Depending on the type of health insurance you have, you may need to get pre-approved for some types of medical care. This is called an “authorization.” If you have both Medicare and Medicaid coverage, authorizations may seem confusing, especially if your Medicare and Medicaid plans are with 2 different companies. Here are some helpful guidelines for when you need to get authorizations for care: ■Contact your Medicare plan for acute care authorizations. Acute care includes things like doctor visits, hospitalization, prescriptions, and behavioral health. ■Contact your Medicaid plan for authorizations for longterm services and supports (LTSS). LTSS can include home care, assisted living, and nursing facility care. El Paso Health STAR+PLUS is a Medicaid plan. So if you need help with LTSS authorizations, you should contact your El Paso Health Service Coordinator. Authorization process for dual members They are here to help you get the care you need! The right approvals are important for getting care when you need it. But it can be confusing sometimes. If you ever have questions or need help, call us at El Paso Health. We are here to help you every step of the way. Nonprofit Org. U.S. Postage PAID Salem, OR Permit No. 86 El Paso Health PO Box 971100 El Paso, TX 79997-1100 Spring • 2025
Help us stop waste, fraud, and abuse What can a Service Coordinator do for you? Your local Service Coordinator helps you find the right services and support. They will look at your needs to see how they can help. Your Service Coordinator can help with doctor visits, behavioral health-care visits, home care, and more. They can also tell you about other programs, like health care or community services, that may be useful. Your Service Coordinator will help make a plan just for you and make sure you get the services you need. If your situation changes, they will check on you and make changes to your plan, if needed. Do not hesitate to reach out to them when you need help. To reach an El Paso Health Service Coordinator, you may call 1-833-742-3127. At El Paso Health, we work hard to stop waste, fraud, and abuse. These problems make health care more expensive and unfair for everyone. Our Special Investigations Unit (SIU) is here to protect our members and keep health care honest. Our SIU team includes: Here’s how it works: 1Review. The team checks medical records and bills to look for mistakes. 2Investigate. If something seems wrong, they look deeper to find the issue. 3Take action. If they find waste, fraud, or abuse, they fix the problem and work to stop it from happening again. If you see examples of waste, fraud, or abuse in health care, you can help! Call the El Paso Health Fraud Hotline at 1-866-356-8395. You don’t have to give your name, and your report will stay private. ■Alina Macias, SIU Claims Auditor ■Jennifer Herrera, SIU Assistant ■Ismael Gamez, Nurse Auditor The SIU team makes sure that doctors and health-care providers bill correctly and follow the rules. 2 resources
El Paso Health has a Community Connection Unit that can help members with situations related to nonmedical drivers of health. We have coordinators who can assist you in finding help and resources for the following: ■ Housing ■ Utilities ■ Education ■ Food pantries From left: Community Connection Supervisor Gabriela Mendoza and Community Connection coordinators Monica Leal, Ofelia Payne, and Christian Carbajal The Community Connection coordinators are here to help you. Please contact us for more info at 915-532-3778. Meet our Community Connection Unit Understanding your OTC benefits How does your over-the-counter (OTC) benefit card work for you? Your card can be used to buy your OTC health-related and personal care items. Using your OTC card is easy. All you have to do is swipe your card when making your purchases. Here are some of the rewards yo may be eligible to receive: ■$35 per quarter for OTC products. ■$25 reward for completing certain preventive screenings. ■$50 per quarter for members with diabetes for approved healthy food items. (Please keep in mind not everyone will qualify for the healthy food reward. Prediabetes will not qualify.) For information on specific rewards, check our Healthy Rewards page on our website: www.elpasohealth.com/ members/healthy-rewards. Use your OTC catalog to see what items qualify for the OTC rewards. Checking your balance is also easy. You can check your balance in 3 ways: ■Go to mybenefitscenter.com. ■Download the Benefit Center app. ■Call 1-833-684-8472. Thank you for choosing El Paso Health. 3 resources
Why visit your doctor after hospitalization for mental health? Visiting your doctor after a psychiatric hospitalization can help with your transition to the home and work environment. This will also help to make sure the gains made during hospitalization are not lost. A follow-up visit helps your doctor and therapist detect early post-hospitalization reactions or medication problems, and demonstrates continuing care. Why follow up? 1. Visiting your doctor will allow you to discuss how you are feeling and if any changes to your medications are needed. 2. Talking to your doctor can help you find the right therapist or support groups. They can recommend programs that fit your needs. 3. Regular visits help your doctor check your progress. They can offer guidance and encouragement as you continue to heal. 4. If you have any worries or side effects from your treatment, your follow-up visit is a great time to discuss them. Tips for your visit ■Write down any questions or concerns you have. ■Bring a family member or friend for support if you want. ■Be honest about how you’re feeling. El Paso Health has a crisis line open 24 hours a day, 7 days a week. A qualified and trained person will be there to help you. If you need help, please call 1-877-377-2950. ABOUT YOUR HEALTH is published as a community service for the friends and patrons of EL PASO HEALTH, 1145 Westmoreland Drive, El Paso, TX 79925, telephone 1-833-742-3127, website www.elpasohealth.com. Information in ABOUT YOUR HEALTH comes from a wide range of medical experts. If you have any concerns or questions about specific content that may affect your health, please contact your health-care provider. Models may be used in photos and illustrations. 2025 © Coffey Communications, Inc. All rights reserved. EPHSPM10232502-EPH-SPM-Spring 2025 Member Newsletter wellness
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