New Mexico Turquoise Care

If you are a new Turquoise Care program member, getting connected during your first 30 days is very important. Here is a to-do list. When you complete this list, it lets us know your choices when it comes to managing your health:  

1. Complete your Health Risk Assessment (HRA). This is an important first step. It helps us know how you are doing today. Call Member Services at 1-877-236-0826 / TTY 711. 
   
2. Let us know how you want to hear from us. This includes mail, email, and texting options. We can also help you set a large print, braille, or other format choice. If English is not your first language, we will send materials in your language. You can share these preferences by calling Member Services.  
3. Choose a Primary Care Provider (PCP). As soon as you can, it is important to choose a Primary Care Provider (PCP) who is part of the UnitedHealthcare provider network. This is your main doctor who sees you for annual checkups, routine sick or well visits, and immunizations (shots).  Here are the options for choosing your PCP:
   • Log into your member portal at MyUHC.com/CommunityPlan.
   • You can use our provider search tool to view all of the providers in our network. 
   • Call Member Services for help finding a PCP. We can also email or send you a list of providers from which to choose. 

You should also:

• Get to know your health plan. Refer to the Health Plan Highlights (page 13) of the Member Handbook.
• Schedule an appointment with your PCP. 
  
• Connect with your Care Coordinator. Call Member Services to get started. Your Care Coordinator is “your go-to person.” 
• Ask questions! We want to hear from you. Get connected to resources, programs, and services. Call Member Services to find out about all the extras we offer here at UnitedHealthcare. We want to make this a pleasant and easy experience for you.

If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-877-236-0826, TTY 711. We are open Monday through Friday, 8 am to 8 pm EST. You can call us at this number 24/7 to get urgent assistance.

UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual. Our provider directory shows which languages doctors speak. Additionally, many of our Member Services Advocates speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.

If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number, 1-877-236-0826, and they will connect you to us.

You can also get information in large print, Braille or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call us Monday through Friday, 8 am to 5 pm MT.

Our toll-free Member Services number is 1-877-236-0826, TTY: 711.

The Just Plain Clear® Glossary contains thousands of health care terms defined in plain, clear language to help you make informed decisions. Visit justplainclear.com to use this free and helpful tool. This resource is currently available in English, Spanish as well as other languages. 

Search for a behavior health/mental health specialist

Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week.

Our nurses will:

• Listen to symptoms.
• Help with self-care.
• Advise you about getting care at a doctor visit or an urgent care center.
• Help you know when to go to the emergency room.

Your secure member website. See your covered benefits, search for providers, view your member handbook and much more. Visit MyUHC.com/CommunityPlan to get started.

It’s designed for people on the go and includes many of the same features as the member website. Find it at the App Store or Google Play.

Our Healthy First Steps® program makes sure that both mom and baby get good medical attention. 

We will help: 

• Get good advice on nutrition, fitness and safety. 
• Choose a doctor or nurse midwife. 
• Schedule visits and exams.
• Arrange rides to doctor’s visits. 
• Connect with community resources such as Women, Infants and Children (WIC) services. 
• Get care after your baby is born.
• Choose a pediatrician (child’s doctor).
• Get family planning information. 

Quit Using Tobacco or Vaping Products

Quitting is hard, but we can help. Did you know that 20 minutes after you quit, your heart rate drops to a normal level? And within 24 hours after quitting the carbon monoxide level in your blood drops to normal.

Talk to your doctor about quitting. Or call 1-866-QUIT-4-LIFE (866-784-8454) to get free coaching, counseling and supplies to help you quit.

If you have a life-threatening emergency, call 911. An ambulance will be provided if you need to be sent to the hospital.

If you need a ride, your benefits include transportation. 

