Presbyterian | Summer 2019 | Your Story

Presbyterian Health Plan online provider directory Presbyterian Health Plan has a web-based provider directory on . Choose “Find a Doctor” in the red box on the right of the screen. Both members and nonmembers can search for providers using this online tool. In the directory, you can find the following information: ● ● Name ● ● Gender (male/female) ● ● Specialty ● ● Hospitals where they practice ● ● Board certification ● ● If they are accepting new patients ● ● Languages they speak in the office ● ● Office locations and phone numbers You can search on one or more of the items listed above. To get all of the information you want, fill in as many blanks as you want on the search page. The search page has instructions for both smartphone users and computer users. You can also get provider information on paper or by phone by calling the Presbyterian Customer Service Center at the number on the back of your member ID card. Presbyterian’s ombudsman program Presbyterian 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. How the ombudsman can helpmembers ● ● Help with issues or problems (before going through the grievance or appeal process) ● ● Help to get through and learn the Presbyterian Health Plan system ● ● Help with referrals and resources (aid) ● ● Refer or recommend a care coordinator ● ● Learn about member rights under Centennial Care What is an ombudsman (Awm-budz-muhn)? An ombudsman is someone who looks into problems and helps to try and solve them. They do this without taking anyone’s side. What is the role of the ombudsman? The Presbyterian Centennial Care ombudsman works for the member to help with issues through support and research. 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 helpme? The ombudsman works for the member on issues and is not part of the grievance (complaint) system or appeals (have one more 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 choices about the member’s care. To reach the Centennial Care Ombudsman: Phone: (505) 923-5780 Fax: (505) 923-8159 Email: Address: Presbyterian Health Plan 9521 San Mateo Blvd. NE Albuquerque, NM 87113 9