About TotalCare (HMO D-SNP) Primary Care services

The types of services you get with routine care include:  

• Checkups.
• Vaccines.
• Treatments.
• Prescriptions.
• Tests and screenings.
• Health education and counseling.

You will get all of your routine care from your primary care provider (PCP). Your PCP will:

• Get to know your health history and needs.
• Keep your health records.
• Give you the preventive and routine care you need.
• Refer (send) you to a specialist if you need one.
• Arrange for hospital care if you need it.

You can start getting primary care as soon as your coverage starts. If you are a new TotalCare member or you have a new PCP, you should see your new PCP for your annual wellness visit. This helps your new doctor get to know you and your health.

Remember to do the following when you call to schedule your new patient exam (either an annual wellness visit or a Welcome to Medicare preventive visit):

• Tell the person who answers the phone that you are a TotalCare plan member.
• Give them your TotalCare Member ID number.
• Bring your TotalCare ID card to your appointment.

Be ready to talk with your PCP about your health needs and concerns. It is a good idea to bring a list of your medications and any questions you have to your visit.

Talking openly with your provider is important to make sure you get the care you need. Clear and honest communication between you and your PCP can help you feel safe to voice your concerns and make informed choices.

We know that talking with your PCP (or other provider) is not always easy, but being open can help you feel more satisfied with your care. Below are some examples of topics to discuss with your provider if you have health concerns during your visit.

Other tips for your visit to the provider:

• Bring a list of all the medications you are taking.
• If you have any medical needs, such as wheelchair access, or need language assistance or interpreting services, let the provider’s office staff know so they can help you.
• Ask about the office’s rules for missed appointments. The office can help reschedule your appointments or offer phone appointments, if it is hard for you to go in person.
• If you do not have transportation to your appointment, the Alliance can help with transportation services.

After your new patient exam, you can keep getting regular checkups (routine care) from your PCP. When you need routine care, call your PCP to make an appointment.

It is important to know that routine care is not the same as urgent care or emergency care.

Urgent care is for when you need help quickly to stop or prevent a serious health problem or injury from getting worse.

• For urgent care concerns, call your PCP.
• If you can't reach your PCP, call Member Services at 833-530-9015; (Hearing and Speech Assistance - 800-735-2929 (TTY: 711))
• You can also call the 24/7 Nurse Advice Line at 844-971-8907 (TTY: Dial 711).

Emergency care is for life-threatening medical conditions.

• For an emergency, call 911 or go to the nearest emergency room.
• If you are not sure if it is an emergency, call your PCP.
• You may also call the 24/7 Nurse Advice Line at 844-971-8907 (TTY: Dial 711).

Examples of emergency care may include, but are not limited to:

• Broken bone.
• Severe pain.
• Chest pain.
• Severe burn.
• Drug overdose.
• Fainting.
• Severe bleeding.
• Psychiatric emergency conditions, such as severe depression or suicidal thoughts.
• In active labor.

Do not go to the ER for routine care. You should see your PCP for routine care, because they know you and your health best.

You need to pick a TotalCare network primary care provider (PCP) from the TotalCare network. This provider will coordinate all your health care needs. You must pick a PCP in the TotalCare network at the time you enroll. If you do not, we will assign you a PCP. You can change your PCP at any time. To find a PCP near you, go to the online Provider Directory or call Member Services.

If you don’t choose your PCP when you first enroll, you can do so by filling out the Choose Primary Provider form online. You can also call Member Services for help.

Your TotalCare Member ID card will include the name of your PCP’s provider group.

To change your PCP, call Member Services. You can also fill out the Choose Primary Provider form. The change will start on the first day of the next month. If you change your PCP, you will get a new ID card.

An HRA is a tool that helps your doctor learn about your health conditions and how your daily habits affect your health. You will get a call from us asking you to complete the assessment if one wasn’t completed when you enrolled. This information helps your doctor understand how you're feeling—both body and mind—and find ways to help you stay healthy.

An HRA also helps you:

• Learn about preventive care.
• Make healthy lifestyle choices.
• Manage your chronic conditions.
• Take charge of your health and wellness.

You can complete your HRA in any of these ways:

1. Online: On the first day you are a TotalCare plan member, you can log into the Member Portal, go to the “Assessments” section, and select “Health Risk Assessment” (portal available in English only).
2. By Phone: Call your Care Team at 800-700-3874, ext. 5512 (TTY: 711), Monday through Friday, 8:00 a.m. to 5:00 p.m. Someone can help you fill it out and answer your questions.

You will also get additional information in the Quick-start Plan Guide included in your welcome packet.