We cover trips to:

• Medical appointments
• Food pantry
• WIC appointments
• Medicaid eligibility appointments
• Places of worship
• Birthing classes
• Grocery stores
• Job-related activites
• Support group meetings

Following these simple rules will help you get a ride: 

• Call at least 3 business days ahead of time 
• Call 1-877-236-0826, TTY 711 to set up your ride 
• If you cancel your visit, call 1-877-236-0826 to cancel your ride 
• Have your Medicaid ID card available 
• Rides are only for approved reasons 
• Know the address of your health care provider and the date and time of your appointment 
• Be specific about where you need a ride to 
• After your visit, call for a ride home 
• If your doctor gives you a prescription, you can stop at the pharmacy to get it 
• Let us know if you have special needs like a wheelchair 
• Members under the age of 16 must have a parent or guardian with them 
• Transportation may be limited to a provider near you

You may also qualify for a bus pass or friends and family mileage reimbursement. Give your Member Services Advocate a call to schedule a ride or ask questions about getting transportation services.

This service is for rides planned in advance. 

We offer benefits and extra services, such as: 

Car seats

Pregnant members can get a car for safe infant travel. Limit 1 car seat per baby delivered.

SelfCare digital app

SelfCare is a self-help digital application that uses cognitive behavioral therapy- based tools and techniques to improve overall mental well-being and behavioral health tracking, supporting members before they are in crisis. Self Care is designed to enable resilience by helping members build new skills and daily habits.

Features include selfpaced digital programs available on demand, any time; industry-recognized clinical depression, anxiety and well- being surveys; and evidenceinformed mental health support through trackers, mental health skills and tools collections and communities, all offered in both English and Spanish. With a 97% member satisfaction rating, Self Care provides digital support for members who may not be ready for traditional treatment.

LifeLine phone support

Enable members to connect to their providers virtually, via phones, data plans, home-based internet and remote patient monitoring devices. 

Limit of up to $250 per member.

Traditional Healing

Supports member preference for alternative healing supports and provides resources to promote person-centered care and maintenance of general health. We will provide a $300 annual reimbursement for Native American members and for traditional or healing practices.

Home-Delivered Meals

Members in transition of care can get 14 days of home-delivered meals.

UnitedHealthcare provides home-delivered meals for members in transition of care. Meals can be tailored to meet regular or special dietary needs. Such as puréed, gluten-free or vegetarian. Qualifying members can get meals for 14 days:

• After giving birth for the member and up to 4 household members
• Post-release for justice-involved members
• On leaving a skilled nursing facility

Babyscripts

A digital maternity engagement, education and incentive program for members who are pregnant and new parents.

The app includes daily educational content on healthy behaviors, the baby’s development, vaccinations, potential health risks and many other topics. There are in-depth resources on nutrition, exercise, labor and delivery, breastfeeding and more.

The app provides appointment reminders and risk assessments in English and Spanish. Health assessment data collected via the app will feed into care management platforms to support member stratification, care pathway creation and engagement.

Available for prenatal, postpartum and members parenting children. 

Program ends at 12 months post delivery. 

Virtual doula and breastfeeding support

Virtual Maternal Health Solution, offers 24 hours a day, seven days a week, on-demand access to doulas and lactation consultants to address members’ acute needs, concerns and questions about their perinatal journey and baby’s health.

Galileo supports the perinatal journey by offering routine prenatal care in coordination with local providers for testing, ultrasound and other services requiring in-person care; tracking and management of appropriate screens and tests; early identification, management and referral of high-risk pregnancies; and integrated behavioral health screening and referrals.

Galileo’s focus on whole person care includes prioritizing SDOH screening and referrals to community supports, which further enhance the resources available to our pregnant and parenting members.

All of Galileo’s services are available in Spanish and English. Members who set their preference to Spanish will receive the full Spanish experience (not English translated to Spanish).

Clothing allowance for school aged children

Provides $100 per child per year to help parents buy clothing for their children.

Workforce fund

Provides scholarships/funding to members seeking to obtain certificate, degree or workforce programs. 

Required program enrollment information. Limit up to $1500 per member. 

Emergency needs fund

Provides financial assistance to help with vital non-medical needs. Things like housing, food, transportation, gasoline, clothing and more. Funds are given out on a case by case basis.

