Good Cause



IMPORTANT UPDATE

AmeriHealth Caritas Iowa, Inc. is withdrawing from the IA Health Link managed care program effective November 30, 2017. AmeriHealth Caritas members have been tentatively assigned to UnitedHealthcare but may choose to receive coverage through Amerigroup Iowa. Members may change their MCO for any reason until March 1, 2018. Members must  change their MCO by November 16, 2017, for their coverage to begin with Amerigroup Iowa on December 1, 2017. Learn more by reading the sample member letter and the Press Release 
 

FAQ for Members

FAQ for Providers

Updated information will be posted as it is available. Please check back regularly.

Because we want you to be happy with your MCO/dental carrier, you may request to change your MCO/dental carrier during your 12 months of closed enrollment. A request for this change, called disenrollment, will require a Good Cause reason.
 

What are some examples of Good Cause reasons?

  • Your provider is not in your MCO's/dental carrier's network.
  • You need related services to be performed at the same time and not all related services are available within your current MCO's/dental carrier's provider network. Your Primary Care Provider/dentist or another provider determined that receiving the services separately would subject you to unnecessary risk.
  • Lack of access to providers experienced in dealing with your health care/dental needs.
  • Your provider has been terminated or no longer participates with your MCO/dental carrier. 
  • Lack of access to services covered under the contract.
  • Poor quality of care given by your MCO/dental carrier.
  • The MCO/dental carrier plan does not cover the services you need due to moral or religious objections.

How do I change my MCO/dental carrier if I have a Good Cause reason?

We want you to be happy with your MCO/dental carrier. If you are requesting to change your MCO/dental carrier due to Good Cause, please follow the two steps below.
  1. First, you must contact your current MCO/dental carrier to go through the MCO's/dental carrier's grievance process for resolution.
  • The MCO grievance process may take up to 30-45 days to process.
  • The dental carrier grievance process may take up to 30-90 days to process.
Please contact your MCO/dental carrier's Member Services department:
 
IA Health Link Members
Managed Care Organization Member Services Contact Information
Amerigroup Iowa, Inc.
Phone:     1-800-600-4441
Email:       MPSWeb@amerigroup.com
UnitedHealthcare Plan of the River Valley, Inc.
Phone:     1-800-464-9484
Dental Wellness Plan Members
Dental Carrier Member Services Contact Information
Delta Dental
Phone:     1-888-472-2793
MCNA Dental
Phone:     1-855-247-6262
Email:       info@mcna.net
  1. If your issue has not been resolved following the decision of your grievance, you may call Iowa Medicaid Member Services at 1-800-338-8366 or locally in the Des Moines area at 515-256-4606, Monday through Friday, from 8 a.m. to 5 p.m. for additional assistance. The final decision for disenrollment will be determined by the Department of Human Services (DHS).

Iowa Medicaid Member Services (Monday to Friday from 8 a.m. to 5 p.m.)
1-800-338-8366 (Toll Free) 
515-256-4606 (Des Moines Area)
515-725-1351 (Fax)
 
For telephone accessibility assistance if you are deaf, hard-of-hearing, deaf-blind, or have difficulty speaking, call Relay Iowa TTY at 1-800-735-2942.
 
Llame al 1-800-735-2942, a Relay Iowa TTY (teléfono de texto para personas con problemas de audición, del habla y ceguera) si necesita asistencia telefónicamente.