A Member Services Representative at your child’s health plan can help you by answering questions about:
- Eligibility, benefit coverage, and enrollment in the health plan
- How to access other services, such as case management
- How to find a primary care provider (PCP) or specialty providers in the plan
- How to change your child’s PCP
- How the prior authorization process works
- What to do if you have a complaint or grievance
- What to do if you disagree with a decision made by the health plan and you want to appeal the decision
- Coverage for services your child receives out-of-state
Have your child’s insurance card with you when you call. You will find the plan’s phone number and your child’s membership number on the card. Also, write down your questions before you make the call.
This information is provided by the Division for Children & Youth with Special Health Needs within the Department of Public Health.