Behavioral Health programs

Our online behavioral health resources connect members to information and resources for overall health and wellness, including specific behavioral health tools, resources and information.

For example, our health and wellness library feature 60 centers and over 220 videos focused on topics such as:

• Physical health, 
• Mental health, 
• Substance use, 
• Recovery tools, 
• Resiliency skills development, 
• Caregiving, 
• Parenting, 
• Supports for Native Americans, 
• School and education, 
• Suicide prevention, 
• Mindfulness, 
• Disaster planning and recovery that combine resources (e.g., articles, videos, training programs, screeners). 

Seeking Safety

Seeking Safety is designed to help people who have experienced trauma or substance problems develop and sustain recovery goals.

Seeking Safety encourages ones who have suffered trauma to find a safe environment to engage with their peers, respect themselves and develop and use healthy coping techniques to achieve their recovery goals.

We are the only managed care entity approved by Seeking Safety’s creator to train and use certified provider-based peers to render this program.

Substance Use helpline

A private helpline to talk about issues with substance use. Connects members, family and friends with a behavioral health expert. All callers can remain anonymous.

Many people are scared or ashamed to talk about substance use issues. And that can stop them from getting treatment. That’s why we offer a private substance use helpline. Anyone can call — members, their family, friends or caregivers.

Call and talk with a licensed behavioral health expert. They can:

• Answer any questions you have
• Reefer members to get an assessment
• Help plan the next step for members who choose to get treatment

There’s no cost to call our substance use helpline. It’s available 24/7. And all callers can remain anonymous.

Hypoallergenic mattress cover and pillow cases

Reduce and prevent allergic reactions. Increase opportunity to participate in sports and other health-promoting activities; decrease ER visits.

Limit of 2 pillow covers and 1 mattress cover per year.

Diet and nutrition counseling

Dietary counseling for any UHC member with any network provider.

One Pass

One Pass™ is a total physical, mental, and social well-being solution for adults 18 and older, providing access at no additional cost to gyms and fitness locations, including leading national brands, independent gyms, and boutique studios. As well as on-demand and livestreaming digital content, brain training, and social activities designed around you and your goals and lifestyle. Includes YMCA.

Requires member code for access. 

Chiropractic and acupuncture

Chiropractic care focuses on bones and muscles. It can help ease pain in the limbs, spine and neck. Acupuncture is part of traditional Chinese medicine. Thin needles are put into the body to help relieve pain.

Limited to 5 visits per year and $75 per visit.

Vision exam (enhanced)

Members 21+ can get a vison exam once every 24 months.

Dental (enhanced)

Members 21+ can get 1 fluoride treatment every 6 months. They can also choose to get 1 lifetime ACC/fluoride varnishing treatment.

EmissarYouth

This program connects peer support specialists with youth in foster care. It includes a 1-hour in-person meeting each week. Plus a mobile app to stay in touch between meetings.

On My Way (OMW)

OMW helps prepare youth members for living on their own. This online program teaches important life skills. Things like finding housing, getting a job and managing money.

OMW helps prepare youth members for living on their own. This online program helps young adults transition from foster care or out of the justice system. OMW teaches important life skills to help:

• Manage money
• Find housing
• Create a resume
• Get a job
• Apply for college
• Set and achieve personal goals

Being healthy is not always about your medical needs. Sometimes you need help connecting to resources out in the community. We call these social needs.

These are things like housing, getting food every day, getting to the grocery or feeling safe. We can also help you get access to help with employment or finishing your education. Want to find help on your own? Check out UHCHealthierLives.com. You can also talk to your Care Coordinator or Member Services. They can give you referrals to local organizations.

Getting to the doctor when you are healthy is important. We have guides to help you know what to expect at each well visit. You can also talk to Member Services for support and information.

We also have helpful guides for most health problems and conditions. These materials can be found on https://member.uhc.com/communityplan.

