Frequently Asked Questions

What if I have questions?

Contact a Member Advocate at the number listed on your ID card.

I have not received my member ID card but need to see my doctor. What should I do?

Contact a Member Advocate for assistance. If your enrollment via your plan sponsor has been processed, a Member Advocate will be able to give you your unique member ID number. This number allows a doctor to verify your eligibility and bill your services to OhioHealthy. If your doctor requires you to present a card at the time of service, a Member Advocate will fax a sample of your card to the doctor’s office. You also have the option to print a temporary ID card online when you register your OhioHealthy account. Click on Select member ID card under Benefits on the Members tab.

Why do I need to carry my member ID card?

Your member ID card identifies you as a covered member of OhioHealthy. Your card contains helpful information for your providers of service, including where to call for prior authorization. It also has helpful contact information including how to reach our Member Advocates, telemedicine provider and our after-hours nurse advice line.

I received a new member ID card in the mail, but I already have one. Should I throw the new one away?

No. Unless you ordered a new card online or through a Member Advocate, your information may have changed. Always present your new ID card to your doctor.

How do I request a member ID card?

You can contact a Member Advocate for assistance, or you can request a card by signing into your OhioHealthy account. Once ordered, the card should arrive in 7-10 business days.

Where should I go when I need care?

You have the best experience when you choose the right care from the start. When you need care, you may have more options than you realize—ones that could save you time and money.

If you are experiencing a life-threatening emergency, call 911 or go to the nearest emergency department.

For non-emergency care, contact your primary care physician to schedule an appointment. Depending on your physician, virtual care from your mobile device or computer may be an option. If you don’t have a primary care physician, use the OhioHealthy Provider Search Tool.

If your primary care physician is not available:

Option 1 | CONTACT A MEMBER ADVOCATE

Contact a Member Advocate Monday through Friday 8:30 AM – 5 PM by calling the number on the back of your member ID card.

Option 2 | CALL THE FREE NURSE ADVICE LINE

Contact a licensed nurse 24/7 for support or questions by calling (844) 834-4375.

Option 3 | VISIT THE EXPRESS APPOINTMENT CENTER

Schedule a same-day appointment with the Express Appointment Center by calling (614) 788-2730. The Express Appointment Center offers the same services as your OhioHealth primary care office from minor illnesses and injuries to the routine management of chronic health conditions.

Option 4 | SCHEDULE A VIRTUAL CARE VISIT

Schedule a virtual visit with Teladoc through the convenience of your mobile device or computer. Teladoc is a national network of on-demand providers offering 24/7 access to board-certified physicians. Download the Teladoc Mobile App or visit Teladoc to get started.

Have questions about where to go for care? Contact a Member Advocate by calling the number on the back of your member ID card.

If I’m currently receiving treatment, how can I ensure a smooth transition of care from my previous health plan to OhioHealthy?

OhioHealthy understands the importance of maintaining your health coverage without interruption in your medical treatments. If you have a future procedure scheduled, or if you are currently receiving treatment for an on-going condition by a provider not in the network you may need added support in your switch to OhioHealthy. If this applies to you, please submit a Transition of Care Assessment within 30 days. Transition of care to an in-network should be accomplished within 90 days.

Once your Transition of Care Assessment has been reviewed, a member of the care management team will contact you to assist with finding in-network providers and create a plan to ensure a smooth transition.

What happens when I call the 24/7 Nurse Advice Line?

The 24/7 Nurse Advice Line nurses have training in emergency medicine, acute care, OB-GYN and pediatric care. A nurse will ask you to describe your medical situation in as much detail as possible. Be sure to mention any other medical conditions that you have, such as diabetes or hypertension.

The staff is well-prepared to answer medical or behavioral health questions for members and their dependents. However, since they are unable to access medical records, they cannot diagnose or treat medical conditions, order labs, write prescriptions, order home health services, or initiate hospital admissions or discharges.

Depending on the situation, you may be advised about appropriate home treatments or a visit to your doctor may be advised. If necessary, the nurse may direct you to a plan urgent care center or emergency department.

How can I tell if it is an emergency?

