ISSUE 3 / FALL 2024
IMPORTANT!
New Pharmacy Benefit Manager
On October 1, 2024, Maryland Physicians Care (MPC) will change to a new prescription drug Pharmacy Benefit Manager, CVS Caremark. There will be no change to the pharmacies used to fill prescriptions and no changes to any current medications available. Members affected by this change will receive a personalized letter with more information.
A new member ID card with CVS Caremark as the pharmacy benefit manager will be mailed before this change. Members should continue to use their existing MPC ID card with the ESI name on it until Monday, September 30, 2024. Once the new card is received, members can start using the new ID card with CVS Caremark name on it beginning on Tuesday, October 1, 2024.
If you have any questions, please visit our website at www.MPCMedicaid.com. You can also call the Member Services Department at 800-953-8854. For members with hearing or speech difficulties, call TDD 800-735-2258.
Maryland Medicaid requires you to renew your coverage.
Keep your records up to date!
If you have moved or have a new phone number, log into your account at https://www.marylandhealthconnection.gov/ or call 855-642-8572 to update your contact information so that you will receive your notice when it is time for you to renew.
Do not let your Medicaid Benefits expire.
Keep your Maryland Physicians Care coverage.
Here is what to do:
- Watch for your Renewal Notice. A renewal notice will be sent to you by Maryland Health Connection. You will receive your notice by mail or online through your Maryland Health Connection account. This notice will tell you to complete your renewal.
- When you receive your notice from Maryland Health Connection, log into your account at https://www.marylandhealthconnection.gov/ or call 855-642-8572.
- Renew your coverage as soon as you receive your notice.
If you do not renew, you will lose your health benefits.
- Don’t wait.
- Don’t let your MPC Medicaid coverage expire.
- Complete your renewal when you receive it!
Get help online, in person, or by phone.
- Call Maryland Health Connection at 855-642-8572. Help is available in more than 200 languages. Deaf and hard of hearing can contact the Relay Service at 855-642-8573.
- Call or visit your local Department of Social Services.
- Call or visit your local Health Department.
- Connect with a broker or navigator.
Emergency vs
Urgent Care
What Type of Emergency Is it?
Choosing the right place for care at the right time is important. When you can’t see your doctor, you may think your only option for help is a hospital emergency department. The hospital is the best place to go if you have a true medical emergency. But for less serious situations, you have other choices. You can use your MyVirtualMPC app or go to an urgent care center.
Here Are Some Helpful Tips:
- Emergent Care: If you require immediate medical attention to avoid serious impairment to your health, call 9-1-1 or go to the closest hospital emergency department. You can self-refer to any emergency department, and pre-authorization is not required.
- Urgent Care: If you have an illness or injury that could become an emergency within 48 hours if not treated, go to an in-network urgent care center. Pre-authorization is not required, but the center must participate with Maryland Physicians Care, or you may be billed.
- MyVirtualMPC: If you need non-emergency care and cannot see your PCP, you can use the free MyVirtualMPC mobile app for a quick video visit with a local doctor 24/7. Visit www.myvirtualmpc.com for information and to register or download the app from your smartphone’s app store.
Breast Cancer Screenings
Regular breast cancer screenings are important for a woman’s health. Early detection is key for successful treatment. The best ways of identifying breast cancer early include doing monthly breast self-exams, getting regular clinical exams, and having regular mammograms.
A monthly breast self-exam is a simple way to identify changes in the breast. It allows a woman to become familiar with how her breast looks and feels. It helps identify lumps or any changes to the skin. If the breast feels different while self-examining, report it to your provider.
A mammogram is a scan of the breast. It creates an image of breast tissue. This helps detect and identify changes to the breast. They are used to identify breast cancer early, often before symptoms are noticed. Mammograms can identify tumors too small to be felt. Mammograms are key screenings for early detection.
Regular mammogram screenings detect problems early and improve treatment success rates. They identify abnormalities before they are severe. If you notice an abnormal breast lump, change in skin, or have other concerns regarding your breast, contact your doctor. For more information on breast cancer screenings, see the MPC Women’s Health website.
Healthy Eating for Back-to-School
Making yummy and healthy lunches and snacks without spending too much money can be tough, but with a bit of planning, you can do it! Here are some easy tips to get you started:
- Plan for the Week: Decide what lunches you’ll make for the week. This way, you only buy what you need and won’t get tempted to buy extra stuff. Mix different kinds of foods to keep things interesting.
- Try New Ideas: Instead of sandwiches, use tortillas or pita bread. Fill them with turkey, chicken, or beans and add lots of veggies. You can also add some hummus or a light dressing for extra taste.
- Use Leftovers: Save leftover food from dinner for lunch the next day. For example, turn leftover chicken into a chicken salad or use leftover veggies to make a stir-fry.
