UNDERSTANDING
MANAGED CARE

Different Types of
Managed Care

How to Choose a
Managed Care Plan

Quality
Choosing Your Physician
Assuring Coverage
of Health Care Services

Appeal and
Grievance Procedures
For More Information
Glossary

INDEX

UNDERSTANDING
MANAGED CARE

CONSUMER PROTECTIONS

MEMBER RESPONSIBILITIES

QUESTIONS TO
ASK YOUR PLAN

QUESTIONS TO
ASK YOUR PLAN:
PEOPLE WITH
SPECIAL HEALTH NEEDS

BACKGROUND
INFORMATION: NC HMOS

HOW TO INTERPRET
THE INFORMATION

HMO COVERAGE OF SPECIFIC SERVICES

COMMON EXCLUSIONS

ENROLLMENT TRENDS

DISENROLLMENT TRENDS

UTILIZATION REVIEW INFORMATION

FINANCIAL DATA

GLOSSARY

INTERNET RESOURCES

INTERNET RESOURCES:
INDIVIDUALS WITH DISABILITIES

STATE FUNDED HEALTH PROGRAMS FOR
YOUNG CHILDREN
AND THEIR FAMILIES

NC DEPARTMENT
OF INSURANCE

NC STATE EMPLOYEES
HEALTH PLAN

NC DEPARTMENT OF MEDICAL
ASSISTANCE (MEDICAID)

NC HEALTHCHOICE

NC COUNCIL ON DEVELOPMENTAL
DISABILITIES

MEDICARE

YOUR COMMENTS

NORTH CAROLINA
INSTITUTE OF MEDICINE

FOR MORE INFORMATION

Federal Resources

US Department of Labor
ERISA Questions
Pension and Welfare Benefits Administration
US Department of Labor
Sam Nunn Federal Center
61 Forsyth St., SW
Suite 7B54
Atlanta, GA 30303
404-562-2156
http://www.dol.gov/dol/pwba/

US Department of Health and Human Services
http://www.dhhs.gov

Health Care Financing Administration
http://www.hcfa.gov

Medicare
http://www.medicare.gov

Medicaid
http://www.hcfa.gov/Medicaid/Medicaid.htm

Child Health Insurance Programs
http://www.hcfa.gov/init/children.htm

State Resources

NC Department of Insurance
Market Practice Examination Reports
Guide to Appeals and Grievances, Your Rights as a Health Insurance Customer
Managed Care Plan Handbook: A Comparison Guide for North Carolina Consumers
HMO Performance Report: A Comparison of Health Maintenance Organizations in North Carolina
1-800-443-9354 (for information from SHIIP)
1-800-546-5664 (for all other publications)
http://www.ncdoi.com

NC Department of Insurance Consumer Services Division
HMO Complaints
1-800-662-7777

NC Division of Medical Assistance
Medicaid
1985 Umstead Dr.
PO Box 29529
Raleigh, NC 27626-0529
919-857-4011 (phone)
919-733-6608 (fax)
http://www.dhhs.state.nc.us/dma/

CARELINE
Information and referrals about state-funded NC DHHS programs (Medicaid, NC Health Check or NC Health Choice)
1-800-662-7030

NC Health Choice
NC’s Child Health Insurance Program, insurance coverage for children in families below 200% of federal poverty guidelines
http://www.dhhs.state.nc.us/dma/cpcont.htm

NC Family Health Resource Line
Information about NC Health Choice and NC Health Check (Medicaid coverage for children under the age of 21)
1-800-367-2229

Children with Special Needs
Information on Health Choice services for children with special needs.
1-800-737-3028
State Employees Health Plan
1-800-422-4658
http://statehealthplan.state.nc.us

NC Board of Medical Examiners
Disciplinary actions or restrictions on physicians practicing in NC
919-326-1100
http://www.docboard.org

Managed Care Resources

Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)
Hospital and managed care accreditation
http://www.jcaho.org

National Committee for Quality Assurance (NCQA)
Managed care accreditation
http://www.ncqa.org

Aetna US Healthcare
http://www.aetnaushc.com

Blue Cross Blue Shield of North Carolina
http://www.bcbsnc.com

Cigna HealthCare of North Carolina
http://www.cigna.com

Doctors Health Plan
http://www.dhpcares.com

Generations
http://www.famplan.com

Optimum Choice/MAMSI
http://www.mamsi.com

Partners National Health Plan of North Carolina
http://www.partnershealth.com

Coventry/Principal (web site for parent company)
http://www.chcc.cuty.com

Qualchoice
http://www.qualchoicenc.com

The Wellness Plan of North Carolina, Inc.
http://www.twpnc.com

United HealthCare of North Carolina
http://www.uhc.com/northcarolina

WellPath
http://www.wellpathchp.com

Other Resources

Public Citizen Health Resource Group
Records of physicians who have received disciplinary action by a state Board of Medical Examiners
Washington, DC
202-588-1000

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