UPMC Health Plan
Miembros de

HealthChoices Member FAQs

Am I eligible for an exemption to the Able-Bodied Adults without Dependents (ABAWD) Time Limit for the Supplemental Nutrition Assistance Program (SNAP)?

One of the ways to be considered exempt from the time limit is that an individual must be medically certified as physically or mentally unfit for employment. An ABAWD Time Limit Medical Exemption form must be completed by a qualified provider. This brochure created by the Pennsylvania Department of Human Services provides additional information about the changes in the SNAP benefits.

For additional information related to SNAP and the recent changes, please visit the DHS website, where you may review their Frequently Asked Questions.

Will I Need to Carry My ACCESS Card Once I Am Enrolled in HealthChoices?

Yes. Your provider needs to see this card in order to check your eligibility. You also need it in order to use other services that may be available to you under Medical Assistance.

When Do I Become a Member of Community Care?

You will automatically become a member of Community Care when you become eligible for Medical Assistance.  Depending on the county you live in, your physical healthcare may remain with Medical Assistance (referred to as ACCESS) or you may select a physical health managed care organization for your physical healthcare from several providers.  

What member identification cards should I carry with me?

In addition to your Access Identification card, you may have a card for your physical health plan. You will also receive a Community Care Identification Card when you receive your Community Care Member Welcome Packet. Your Community Care Identification Card should be carried with your Access and physical health plan Identification Cards. You should carry the Community Care Identification Card with you at all times because it has important information on it.

  • It will identify Community Care as your behavioral health care plan
  • It will help you remember our phone number. You can receive help or information at any time by calling our number
  • It will help you receive behavioral health emergency services when you are away from home.

What If I Am Already Receiving Behavioral Health Services?

If you are in treatment for a mental health or drug or alcohol problem, tell your provider that you will soon be a HealthChoices member. The person you have been seeing might not be a part of our network. In this case, we will work with your provider, or we will arrange for you to see someone who is part of our network.

What Do I Do If I Need to Start Behavioral Health Services Before My Membership Takes Effect?

You may contact any Medical Assistance behavioral health provider directly to schedule an appointment, but be sure to inform the provider that you will soon be a Community Care member. If you would like help in finding a provider, scheduling an appointment, or if you have any questions, please call us. We'll be glad to assist you.

Do I need to call Community Care to request an authorization for care? Do I need a referral from my PCP (primary care physician)?

No. You may go to any Community Care provider and the provider will take care of getting an authorization from us. You do not need a referral from your PCP for mental health or drug and alcohol treatment. If you need help finding a Community Care provider near you, please call us. We will be glad to assist you.

Who pays for my medications?

In most cases Community Care does not pay for medications. The only exception is methadone for drug treatment. Your prescriptions are covered by your physical health plan.

What if I get sick away from home and need treatment?

If you have a behavioral health emergency when you are out of the Community Care service area, go to the nearest emergency room. Just show them your Community Care Identification Card and they will call us.

What if I get a bill or a provider asks me to pay for treatment or pay a co-pay?

Community Care will pay your bills for mental health or drug and alcohol treatment. There are no co-payments or deductibles for the behavioral health care that we approve. We will only pay for care from an out-of-network provider if we approved it ahead of time or if was an emergency. If you have other insurance in addition to Community Care, that insurance company may have different rules about co-pays.

You should not receive a bill or be asked to pay for behavioral health services if you are receiving care from a Community Care provider. If you get a bill for services from one of our providers, please call us or send the bill to:

Community Care Complaints Department
339 Sixth Ave., Suite 1300
Pittsburgh, PA 15222

Can I go to any provider?

You must choose a provider that is enrolled with Community Care. Please call us so that we can help you find a provider near you or search our online Provider Directory.

How can I find out about the professional qualifications of my provider?

Community Care has a large network of different types of health care practitioners to provide you with care and service. There is information about these practitioners in our directory. We tell you the name, address, and telephone number of each practitioner in our network. If you would like more information about the professional qualifications of our practitioners, please call the member services line listed for your county. Customer Services will tell you the specialty and school attended of any of our practitioners. If the practitioner is a physician, the residency and board certification status will also be provided.

Who pays for laboratory tests (blood tests, urine tests, etc.) ordered by my doctor because of medicine I am taking?

Laboratory services are paid for by Community Care if ordered by a psychiatrist in our network.

Can I get help with transportation to my doctor's office or other treatment appointments?

There are certain restrictions concerning transportation. If you need transportation to an appointment, you may be eligible for the Medical Assistance Transportation Program (MATP). Please call MATP directly at (toll free) 1-888-547-6287 to learn more about transportation through the Pennsylvania Department of Human Services.

What do I do if I need outpatient services?

You can contact and schedule appointments with any provider in the Provider Directory. You do not need prior authorization or a referral from Community Care or another provider to see a network provider.

You can also search for a provider near you in the online Provider Directory by clicking here.

Our customer service representatives are available 24 hours a day, 7 days a week to help you choose a provider that best meets your needs. If you have questions or need help deciding on a provider, please call the member services line listed for your county.

What do I do if I need inpatient care, partial hospitalization, sub-specialty care, or other behavioral health care services?

Usually your treating provider will arrange hospital care, partial hospitalization, sub-specialty care or other behavioral health care services for you. If you think you need these services, you can make arrangements with any provider in the Provider Directory. You do not need prior authorization or a referral from Community Care or another provider for these services.

Our customer service representatives are available 24 hours a day, 7 days a week to help you choose a provider that best meets your needs. If you have questions or need help deciding on a provider, please call the member services line listed for your county.

How does Community Care protect my private information?

Community Care keeps your PHI private. PHI means protected health information. We have a Privacy Officer. The Privacy Officer teaches our staff how to protect your PHI. We teach our staff about PHI each year. We have policies and procedures about PHI. They tell staff how to guard your information. We also have a Security Officer. The Security Officer keeps electronic PHI safe.

Employees may only see information they need to do their job. They sign a Confidentiality Statement. This means they agree to keep your PHI private. Staff may not talk about PHI in open areas. This includes break rooms and elevators. We check to be sure staff follow these rules.

We keep paper PHI in locked cabinets or drawers when not in use. Paper on fax machines does not show PHI. Printers and copy machines do not show PHI.

Computer firewalls protect your PHI. Computers have passwords. Staff may not share computers. Staff must lock computers when not in use. PHI is not in email. Emails are encrypted.

The Privacy Officer checks to see all rules are followed. This keeps your PHI safe.

Who should I speak with if I want to apply for Medical Assistance or have questions about my eligibility?

Please contact your local County Assistance Office. Phone numbers for the county offices can be obtained on the DHS website.

You can begin the Medicaid application process by visiting the COMPASS website.