Presbyterian | Spring 2020 | Your Story

8 Presbyterian Health Plan has a program to help members. This program works with members to help them learn how their insurance works. The Ombudsman will also help members get the care they need. What is an Ombudsman? An Ombudsman (awm-budz-muhn) is someone who looks into problems and helps to try and solve them. They do this without taking anyone’s side. The role of the Presbyterian Ombudsman The Presbyterian Centennial Care Ombudsman works for the member to help them with member issues through support and research with Presbyterian Health Plan. How the Ombudsman can help you ● ● Help member with issues or problems (before it goes to the grievance or appeal process) ● ● Help member get through and learn the Presbyterian Health Plan system ● ● Help member with referrals and resources (aid) ● ● Refer member to a care coordinator ● ● Teach members about their rights under Centennial Care Often asked questions When should I call the Ombudsman? Talk with the Ombudsman early if you are having a problem with getting the care you need. If you are having trouble getting in touch with healthcare providers, use the Ombudsman to help you with your needs. How can the Ombudsman help me? The Ombudsman works for the member on issues and is not part of the grievance (complaint) system or appeals (have another look at) process. The Ombudsman works with the member to guide them through Presbyterian Health Plan processes. The Ombudsman works with your care team to be your voice—to talk about your needs. What does an Ombudsman not do? The Ombudsman does not take the place of processes such as appeals or grievances. The Ombudsman will not make final decisions about a member’s care. Communication is important to you and to us. That’s why we offer translation services if you need them. We want to make sure you have the information in the language or format you use so you can take charge of your own healthcare. We have bilingual staff and certified translator services if you want to use these services. These services are available to help you talk with providers, nurses, and caregivers; learn about your health plan; and much more. Our translation and interpreter services include: • Language translation • Written materials translation • Telephonic interpreters • In-person interpreters • American Sign Language interpreters • Video remote interpreters It’s easy to request these services. All you need to do is ask for these services at any one of Presbyterian’s clinics or hospitals. You can also call the Presbyterian Customer Service Center at the number on your member ID card. Presbyterian Centennial Care Ombudsman Presbyterian’s translation and interpretation services To contact the Presbyterian Centennial Care Ombudsman: Phone: (505) 923-5780 Fax: (505) 923-8159 Email: ombudsman@phs.org Address: Presbyterian Health Plan 9521 San Mateo Blvd. NE Albuquerque, NM 87113