- Make Your Own Lunch Kits: Pack whole grain crackers, cheese slices, lean deli meats, and fruit. It’s cheaper and healthier than buying pre-packaged options!
- Prep Ahead: Cut up fruits and veggies like bell peppers, celery, and melon into easy-to-grab pieces. This saves time during the week.
- Buy in Bulk: Instead of buying single-serve items like yogurt or juice boxes, get larger sizes and pack single servings yourself. It’s usually less expensive.
Get kids involved in planning and making meals. This helps them learn how to cook and understand what makes a meal healthy. Show them that you enjoy healthy foods and talk about why they’re good for you.
Encourage a positive attitude about food. Instead of saying some foods are “good” or “bad,” talk about why healthier choices are great. Encourage kids to try new foods and praise them when they do.
With a little bit of planning and smart choices, you can make sure your kids have tasty and healthy lunches and snacks while learning to make good food choices. This helps them stay healthy now and builds good eating habits for the future.
You can also take a free nutrition quiz, use a meal planner, and more in the Healthy Eating section of MPC’s self-management tools here.
Remember to stay healthy in the summer. Drink water and try eating grilled vegetables. Enjoy treats, but only once in a while/ in moderation. Here’s to a fall of fun and good health!
Join Belong, the Membership Rewards Program from Maryland Physicians Care, for:
- A chance to win prizes, such as Fitbits, Blenders, Air Fryers, and Plush Blankets
- Valuable Coupons for Grocery Stores
- Free Gifts at MPC Well on Wheels Community Events
- Healthy Recipes
Ready, Set, Cook!
Shrimp Lettuce Wraps
If you don’t use all of the shrimp mixture in this recipe, you can also enjoy it cold on a lettuce wrap for lunch the next day.
Nutrition Information
(see full recipe for more information)
Nutrition Facts
Percent Daily Values are based on a 2,000-calorie diet.
Serving Size: 1 Wrap / Servings: 7
Planet Fitness is Free with MPC in Prince George’s County
MPC is running a test pilot program with Planet Fitness. If you live in Prince George’s County and your Medicaid Plan is with Maryland Physicians Care, Planet Fitness is Free! Based on the success of this pilot program, the free membership opportunity will be extended to other counties in Maryland!
Enjoy a Classic Membership at any of the 11 participating Prince George’s County Planet Fitness locations, including unlimited access to free in-club training, app workouts, Wi-Fi, partner rewards, and discounts. Let’s prioritize your wellness journey together!
For information about the program, a list of participating Planet Fitness locations and member activation, call MPC Member Services at 800-953-8854. Please have your Maryland Medicaid ID number handy.
MPC Ensures Members Get Timely Care
If you have problems getting the care you need within these time frames, please contact Member Services at 800-953-8854. MPC has Customer Service Representatives, Case Managers, Special Needs Coordinators, and Outreach Staff available to help you.
Maryland Physicians Care offers medical coverage and health benefits that are close to home.
This coverage includes access to primary and urgent care visits, pregnancy and new mother benefits, specialists care, pharmacy coverage, primary mental health services, vision and dental care* (including adults), and more. MPC’s participation in the HealthChoice program is available to Maryland Children’s Health Program or MCHP qualified recipients. Members can work within MPC’s network of doctors to find the care that is right for them.
*Dental care is provided by Maryland Healthy Smiles Dental Program (MHSDP).
Utilization Management Overview
Utilization Management (UM) allows members to receive high-quality services for their need of care. The goal is to understand the effectiveness of treatment for each member before, during, and aftercare. This includes home care, pharmacy, outpatient, and inpatient hospital services.
Sometimes, prior authorization (PA) is needed. A provider must authorize the request for service or medication. The provider is responsible for the PA and cannot bill you when they have not authorized the request. Maryland Physicians Care does not reward healthcare providers or other individuals for issuing denials of coverage or service.
Staff can receive inbound calls on UM concerns after normal business hours. Providers should fax requests to the appropriate number. They can also call 800-953-8854 and follow the prompts for Authorization/Concurrent Review and leave a message. All communication after midnight Monday—Friday will be contacted on the same business day.
For more information on Utilization Management, please call 800-953-8854 and follow the prompts. Our staff is available eight (8) hours daily during business hours for inbound collect or toll-free calls. Language aid is available free of charge. Maryland Physicians Care provides members TDD/TTY (Telecommunication Device for Deaf/Teletypewriter) services if needed at 800-735-2258.
Supporting Children’s Vision
Vision is often overlooked in children’s health. It is important for eye exams to begin at an early age. Vision plays a key role in a child’s development. It helps them learn in their day-to-day life and interact with the world around them.