An emergency is the sudden onset of a medical condition with such severe symptoms or pain that an average person with an average knowledge of health and medicine would seek medical care immediately because there may be serious risk to your physical or mental health or that of your unborn child.

Some examples of situations that would require the use of an emergency department include but are not limited to:

• Heart attack or severe chest pain
• Loss of pulse or breathing
• Stroke
• Poisoning
• Loss of consciousness
• Seizures

What should I do if I have an emergency?

In any life-threatening emergency situation, always call 911 or go to the closest emergency department.

If you received emergency care and are admitted, you or a family member should contact OhioHealthy within 48 hours (two business days) or as soon as medically possible. This enables OhioHealthy to arrange for appropriate follow-up care, if necessary.

What conditions generally do not require emergency department treatment?

The following conditions do not ordinarily require emergency department treatment, and may be more appropriately treated in your doctor’s office, or at an urgent care center covered by your plan:

• • Sprains or strains
  • Chronic conditions such as arthritis, bursitis, or backaches
  • Minor injuries and puncture wounds of skin
  • Colds, Flu, Fever, Sore Throat
  • Ear Infection
  • Sinus Infection
  • Urinary Tract Infections

What is the difference between an emergency department and an urgent care center?

An emergency department is designed, staffed, and equipped to treat life-threatening conditions.

An urgent care center is a more appropriate place to seek treatment for sudden acute illness and minor injuries when your doctor’s office is closed or not available.

Copayments and coinsurance amounts for emergency department visits are generally higher than copayments for urgent care visits. If you are transferred to an emergency department from an urgent care center, you will be charged an emergency department copayment or coinsurance.

Do I need to contact OhioHealthy or my primary care physician before going to the emergency department or urgent care center?

No. In case of an emergency, you should always call 911 or go to your nearest emergency department. In non-emergent situations, if you are unsure where to go for the treatment of your condition, you can call your primary care doctor's office or a Member Advocate. If it is after business hours, you can call the 24/7 Nurse Advice Line at the number on your ID card.

What if I become ill when I am outside of OhioHealthy's service area?

Your OhioHealthy plan includes coverage for emergency services when you are outside the service area. If you have an unexpected illness or injury when outside of the service area, you should call a Member Advocate at the number on your ID card. If it is after business hours, contact the 24/7 Nurse Advice Line at the number on your ID card.

If you are in a life-threatening emergency, call 911 or go to the closest emergency department.

OhioHealthy may review all emergency department care retrospectively (after the fact) to determine if a medical emergency did exist. If an emergency did not exist, you may be responsible for payment for all services.

What if I need to be hospitalized?

If you received emergency care and are admitted, you or a family member should contact OhioHealthy within 48 hours (two business days) or as soon as medically possible. This enables OhioHealthy to immediately begin reviewing your care and to arrange for appropriate follow-up care.

Be prepared to give the following information:

• • Member name
  • Reason for treatment
  • Hospital name
  • City and state where treatment is occurring
  • Name of treating doctor

The doctor or hospital may also call the Medical or Behavioral Health Preauthorization number on the back of your card.

What happens once I am admitted to the hospital?

As part of your OhioHealthy coverage, a member of our clinical team will follow your case from beginning to end. He or she will review your medical record, check your progress and arrange for your continuing care needs after you leave the hospital.

How do I access behavioral health services?

You may contact either a Member Advocate or your primary care physician for guidance prior to seeing a behavioral health provider.

Do I need a referral for behavioral health inpatient services?

No. If you need to be hospitalized, your behavioral health provider (not your primary care physician) will arrange for your admission to the appropriate in-network facility.

How do I handle a behavioral health emergency?

In an emergency, always call 911 or go to the nearest emergency department. For nonemergency behavioral health information, contact a Member Advocate or the 24/7 Nurse Advice Line. The numbers are listed on the back of your member ID card.

How does OhioHealthy protect my personal information?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health plans protect the confidentiality of your private health information. OhioHealthy will not use or further disclose HIPAA protected health information (PHI) except as necessary for treatment, payment, and health plan operations, as permitted or required by law, or as authorized by you.

A complete description of your rights under HIPAA can be found in the OhioHealthy Integrated Notice of Privacy Practices. A copy of the notice will be included in your Evidence of Coverage (EOC) or Certificate of Insurance (COI) when you enroll. You can view a copy of our privacy notice online.

