FAQs about Mercy Care Advantage

Call Member Services at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

Or visit these helpful links anytime:

Looking for network doctors, specialists, hospitals and dentists? You can find a provider.  

Need info on your benefits? Check these resources:

• Summary of Benefits English (PDF) | Español (PDF)

• Evidence of Coverage English (PDF) | Español (PDF)

Need to know what drugs we cover? See your Part D prescription drug benefits.

You can find info on the services we cover in your:

• Summary of Benefits English (PDF) | Español (PDF)

• Evidence of Coverage English (PDF) | Español (PDF)

Check our materials and forms page for other member materials. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

We’ll send you a new ID card. Call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

A PCP is your primary care physician. They’re the doctor, nurse, physician assistant or clinic that provides your main health care. You’ll choose your PCP from our network.

When you join, you’ll get a welcome letter. Your welcome letter will have the name and phone number of your PCP. You can change your PCP anytime. 

Questions about your PCP? Just call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

You can only choose your PCP and other providers in our network. If you need emergency care, you can go outside our network. 

Need help finding a doctor in network or changing your PCP? Visit our find a provider page. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

Specialists are providers who treat specific conditions. Your PCP will refer you to a specialist if you need to see one. 

You can find network specialists on our find a provider page. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

Yes. But you would need to pay for these services yourself. We don’t pay for services outside our network. Neither does Original Medicare. 

There are some exceptions. For example, if you need emergency care, you can go outside our network. Learn more about emergencies later on this page.

Call the provider’s office and give them your plan info. If you keep getting bills, just call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

You can find dentists on our find a provider page. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

A hospital stay is a big change from your everyday care. It can also be stressful, but you can take steps to prepare. Knowing what to expect can make you feel better.

Find a hospital

Visit our find a provider page to find hospitals in our network. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

Check your pre‑admission packet 

Before your hospital stay, you may get a pre‑admission letter or phone call. This info explains:

• What tests you may need before your hospital stay

• Where you should go on the first day 

• What time to arrive at the hospital

• When your family and friends may visit 

Bring these things to the hospital

1. Mercy Care Advantage (HMO SNP) member ID card 
2. Other types of ID (e.g., driver’s license or state ID) 
3. Advance directive paperwork — the hospital can help if you don’t have this
4. A list of your doctors, including your primary care physician (PCP) 
5. Cell phone and charger (ask if you can use your cell phone safely)
6. Phone numbers of family members, caregivers and other emergency contacts 
7. A list of your allergies to medicine or food
8. A list of medical equipment you use at home
9. Names of your medicines, vitamins, herbal products and over-the-counter products you take, including how much and how often you take them 
10. Eyeglasses, dentures or hearing aids 
11. Personal care items such as a toothbrush, toothpaste, a hairbrush, etc. 
12. Newspapers, magazines and/or books 

Leave these things at home

• Medicine bottles (unless your doctor asks you to bring them) 

• Wallet, jewelry and other valuables 

• Medical equipment you use at home

Work with your Mercy Care Advantage concurrent review nurse

This nurse:

• Checks your progress during your hospital stay 

• Communicates with your primary care physician (PCP) and other specialists about your progress 

• Helps you make a care plan for home

Know your treatment rights

Remember, you have a right to ask questions about your condition and treatment. Here are some tips:

• Write down your questions or concerns. Then you can be ready to ask them when the doctor or nurse is with you. 

• Ask them to explain again if any info isn’t clear to you. 

• Ask for info in your primary language if that’s not English.

• Ask for a sign language interpreter if you’re deaf or hard or hearing. 

Be ready to leave the hospital

When you’re ready to leave, the hospital staff reviews your discharge instructions with you. This is a good time to ask questions. Here are some ideas: 

• Where am I going after I leave the hospital?

• Do I need new medicines? Who is prescribing them? 

• How do I take my medicines? 

• Will I need any special supplies or equipment? How soon will I get them? 

• What symptoms should I look for? 

• Who should I call if I have a problem? 

• How soon should I see my PCP or specialist? 

Give your Mercy Care Advantage concurrent review nurse your cell phone number or other contact info. Then, they check on you after you leave the hospital.

An emergency is a health condition that can cause serious health problems or even death without fast treatment. You don’t need approval from anyone (your PCP or us) to get emergency health care services. You can go to the nearest emergency room or other setting for emergency care. 

