Yes. In Arizona that agency is the State Health Insurance Assistance Program or “SHIP”.
SHIPs are state organizations paid by the federal government to give free health insurance information and help people with Medicare. Your SHIP can explain your Medicare rights and protections, help you make complaints about care or treatment, and help straighten out problems with Medicare bills.
You can contact the SHIP in Arizona:
DES Division of Aging and Adult Services
State Health Insurance and Assistance Program
1789 W. Jefferson St., 950A
Phoenix, AZ 85007
Statewide Hotline: 1-800-432-4040.
“QIO” stands for Quality Improvement Organization.
A QIO is a group of doctors and healthcare professionals in Arizona who review medical care and handle certain types of complaints from patients with Medicare. In Arizona the QIO is called Health Services Advisory Group or HSAG. HSAG review complaints made by Medicare patients which include, but are not limited to, complaints about quality of care or a complaint about coverage on their hospital, SNF, home health agency or comprehensive outpatient rehabilitation stay.
HSAG can be contacted at:
1600 E. Northern Ave., Ste. 100
Phoenix, AZ 85020
In an emergency you should get care immediately. You do not have to contact your PCP or get permission in an emergency. You can dial 911 for immediate help by phone, or go directly to the nearest emergency room or urgent care center.
If you need to talk with your PCP or get medical care when the PCP’s office is closed and it is not a medical emergency, call Health Choice Generations Member Services at 1-800-656-8991. If you are calling after normal business hours – normal business hours are 8 am – 8 pm, 7 days a week and leave a message in the private voice mail box. Your call will be retrieved and responded to the next business day. Most physicians have an after hours phone number so if you call your doctor’s office make sure you leave a message for your doctor too. There will always be a health professional on call to help you.
Health Choice Generations covers urgently needed care that you get from non-plan providers when you are outside the plan’s service are but still in the United States. If you need urgent care while you are outside the plan’s service area, we prefer that you call your PCP first, whenever possible. However, we will cover follow-up care that you get from non plan providers outside the plan’s service area as long as the care you are getting meets the definition of urgently needed care. In addition, Health Choice Generations covers renal (kidney) dialysis services that you get when you are temporarily outside the plan’s service area. Refer to Chapter 3 of the HC Generations Evidence of Coverage for more information.
If you have any concerns or problems getting the services that you believe are covered for you as a member, we want to help. Please call Member Services at 1-800-656-8991 (TTY users call 711) or e-mail us at: Comments@steward.org. You have the right to make a complaint if you have problems related to getting services or payment for services that you believe are covered for you.
Medicare has rules about when and how we can make changes in your benefits. We can increase your benefits at any time during the calendar year (January – December), but we can not decrease your benefits during the calendar year. We may only decrease benefits at the beginning of a calendar year following a contract change. If we decide to increase any benefits during the calendar year, we will let you know in writing. Note: Medicare can change its national coverage at any time during the year. Since Health Choice Generations covers what Original Medicare covers the plan would have to make any change to benefits that Medicare makes. We will let you know time frames and specific details in advance should this happen.
If you have other health insurance coverage besides Health Choice Generations, it is important to use this coverage in combination with your Health Choice Generations coverage to pay for the care you receive (this is known as Coordination of Benefits). Using all the coverage you have helps keep the cost of healthcare more affordable for everyone.
It depends on the situation. In general, the insurance company that pays its share of your bills first is called the primary payer. The other company or companies that are involved are called secondary payers; this company will each pay their share of what is left of your bills. Who pays first or second – or at all – will depend on what type of additional insurance you have and the rules that apply to the situation.
As explained previously, Health Choice Generations covers certain healthcare services that you get from non-plan providers. These include care for a medical emergent or urgent care; renal dialysis that you get when you are outside the plan’s service area; care that has been approved in advance by Health Choice Generations; and services that we denied but were overturned in an appeal. If a non-plan provider asks you to pay for covered services in these situations, please contact us.
If you lose your AHCCCS eligibility Health Choice Generations is required by CMS to give at least a 30 day grace period after which you will be dis-enrolled from Health Choice Generations if you do not re-establish your AHCCCS eligibility. You will receive Medicare benefits during this time because you will be deemed eligible. In other words, if you lose your AHCCCS eligibility, Health Choice Generations will pay for your Medicare benefits for at least 30 days from the day you lose your AHCCCS benefits. Until your membership ends, you must keep getting your Medicare services through Health Choice Generations or you will have to pay for them yourself.