The state of Ohio also has laws in place to protect the privacy of our members’ insurance information. We will not release data about you unless you have authorized it, or as permitted or required by law. OhioHealthy requires an Authorization of Designated Agent form whenever anyone other than the OhioHealthy member needs to obtain and/or change health information. You can download a copy of the form under Forms and Documents, or by calling a Member Advocate at the number on your ID card.

Under HIPAA and Ohio law you have certain rights to see and copy health information about you. Under HIPAA you have the right to request an accounting of certain disclosures of the information and under certain circumstances, amend the information. You have the right to file a complaint with OhioHealthy or with the Secretary of the U.S. Department of Health and Human Services if you believe your rights under HIPAA have been violated.

What if I need to see a specialist?

You do not need a referral from your primary care doctor for specialist care. If you and your doctor decide you need to see a specialist, your doctor will coordinate your care and you can make your own appointment.

Before you see a specialist, you should confirm that the specialist is in the OhioHealthy Network. Use the Find Doctors and Locations search tool or contact a Member Advocate at the number on your ID card to make sure that your specialist is in the network.

What if my doctor directs my care to a non-network doctor?

It is your responsibility to ensure that you are using in-network doctors and locations.

If you have an OhioHealthy plan and your doctor directs you to a non-network doctor, you will be responsible for payment of these services. You have the option of using in-network doctors or out-of-network doctors. Claims from out-of-network doctors will be paid at a reduced benefit level and you will usually pay higher deductible, copay and coinsurance amounts. You may also be balance-billed for any charges in excess of your plan’s maximum allowable charges.

To find an in-network doctor, use the Find Doctors and Locations search tool, or call a Member Advocate at the number on your member ID card.

Is my specialist authorized to order diagnostic or X-ray tests for me?

Yes, but some tests may require preauthorization by OhioHealthy. You can call a Member Advocate or your specialist can call the preauthorization number on the back of your ID card to confirm.

Do I need a referral for my annual gynecologic exam?

No. Your plan does not require referrals. Members may schedule an appointment for a routine annual exam with any OB-GYN in OhioHealthy’s Network.

Can an obstetrician (OB) serve as my primary care doctor while I am pregnant?

Yes, during your pregnancy, your OB can serve as your primary care doctor. As a plan member, you are automatically eligible for the OhioHealthy Partners in Pregnancy program. This program is designed to provide education and support to pregnant women. To learn more and register, call 1 (614) 485.7941 or email caremanagement@ohiohealthyplans.com.

Who is responsible for making sure the doctors I see and the services I receive are covered under my health plan?

It is your responsibility to ensure that you are using in-network or OhioHealthy doctors and locations.

You have the option of using OhioHealthy providers or non-OhioHealthy providers. Because OhioHealthy does not have cost-saving contracts in place with providers not in our network, you will usually pay more for their services. You may also be balance billed for any charges more than your plan’s maximum allowable charges.

To find an in-network doctor, use the Find Doctors and Locations search tool, or call a Member Advocate at the number on your member ID card.

How do I register for my OhioHealthy account?

If you are age 14 or older and a covered member of the health plan, simply go to the registration page. You will need to have your member ID card available when registering.

Your OhioHealthy account is mobile friendly and has all of the convenient features you need to stay connected including:

• • Find/print ID cards
  • Find/locate providers
  • Estimate costs through the treatment cost calculator
  • Contact a member advocate
  • Check the status of an open and/or paid claim
  • Update contact information
  • Schedule virtual care visits for medical and behavioral healthcare

Not yet registered? Register now

Is there an OhioHealthy mobile app?

Yes.

• If your member ID card says OhioHealthyUnity and looks like the image below, download the “myOhioHealthyUnity app” from the Apple Store or Google Play.
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• If your member ID card resembles the image below, download the “OhioHealthy App” from the Apple Store or Google Play.
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I have forgotten my Username and Password for my OhioHealthy account, what do I need to do?

On the login screen, select "Forgot your username or password?" and follow the reset instructions. You may also contact a Member Advocate for assistance.