My Health
· 3
What Is Quality
Improvement?
Did you know we check the quality of
services that members like you receive?
We call this
Quality Improvement
. If
you would like to know how we use
that information to help improve the
quality of our benefts and services, or
if you just want to learn more about the
program, visit
anthem.com
. Click
State
Sponsored
on the bottom right side
of the screen. In the
Select a State
menu, choose
Indiana
. Click the orange
Enter
button. Then choose
Quality
Improvement Program Overview
. You
also can call
1-866-408-6131
for a
paper copy.
If we decide a treatment or service is not covered under your plan, you can use
the appeals process to help get your concern resolved fairly.
Please note that some of these steps must occur within a certain time frame.
You can fnd details about the appeals process for your plan at
anthem.com
, in
your Member Handbook or by calling us at the number on your member ID
card. Follow these key steps.
Step 1:
Call the Customer Care Center. We’ll do our best to resolve your
concern fairly and quickly during this frst call.
Step 2:
If you’re not satisfed with the frst response to your concern, you can
fle an appeal. We will tell you how and let you know about any steps you must
take within a certain time frame.
Step 3:
If the outcome of step 2 does not resolve your concern, you may be
able to appeal further. If your plan ofers a second level of appeal, we will let
you know of any specifc state rules or requirements. We will let you know if
there are other steps you can take.
Step 4:
In some cases, if benefts are denied at the fnal internal appeal level,
you may have the right to request an independent external review.
How to resolve your concerns
HIP members: set up
your own account
If you are a Healthy Indiana Plan (HIP)
member, you can see your personal
history, track claims and offce visits,
check out PMPs, or even send online
messages to the Customer Care
Center. Just set up an online account
at
anthem.com/inmedicaid
. It’s our
secure site. So there is a lot you and
only you can see about your personal
information. But you have to set up your
personal account frst. To sign up, go
online to
anthem.com/inmedicaid
.