My Health
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What is Quality Improvement?
Did you know we check the quality of services that members such as 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 benefits and services, or if you just want to learn more about the
program, visit
anthem.com
.
❯
❯
At the top of the screen, click on
State Sponsored
.
❯
❯
Choose
Indiana
.
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❯
Then choose
Quality Improvement Program Overview
.
You can also call
1-866-408-6131
for a paper copy.
If we decide a treatment or service
is not covered under your plan
and you feel it should be, you can
contact us and use the appeals
process to help get your concern
resolved fairly.
You can find details about the
appeals process for your plan at
anthem.com
,
in your Member
Handbook or by calling us.
Follow these key steps. Please
note that some of these steps
must occur within a certain
time frame.
Step 1:
Call the Customer Care
Center at
1-866-408-6131
.
We’ll do our best to resolve
your concern quickly during
this first call.
Step 2:
If you’re not happy with the
first response to your complaint, you
can file an internal appeal of that
decision within your plan. We will
tell you how. We also 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 make a second internal appeal.
If your plan offers this, we will let you
know of any specific state rules. And
we will let you know if there are other
steps you can take.
Step 4:
In some cases, if benefits are
denied at the final internal appeal,
you may have the right to request an
independent external review. We will
tell you how to do that. We also let
you know about any steps you must
take within a certain time frame.
How to resolve your complaint
Have you
heard about
ConditionCare?
If you have a chronic medical
condition, you don’t have to go it
alone. Our
ConditionCare
program
can help you get more out of life.
It’s private, and there’s no extra
cost for you. You can choose to take
part in the program if you have one
of these conditions:
•
•
Asthma
•
•
Diabetes
•
•
Chronic obstructive pulmonary
disease (COPD)
•
•
Coronary artery disease (CAD or
heart disease)
•
•
Heart failure
ConditionCare
gives you 24-hour
access to a nurse to answer your
questions and offer support. The nurse
also can teach you how to best take
care of yourself. Our nurses work with
a team of dietitians and other health
experts when needed. Also, you’ll get
newsletters with tips for dealing with
your condition.
Join
ConditionCare
.
Just call
1-888-279-5449
.
Calling can be the
first step on the road to better health.