Neighborhood Health Plan

How do I change sites or choose another Primary Care Provider?

Call or email NHP's Member Service Center (1-800-462-5449). The change is usually effective the same day the request is received, and you can see your new PCP as soon as you need to. Within 10 days, you should receive a new ID card in the mail with the name of your new primary care site and phone number printed on the front.

Do I need a referral to see a specialist?

Neighborhood Health Plan requires a referral for you to receive care from any NHP In-Plan specialist. Your PCP should help you coordinate your health care. When you have an established connection with your PCP, he or she can help you address all aspects of your health care and assist you in coordinating all the services you need. Before making your appointment with an in-plan specialist, your PCP should discuss the situation, consider options, and help you decide where you can get the services you need. Your PCP must then begin the process for obtaining the referral. They can communicate directly with specialists and are required to obtain a referral ID number from NHP for these services.

It is your responsibility to make sure that the specialist you wish to see participates with NHP and is available in NHP’s network. When you use In Plan providers, you know that they have been credentialed by NHP and that they will work with our medical staff to help ensure you get the care you need. You may search our provider directory or call the Member Service Center at 1-800-462-5449 (TTY 1-800-655-1761)

How do I get information about providers in NHP's network?

Copies of Provider Directories are available from the Member Service Center (1-800-462-5449). In addition, the online provider directory is updated daily.

Is my information confidential?

All of your information is kept private and confidential. To find out how NHP protects patient information or to receive a copy of NHP's Notice of Privacy Practices, call NHP's Member Service Center at 1-800-462-5449.

What do I have to do to get Behavioral Health treatment?

Beacon Health Strategies coordinates NHP's Behavioral Health services. Call Beacon Health at 1-800-414-2820 for information about getting treatment and finding behavioral health providers in your area, or visit www.beaconhealthstrategies.com. You do not need a referral from your Primary Care Provider for behavioral health services.

Does NHP cover out-of-state or out-of-service-area services?

Members are covered for Emergency and Urgent Care while temporarily outside the NHP service area. However, members should call their Primary Care Site within 48 hours of receiving care. Care which is not covered outside the service area includes care when travel was against medical advice, routine care that can wait until you return home, or care you expect to need (for example, childbirth in your last month of pregnancy). Out-of-area dependent student coverage is available to full-time students who meet eligibility criteria.

I got a bill from my provider/site/hospital. What do I do?

Please contact NHP's Member Service Center at 1-800-462-5449 as soon as possible so that NHP can work to resolve the issue for you. NHP members should not receive bills for services covered by NHP. Please have your bill in front of you when you call.

Can I pay my premium on line?

At this time, NHP does not provide on-line payment functionality. Where you send your premium payment will depend on your plan. Premium payments should be mailed to the address on your invoice.

I am a MassHealth member and I received an Eligibility Review Form in the mail. Do I have to fill it out?

Yes. If you are an NHP member on MassHealth, you must fill out this form every year to keep your benefits. If you need help filling out the form, bring it to your health center or call MassHealth at 1-800-841-2900.

Should I go to the ER if I or a family member gets sick?

Only if it is a life-threatening emergency. Many health problems need attention right away but are not life threatening (for example: flu/cold stomach pains, vomiting, diarrhea, earaches, fever). If you or a family member experiences these symptoms, call your Primary Care Provider or Primary Care Site (the phone number is on the front of your NHP member card). Many doctor's offices/health centers have Urgent Care hours during evenings and/or weekends. If your PCP thinks you need to go to the emergency room, he or she will tell you where to go for care. Your PCP can also call ahead to let the emergency room know that you are coming.

What should I do in an emergency?

If you think your medical problem is life-threatening and needs immediate care, go to the nearest emergency room or call 911 at once. You are covered for care, and do not need a referral. A life-threatening emergency is a problem that needs immediate medical care to save a life, like chest pain, poisoning, trouble breathing, severe bleeding, seizures, or convulsions.

Does NHP cover brand name drugs?

Many brand name drugs are covered by NHP. However, when an FDA approved generic version exists, the brand name is not covered unless it is medically necessary. A generic drug has the same active ingredients and is equally effective as the brand name. Co-payments for generic drugs are always lower than brand name drugs. If you are concerned about your prescription costs, talk to your provider about generic drugs.

Can NHP help me manage my (or my child's) medical conditions?

NHP has special programs for members who have a chronic medical problem such as diabetes, asthma, or disability. Learn more about our diabetes, asthma and other member programs here.

How long should it take for me to get my new ID card?

95% of members receive their card within ten business days of joining NHP. If you do not receive your ID card within three weeks of joining NHP, please contact NHP's Member Service Center at 1-800-462-5449, or email us.

What if I lose my Member ID card?

You can request a new ID card by calling NHP's Member Service Center at 1-800-462-5449, or by emailing us.

I moved and/or my phone number has changed. Do I need to inform NHP?

Yes. It is very important that NHP knows your new address. If you are a MassHealth member, you also need to contact MassHealth at 1-800-841-2900 to update your information. You could lose your benefits if MassHealth cannot locate you, so please take care to let MassHealth know if you move.

Can I email a request to NHP?

NHP's Customer Care Center is available through email, and will respond to inquiries within 1 business day. However, because email is not a private or secure form of communication, we ask that you call the Member Service Center at 1-800-462-5449 if you would like to change your PCP, update your address, or need to discuss confidential information.

Does every member of my family need his/her own ID card?

Yes. All members of your family should have their own ID card. However, each member can choose a different Primary Care Site/Provider.

I just had a baby. Is there anything I need to do to make sure my baby is covered by NHP?

Yes: contact NHP's Member Service Center at 1-800-462-5449. NHP has to know that you have a new member in your family. Your baby needs his or her own Member ID card. You can also choose a pediatrician that will be your baby's Primary Care Provider. If you are on MassHealth, you also need to contact MassHealth at 1-800-841-2900 to make sure your baby is covered.

What are my responsibilities as an NHP member?

As a Member of NHP, you have the responsibility to:

• choose a Primary Care Provider, the doctor responsible for your care
• call your Primary Care Provider when you need health care
• tell any health care provider that you are an NHP member
• give complete and accurate medical information
• understand the role of your Primary Care Provider in providing your care and arranging other medical services you may need
• take part in making decisions about your health care
• follow the plans and instructions agreed on by you and your provider
• understand your benefits: what's covered, what's not covered
• call your Primary Care Provider within 48 hours of any Emergency or out-of-area treatment
• notify NHP of any changes in status such as address, telephone, marriage, additions to the family, etc.