Ad’vo-ca-cy: Acting in support of; speaking on behalf of.

General

• Who are you?
• How can you help?
• When can I call?
• Do you have a toll-free number?
• How are you funded?
• Do you have services in other languages?
• Can I apply for TennCare with you?
• Can you get me my medicine?
• Are you TennCare?
• Do you share my information with other groups?
• Why do you want my social security number?

Reforms

• I’ve lost my TennCare. Are there any services out there for me?
• What reforms have been made?
• I'm not sure if I have Medicaid or TennCare Standard. How do I find out?
• I'm going to lose my TennCare Standard. Can I get Medicaid instead?
• I'm an adult on Medicaid Spend Down. How long will my Spend Down last?
• I might be able to afford insurance, but I'm uninsurable! What will I do?
• If I lose my TennCare coverage, what other types of insurance plans are available?
• Can you give me the names of some private insurance companies?
• I can't afford to pay for private insurance! What can I do?
• What is the pharmacy 'Short List'?
• I don't agree with the changes to TennCare. What can I do and who can I contact?
• Where can I look to find resources around the state?
• What are the Brown Pages and what do I need to know about them?
• I heard the Governor proposed more health insurance for everyone in Tennessee. What are his plans?

Common Problems

• I just received a bill, do I need to pay it?
• I have TennCare, but TennCare won't pay for my treatment. What can I do?
• What happens if my MCO denies a claim and the provider starts billing me?
• I have TennCare but I can’t get my medicine. What can I do?
• I called my MCO to find a doctor, but they don't have any close to me. What can I do?
• I lost my TennCare card. What can I do?
• I can't drive myself to the Doctor. What can I do?
• My income/family information or my address has changed, what do I need to do?
• I am very sick but my DHS worker says I don't qualify for TennCare. What can I do?
• I've lost my TennCare? What can I do?

Eligibility

• What is TennCare?
• What is the difference between TennCare and Medicaid?
• How do I qualify for TennCare?
• How do I apply?
• Where do I go to get an application?
• I have other insurance, can I get TennCare?
• I'm eligible for a HIPAA plan, can I get TennCare?
• I'm eligible for COBRA can I get TennCare?
• I have SSI, can I get TennCare?
• I have Medicare, can I get TennCare?
• I have a card, is my TennCare OK?
• Do I have TennCare Standard or TennCare Medicaid?
• What is the difference between TennCare Standard and TennCare Medicaid?

Benefits

• What health services does TennCare offer?
• What dental services does TennCare offer?
• What mental health services does TennCare offer?
• Does TennCare offer transportation?
• What services does TennCare have for children?

Premiums

• What will I have to pay for TennCare?
• I cannot pay my premium, will I lose my TennCare?

MCOs

• What is an MCO?
• What is a BHO?
• Can I change my MCO?

Pharmacy

• I have TennCare, what pharmacy can I go to?
• What medicines are covered under TennCare?
• What is prior approval? Why would I need it?
• If I lose my TennCare, I won't be able to afford my medications. What can I do
• I'm losing my prescription coverage. How can I contact the Health Options Hotline?
• What is the Pharmacy Short List?
• What is the Prescriber Attestation List?

Appeals

• What is an appeal?
• What is the difference between administrative and medical appeals?
• How long do I have to file an appeal?
• Will I get back on TennCare if I file an appeal?
• How long will TennCare take to answer my appeal?
• What is a fair hearing?
• Do I need a lawyer for a fair hearing?

Childrens Advocacy

• What does the Children's Advocacy Program do?
• Who can file an appeal?
• How do I file an appeal?
• What is the difference between a regular appeal and an expedited appeal?
• Are custody issues appealable through TennCare?
• Is there more than one appeal form for different TennCare services?
• What should I do if an appeal is denied?
• How long do I have to wait before an appeal can be filed?
• Does DCS send all staffings to the TennCare Children's Advocacy Program?
• If a child in state custody is not on TennCare whom do I call?

HIPAA

• What is HIPAA?
• Does the rule require my doctor to send my medical records to the government?
• What does the HIPAA Privacy Rule do?
• Why is the HIPAA Privacy Rule needed?

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