Some examples of emergencies are:

• Poisoning or overdose

• Severe chest pain or heart attack

• Bleeding that you can’t stop

• Passing out or fainting

• Deep cuts or serious burns

• Broken bones

You can read more examples of emergencies.

What to do in an emergency

Call 911 or go to the closest hospital. It doesn’t have to be in our network for emergency coverage and care. 

Learn more about emergency and urgent care. 

Are you or a loved one in a behavioral health crisis? This is when you think you might hurt yourself or someone else. Or you’re feeling overwhelmed and find it hard to cope with stress. 

You can call the Arizona behavioral health crisis line at 1-844-534-HOPE (1-844-534-4673). You can also text HOPE to 4HOPE (44673). Or visit our crisis services page to learn more.

You can also call the 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline). This lifeline offers 24/7 call, text and chat with trained crisis counselors. They can help people with issues like:

• Thoughts of suicide

• Substance use

• Mental health crisis

• Other kinds of emotional distress

• Worry about a loved one in crisis

You can learn more about 988. Or check our community resource guide for more behavioral health resources.

Call 911 or go to the closest hospital. Show your health plan ID card. They’ll use the info on your ID card to bill us, not you. So don’t pay for services. 

Use urgent care for common illnesses or minor injuries, such as:

• Colds and flu

• Sore throats

• Earaches

• Back pain

• Migraine headaches

• Sprains

You can learn other reasons to use urgent care.

Find urgent care on our find a provider page. Learn more about emergency and urgent care. 

Yes, we cover both Medicare Part B and Part D drugs. See your Evidence of Coverage English (PDF) | Español (PDF) on our materials and forms page. 

To get coverage, you’ll need to use a network pharmacy. We may not pay for drugs you fill at an out-of-network pharmacy unless it’s an emergency. 

The pharmacies in our network can change at any time.

Questions? Call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

A formulary (PDF) is the list of drugs we cover. We made this list to meet your needs. And the Centers for Medicare & Medicaid Services (CMS) approved it. Sometimes the list changes. We may add, remove or make changes to coverage limits on some drugs. Or change how much you pay for drugs. We’ll let you know in writing before we make changes that may affect your prescription drugs.

You may be able to get a temporary supply if you’re taking a drug that:

• Isn’t on the formulary

• Has limits

• Has other requirements

You can check the formulary (PDF) anytime. Or visit our Part D prescription drug benefits page to see the Transition of Coverage policy.

You may qualify for Extra Help to pay for your drugs if you have a limited income. Medicare could pay up to 100% of your drug costs. If you qualify, this may include:

• Monthly premiums

• Annual deductibles

• Coinsurance

People who qualify may also avoid the coverage gap or a late enrollment penalty.

Not getting Extra Help? Many people can get these savings and don’t even know it. Find out if you can. Just call:

• Medicare at 1-800-MEDICARE (1-800-633-4227) (TTY 1-877-486-2048), 24 hours a day, 7 days a week

• The Social Security Administration at 1-800-772-1213 (TTY 1-800-325-0778), 7 a.m. to 7 p.m., Monday to Friday

• The Arizona Health Care Cost Containment System (AHCCCS) at 602-417-4000 or 1-800-654-8713

Medicare will tell us how much Extra Help you get. Then we’ll let you know the amount to pay. If you’re not getting this Extra Help, call the numbers above to find out if you can take part.

The MTM program is a free service for members who qualify. It helps those who may be at risk for problems related to prescription drugs. You can learn about these drugs and better understand them. 

Learn more about the MTM program on our Part D prescription drug benefits page. You can also call us at ${MCA_MS_phone_1} or ${MCA_MS_phone_2} (TTY 711). We’re here for you ${MCA_MS_hours}.

You can ask for a coverage decision. This includes the right to ask for an exception for a drug we don’t cover on the formulary (drug list). Here are some facts about exceptions:

• A coverage decision is a decision we make about your benefits and coverage for your drugs. This includes the amount we’ll pay for drugs. 

• You can ask for an exception to cover a Part D drug that’s not on the formulary. 

• You can ask for an exception for us to remove a restriction on a formulary drug. For example, you might have a limit on the number of pills you can get. You’ll need a statement from your doctor to support your request. 

• If we deny coverage for your drug, you can appeal and ask us to review our decision.

• Finally, you can file a grievance if you have a problem with us or one of our network pharmacies. Grievances don’t involve coverage decisions. Learn about grievances versus appeals.

Learn more about Part D prescription drug benefits.