Integrated and Transitions of Care

We understand some members have special needs. In those cases, Trillium offers our members care management services to assist our members with special healthcare needs. If you have special healthcare needs or you have a disability,

Care Management may be able to help you. Our care managers are nurses or social workers. They can help you understand major health problems and arrange care with your providers.

A care manager will work with you and your provider to help you get the care you need. This service is not only for members who have complex medical conditions, but also for any member who wishes to have a care manager. These members often see several providers. They may need medical supplies or help at home.

Conditions may include:

  • Multiple Sclerosis
  • Kidney or renal disease
  • HIV/AIDS
  • Organ transplant
  • Diabetes

Our care managers are nurses or social workers that can help members understand their health problems. Our nurses work with members and their providers to help them get the care they need. The nurse can set up home health or other needed services. Member Services can give you more information about care management services. Call Member Services and ask you can ask to speak to a care manager. 

Please continue to be actively engaged and participating in the care coordination process by:

  • Answering calls from your care manager.
  • Participating in the treatment plan.
  • Attending all appointments. 

When your children are young, they see a doctor who knows all about children’s health, called a pediatrician. But when your children grow up, their health needs change. Your doctor and your plan can help you find a new doctor for their new health needs. Please talk with your doctor or call Member Services to verify the doctors fit for your child’s health needs.

When your children are young, they see a doctor who knows all about children’s health, called a pediatrician. But when your children grow up, their health needs change. That is when it is time to move to a doctor who knows about adult health.

Your PCP and your health plan can help you and your child make this change. If you need help finding a new provider, talk with your PCP or call Member Services.

If you need help, you will be able to get it. We provide mental health and substance abuse disorder benefits without discriminating. These services cover the diagnosis and medically necessary active treatment of:

  • Mental health disorders
  • Substance use disorders

You can choose any provider in our behavioral health network. You don’t need a referral from your primary care provider (PCP). Some behavioral health services may require prior authorization. Please refer to your Evidence of Coverage or call Member Services for more details.

Your PCP looks after your care 24 hours a day, seven days a week.  You can call your PCPs office for information on receiving after-hours care.  You can also call our 24/7 free nurse advice line, at 1-844-647-9667 (TTY 711) if you have questions.

If there is an urgent or emergency problem, if you can, call your PCP first. If your condition is severe, call 911 or go to the nearest hospital. You do not need approval. If you are not sure if it is an emergency, call your doctor. Your doctor will tell you what to do. If your doctor is not available, a physician taking calls can help. There may be a message telling you what to do.

You can also call our 24/7 free nurse advice line, at 1-844-647-9667 (TTY: 711) if you have questions.

Urgent care: Urgent care is when you have a health problem that needs care right away, but your life is not in danger. This could be a child with an earache who wakes up in the middle of the night, a sprained ankle, or a bad splinter you cannot remove. Urgent care is covered anywhere in the United States. If you think you need to be seen quickly, go to an urgent care center that works with Trillium Medicare Advantage. You can also call your PCP’s office or the 24-hour Nurse Advice Line at 1-844-647-9667 (TTY: 711).

 

Emergencies: You are always covered for emergencies. No prior authorization or referral is required. An emergency means a medical or behavioral condition that comes on suddenly, is life threatening, has pain, or other severe symptoms that cannot wait to be treated.

Some examples of an emergency are:

  • A heart attack or severe chest pain.
  • Bleeding that won’t stop or a bad burn.
  • Broken bones.
  • Trouble breathing, convulsions, or loss of consciousness.
  • When you feel you might hurt yourself or others.
  • If you are pregnant and have signs like pain, bleeding, fever, or vomiting.

If you think you have an emergency, no matter where you are, call 911 or go to the nearest location where emergency providers can help you. Emergencies are covered anywhere in the United States. As soon as possible, call your PCP or health plan to help to get follow-up care after the emergency is over. The definition of an emergency is when a person with an average knowledge of health might fear that someone will suffer serious harm to body parts or functions or serious disfigurement without receiving care right away.

Trillium Medicare Advantage has a committee of physicians who review new treatments for illnesses. They review studies from other physicians and scientific agencies. The new treatments covered by our plan are shared with in-network providers. This lets them give the best and most current treatment to you.

Last Updated: 11/30/2017
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