Resources for a Healthy Pregnancy and a Healthy Baby!

MPC focuses on providing women with access to personalized quality care and support services before and after giving birth. It is very important to stay in contact with your healthcare team and adopt healthy behaviors during this time.

MPC has a program that gives you access to a care team that includes an OB provider, nurse care manager, health educator, community health worker, social worker, and pharmacist, as appropriate to meet your individual needs. You will also have access to a registered nurse or a health educator that can act as your primary care advisor. Your primary care advisor performs a full assessment and develops a care action plan to get you started.

Prenatal care during the first 3 months of your pregnancy is important to keep you and your baby healthy. Doctors can spot health problems early when they see mothers regularly. This allows doctors to treat them early. Early treatment can cure many problems and prevent others.

MPC and the Maryland Department of Health provide several programs and services to support healthy pregnancies and babies. These programs can include Home Visiting Services, Doula Support, and Care Management for members who have opioid use disorders or a history of using opioids. Visit the MPC Pregnancy Resources site here to learn more.

 Baked Lentils Casserole

Baked lentils, vegetables, and cheese make a complete vegetarian dinner in one dish.

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 after care. 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.

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.

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. Staff can also receive inbound calls on UM concerns after normal business hours by telephone and leaving a message, by email, or by fax. All communication received after midnight Monday—Friday will be returned on the same business day and calls received after normal business hours will be returned on the next business day. UM staff will identify themselves by name, title, and MPC when calling or returning calls about UM concerns.

Ensuring You Get the Right Care!

MPC’s Utilization Management Program ensures that all members receive quality, medically-necessary services that are delivered in the right healthcare setting.

MPC staff make decisions about the care members receive based on their need for the service and their healthcare coverage. MPC does not reward staff for denying services, and utilization management activities are not designed to reward staff for denying, limiting, or stopping medically-necessary services to members.

Winter Blues

As the days get shorter and colder, you may notice a change in your mood. This is often called the Winter Blues. In some cases, it can be connected to a condition called Seasonal Affective Disorder (SAD).

In the winter, there are fewer hours of daylight. The lack of light can lower our levels of serotonin. Serotonin is a chemical in our bodies that helps us feel good/be in a good mood. When serotonin is low, you may feel tired, less motivated, and experience mood swings.

Winter also brings colder weather. Spending too much time inside can lead to less exercise or time with friends and family. When indoors for too long, it can make you feel isolated and lonely, disrupt your sleep, add stress, or make it hard to think.

There are ways to get rid of the winter blues:

• Take part in regular activities. Go for a walk, go to the gym, or put on an exercise video.
• Keep in contact with friends and family or grab coffee or dinner with a friend.
• Create a consistent sleep schedule.

Winter can be hard on a person’s mental health. Take small steps to feel better and keep the blues away!

You can also explore more ways to assess and manage your stress by checking out the “Managing Stress” section of MPC’s Self-Management Tools or taking a free, confidential mental health test to identify depressive symptoms in those tools. Results are not a diagnosis and are not shared with anyone; they are for you to help guide conversation with your doctor.

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).