnitedHealthcare Community Plan LTSS Appeals and Grievances P.O. Box 31364 Salt Lake City, UT 84131-0364 

Fax: 1-801-994-1082

All members can file an appeal through these processes. You may file an appeal over the phone with Member Services at 1-877-236-0826, TTY 711. 

You may file appeals online at member.uhc.com/CommunityPlan. 

You may also file a written appeal by sending it to: 

UnitedHealthcare Community Plan LTSS Appeals and Grievances P.O. Box 31364 Salt Lake City, UT 84131-0364 

Fax: 1-801-994-1082

Long-term services and supports (LTSS) refers to a broad range of medical, functional and social services that are needed by individuals who have complex health needs due to aging, chronic illness or disability. These services can be provided in a range of settings, including nursing homes, assisted living facilities, convalescent homes, and home and community-based settings.