You will find condition-specific and general health topics, including:

Physical Health

• Arthritis
• Asthma
• Cancer
• Children's health
• Chronic pain
• Diabetes
• HIV
• Heart health
• Infertility
• Men’s health
• Traumatic brain injury
• Virtual visits
• Weight management
• Women’s health

Well-being

• Aging
• Brain health
• Coping
• Exercise & fitness
• Healthy eating
• Mindfulness
• Sleep
  

UnitedHealthcare offers many brochures about health conditions. Talk to your Member Services Advocate about any health needs that you have. We can send you helpful information. We can also connect you with a Care Manager who can help you create a plan of care and make sure you get all the services you need.

The member will need to submit the Traditional Healing Reimbursement Form.  For more information or assistance, please contact Member Services at 1-877-236-0826. For hearing impaired: 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

What are the limitations of the Ombudsman?

• The ombudsman will not file appeals or grievances on behalf of the members
• The ombudsman does not have the authority to override policies or procedures
• The ombudsman will not make decisions for the members
• Members have the right to refuse ombudsman services. An exception for ombudsman services to continue without member consent is in a life-threatening event to the member or to others. If this occurs, the Ombudsman will report this event.

Contact information for members:

The direct telephone number to the Ombudsman’s office is 1-877-236-0826, TTY 711.

How can a member reach their UnitedHealthcare Ombudsman?

• By email: NM_Ombudsman@uhc.com
• By phone: Member Services at 1-877-236-0826; TTY 711 for hearing impaired

An advance directive is a set of written steps you want to be taken when you can no longer make health care choices for yourself. It tells what health care you want or do not want. You should talk about your wishes with your doctor, family and friends. These steps will not change your health care benefits. 

What are advance health care directives? 

By State of New Mexico and federal law, you have the right to make an advance directive. It is a document that lets you say exactly how you wish to be treated if you are too sick to make health care decisions. An advance directive will help your doctor and family make choices about your health care. You can also name someone to make your health care decisions. That person is called a surrogate or an agent. He or she has the right to refuse or stop treatment for you in some cases. 

The document could be called an advance health directive, mental health advance directive, psychiatric advance directive or PAD, living will, durable health care power of attorney and/or durable mental health care power of attorney. 

It is UnitedHealthcare Community Plan policy to let all adult Turquoise Care members know they can do this. State and federal law says hospitals, nursing homes, and other providers have to tell you about advance directives. They need to explain your legal choices about medical decisions. The law was made to give you more control during times when you may not be able to make health care decisions. 

UnitedHealthcare Community Plan follows the regulations in the Mental Health Care Treatment Decisions Act [24-7B-1 NMSA 1978] and the federal regulation 42 CFR 489 subpart I and 42 CFR 422.128. 

How do I get an advance directive? 

Contact Member Services or your Care Coordinator at 1-877-236-0826. If you are speech or hearing impaired, call TTY 711. 

You can also call the State of New Mexico Aging and Disability Resource Center: 1-800-432-2080.

We want to hear from our members about any questions, complaints, or concerns you may have. If you have a grievance, please call Member Services toll-free, at 1-877-236-0826, TTY 711.

If you are not happy with your care or treatment by Member Services, Care Coordinator or a provider, you may file a grievance. You may file a complaint or grievance against us (the health plan) or a provider at any time.

Members may file a grievance verbally with Member Services from 8 am to 8 pm EST, Monday through Friday, at 1-877-236-0826, TTY 711. All members can file a grievance through this process. 

You can also send a letter. Please include your name, address, member ID, reason for your grievance, and any other information you think is important. That address is:

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

You have other rights that include appeals and a State Fair Hearing. For detailed information about complaints and appeals, contact Member Services or view the Appeals and Grievances section of the Member Handbook.

Fraud, waste, and abuse are serious problems. There can be penalties under law. To make a report, call the UHC Fraud Hotline at 1-844-359-7736. You can also call Member Services at 1-877-236-0826. We will not use your name in your report. You will not get in trouble for reporting this. We will look into the matter for you. 

For more information about fraud, waste, or abuse, or to make a report online go here.

We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it. View a copy of our Notice of Privacy Practices.