There are ways to support a child’s vision as they grow. These activities allow development, fun, and a way to bond.
- Building blocks and puzzles help with concentration and hand-eye coordination.
- Painting or coloring improves motor skills and hand-eye coordination.
- Reading books and using your finger to follow the words helps with tracking.
- Playing catch helps with hand-eye coordination and depth perception.
It is possible for children to have vision trouble and need care. Watch for signs of squinting, head tilting, sitting too close to the TV, and/or difficulty keeping eye contact. If you notice symptoms, schedule an eye exam for the child. If the issues go undetected, children could have problems learning, behavioral issues, or vision loss.
Read more here about vision exams and other important exams that are part of a well-child visit.
Cholesterol and Lifestyle Change
What is cholesterol? It is a waxy-like substance found in cells that flows through your blood. Your body needs cholesterol to function properly. However, too much cholesterol can cause a problem. High cholesterol causes a higher risk of heart disease. Maintaining cholesterol levels helps with your heart and overall health.
There are ways to control and improve your cholesterol with lifestyle changes.
- Support your body by eating heart-healthy food.
- Increase fruits and vegetables, whole grains, and lean proteins.
- Avoid trans fats found in store-bought crackers, baked goods, and fried food.
- Limit saturated fats found in red meat and full-fat dairy products.
- Add physical activity to your day.
- Take a walk around your neighborhood.
- Play your favorite sport.
- Avoid smoking and limit your alcohol intake.
- Quitting smoking improves your cholesterol level, benefiting your heart and lungs.
- Drink in moderation, as too much alcohol can lead to serious health problems.
Sometimes, lifestyle change is not enough, and our bodies need additional support. It is important to have your cholesterol levels checked and know your levels. Schedule an appointment with your provider to discuss questions and next steps. They are here to support you. More information on cholesterol can be found here.
MyVirtualMPC – A Doctor is Just a Message Away
Chatting with a doctor is FREE with MyVirtualMPC.
Don’t waste time searching the internet for answers to your medical questions. Your FREE access to MyVirtualMPC gives you access to board-certified doctors who can help you address your medical questions 24 hours a day, 365 days a year.
With MyVirtualMPC, there are no appointments or wait times – simply connect with a doctor in seconds.
Chat with a doctor about any of the following if you or your child:
- are sick, and you are not sure if you need to go to the emergency room
- feel sick, but it’s not an emergency
- have a minor injury
- have general medical questions
- want to refill a prescription (controlled substances, non-therapeutic, and certain other drugs may not be available)
- are not sure where to go to get care
Take advantage of your FREE access to doctors as a valued Maryland Physicians Care member:
Or register at https://app.myvirtualmpc.com/register.
HELP PREVENT
FRAUD AND ABUSE
MPC needs your help to prevent fraud and abuse! Fraud and abuse are against the law. We encourage you to report anything suspicious without the fear of retaliation. MPC reports all suspected incidences of fraud and/or abuse to the Maryland Department of Health, Office of Inspector General for further investigation, which may result in criminal penalties.
Examples of fraud and abuse include:
- Someone using an ID card that does not belong to them
- Doctors billing for services or supplies that were not given
- Doctors giving too many tests and services or unneeded tests and services
- Selling prescription medications or making changes to a written prescription
- Falsely reporting household income
- Not living in Maryland, but receiving Maryland Medicaid
You do not need to give us your name or contact information to report fraud and abuse, but we will keep it private if you do. It is important that you give us as much information as you can because it helps us do a complete and correct investigation.
You can report fraud and abuse in the following ways:
- CALL MPC’s Compliance Hotline at 866-781-6403 and leave a detailed message.
- GO ONLINE at https://www.marylandphysicianscare.com/fraud-abuse/ and complete the Fraud and Abuse Form.
- WRITE to the Compliance Officer at MPC: 1201 Winterson Road, 4th Floor, Linthicum Heights, MD 21090.
You Can Make a Difference in the Services We Provide
Apply for a position on our Consumer Advisory Board (CAB) if you are an MPC Member, can attend bi-monthly meetings, and are at least age 21.
We are looking for young moms, a member with a chronic illness, and members with multiple health concerns. Meetings are conducted virtually.
VISIT OUR WEBSITE
to find information on:
- Quality improvement program
- Care management program
- Population health programs
- Health & wellness
- Clinical practice guidelines
- Utilization management, including decision-making criteria, affirmative statement, and staff availability
- Pharmacy and prescription drug management
- Benefits and coverage
- Member rights and responsibilities
- Protected health information use and disclosure
- Member handbook
- Provider directory
If you do not have internet service, you can reach us by phone (numbers listed in “Who to Call” – below) for more information.
WHO TO CALL