Presbyterian | Spring 2021 | Your Story

www.phs.org/centennialcare 7 Make healthcare easier—get a care coordinator Have you ever felt confused about how to get the care you need? Does your doctor tell you to do or get certain things, but you don’t know where to start? That’s where a Presbyterian care coordinator comes in. Our care coordination program helps members with their special healthcare needs and those who have complex health problems. Care coordinators work with you to create a plan of care to meet your needs. Care coordination can: • Help you get the healthcare services you need • Help you with long-term illnesses and injuries • Make sure you have what you need when you go home from the hospital • Help with communications between you and your healthcare team • Help you and your caregiver(s) understand medications (drugs), diets, and other care needs • Help members who have special needs such as transplants, high-risk pregnancies, and premature babies, and children who need special services or equipment • Work with members who have mental or emotional needs or drug or alcohol problems • Help members with diabetes, chronic obstructive pulmonary disease (COPD), heart disease, and heart failure to handle their health For more details or help with these services, please call the Presbyterian Customer Service Center on the number on the back of your ID card. The ombudsman program works with you to help you learn how your insurance works. An ombudsman will also help you get the covered services you need. How the ombudsman can help you ● Solve issues or problems (before they enter the grievance or appeal process) ● Learn how to get the services you need ● Get through and learn the Presbyterian Health Plan system ● Get referrals and resources (aid) ● Refer you to a care coordinator ● Teach you about your rights and responsibilities under Centennial Care What is an ombudsman (awm-budz-muhn)? An ombudsman is someone who researches problems and helps to try and solve them. They do this without taking anyone’s side. What is the role of the ombudsman? The Presbyterian Centennial Care ombudsman works with you to help with issues through support and research. When should I call the ombudsman? Talk with the ombudsman early if you are having a problem getting the care you need. If you are having trouble getting in touch with healthcare providers, use the ombudsman to help you with your needs. How can the ombudsman help me? The ombudsman works for you on issues and is not part of the grievance (complaint) system or appeals process. The ombudsman works with you to guide you through Presbyterian Health Plan processes. The ombudsman works with your care team to be your voice—to talk about your needs. What does an ombudsman not do? The ombudsman does not take the place of processes such as the appeals or grievances processes. The ombudsman will not make final decisions about your care. To contact the Centennial Care ombudsman: Phone: (505) 923-5780 Fax: (505) 923-8159 Email: ombudsman@phs.org Address: Presbyterian Health Plan 9521 San Mateo Blvd. NE Albuquerque, NM 87113 Presbyterian Health Plan ombudsman program