Quick Reference

Date: January 1, 2016

Quality Improvement
We continually strive to improve the quality of care and services delivered to you, Johns Hopkins US Family Health Plan members. We use a variety of tools to assist in measuring quality, a few of which include: HEDIS (Health Effectiveness Data Information Set) and member and provider satisfaction surveys. To learn more about our quality improvement program and our progress toward meeting our goals, call 410-424-4528 or visit hopkinsmedicine.org/usfhp. Watch the website and Patriot Life throughout the year for updates.

Population Health Programs
We have a variety of programs to help you manage chronic health conditions, recover from serious illness and make healthy lifestyle choices. These services are provided at no cost to you. Members with certain needs may be enrolled automatically in appropriate programs but are under no obligation to participate. For details, visit hopkinsmedicine.org/usfhp. If you have questions about the population health programs and would like to participate, call 410-762-5206 or 1-800-557-6916, Monday through Friday, 8:30 a.m. to 5 p.m., or email [email protected].

Utilization Management
Our utilization management program ensures that you receive the right care at the right time in the right setting. Utilization management decisions are based on the need to provide appropriate care and verify the existence of coverage. USFHP does not provide financial incentives to staff members for denials nor does it promote underutilization of services. To contact utilization management, call 410-424-4480 or 1-800-261-2421. Staff members are available eight hours a day during normal business hours, and messages left after hours will be returned on the next business day. A language assistance line is available, and TTY/TDD services for the hearing impaired can be accessed through the Maryland Relay operator at 711 or 800-201-7165, 8 a.m. to 5 p.m.

Private Health Information
USFHP is committed to respecting your privacy and confidentiality.  Information regarding the collection, use, disclosure and internal protection of your protected health information is outlined in the Notice of Privacy Practices publication and privacy and confidentiality statement that you can view on our website. Simply go to hopkinsmedicine.org/usfhp and click on the Member Visitor link. To receive a paper copy, call USFHP customer service at  
1-800-808-7347.

Pharmacy Resources
A variety of pharmacy information and resources are available to you on the USFHP website at hopkinsmedicine.org/usfhp. This includes information related to the pharmacy formulary, pharmaceutical restrictions or preferences, requesting a benefit exception, step therapy, generic substitution and other pharmacy management procedures. The pharmacy formulary is updated regularly to include new medications and the latest safety information. For additional information on the pharmacy formularies and updates, visit hopkinsmedicine.org/usfhp/pharmacy. You can also contact the customer service department at 1-800-808-7347 with any questions or concerns.

USFHP Member Handbook
Our recently revised USFHP Member Handbook is packed with vital information about your benefits and how to use them. To view the handbook, go to hopkinsmedicine.org/usfhp and click on the Member and Visitors link. To receive a paper copy, call USFHP customer service at 1-800-808-7347.

The handbook explains:

• How to access care and obtain primary care services
• Benefits and services included and excluded from your coverage
• Your financial responsibilities for health care services
• Coverage when you are out of the service area
• Prescription plan and pharmacy information
• How to submit a claim if you receive a bill you don’t think you have to pay
• Your rights and responsibilities as a health plan member
• Information about our network providers and their qualifications
• How to obtain care after normal office hours
• How to obtain care from a specialist, mental health and substance abuse providers, or hospitals
• How to pay us a compliment, submit a complaint or request a review of an adverse decision
• What to do if you think the situation is a medical emergency
• How to obtain assistance if your primary language is not English
• How USFHP evaluates new medical treatments to determine whether or not they should be covered

NurseLine
The USFHP NurseLine gives members real-time telephone access to a registered nurse so that you can get answers to your medical questions to help you understand and assess your situation. The service is available 24 hours a day, 7 days a week, by calling 1-866-444-3008.

NurseChat
Johns Hopkins USFHP members can call or chat with a registered nurse any time of the day or night using NurseLine or NurseChat. Nurses will answer questions and provide information about your medical concerns. If you prefer to use the Internet to get a health question answered, go to hopkinsmedicine.org/usfhp, click on the Contact Us link and scroll down to find NurseChat. This will allow you to reach a registered nurse any time of the day or night. While you’re on the website, check out our other health resources, such as the health information library and the Symptom Checker.

Download Issue (PDF)