Problems With Your CareAdvantage Medical Benefits?
If you are in one of the following situations, you can ask CareAdvantage to make a “coverage decision” to resolve your
problem.
- HPSM will not approve medical care your doctor wants to give you
- You have received medical care you believe is covered, but CareAdvantage will not pay for it
- You want to ask HPSM to reimburse you for a service you paid for, and that you believe should be covered
- You have been told that coverage for certain medical care you have been receiving will either end or be cut back
Hospital stays, home health, and skilled nursing facility services
For problems related to coverage for these services ending too soon, please refer to the 2012 CareAdvantage Evidence of Coverage
, see Section 9 page 170 and Section 6, page 140 on how to ask for a coverage decision.