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Help for families who need TennCare
Help for families who have TennCare
Help for families who are losing TennCare
Resources for Outreach Partners
Help for families who have TennCare
Already have TennCare?
Learn how to use it and how to keep it!
Using TennCare!
How to Use Your TennCare Cards
Getting New TennCare Cards
MCO Phone Numbers
BHO Phone Numbers
The Benefits of TennCare for Children under 21
Your Child’s Primary Care Doctor
Finding a New Doctor or Specialist
Finding a Dentist
Finding a Counselor, Therapist, or Treatment Center
Getting Parenting Help
Changing Health Plans
Getting Your Child’s Medications
Staying safe! Pharmacy Tips for Parents
Filing a Medical Appeal
Dealing with Medical Bills
Who to Call for Additional HelpKeeping TennCare! The 4 Rs
Report! How to tell DHS that your family has moved
Recertify! How to keep your TennCare Medicaid
Roll Over! How to move from TennCare Medicaid to TennCare Standard
Renew! How to keep your TennCare StandardUsing your TennCare
How to Use Your TennCare Cards:
All children are assigned to a Managed Care Organization (MCO) AND a Behavioral Health Organization (BHO) at the time they are enrolled in TennCare. Usually, these are just called “health plans”. Your child should get a card from each health plan. The MCO card is for physical health care, like doctor visits. Present it at the front desk any time your child has a doctor appointment. The BHO card is for mental health care, like counseling, therapy, or alcohol and drug treatment. Show it any time you sign your child in for a counseling or therapy session. Finally, your child should get a pharmacy benefits card from First Health. You’ll take this one to the drugstore any time you need to fill a prescription.
Do you need a new TennCare card? Call your MCO! They’ll mail you a new one. (See phone numbers below.) In the meantime, don’t miss any doctor appointments your child needs. Your child’s PCP (main doctor) and any other TennCare providers should be able to verify your child’s coverage WITHOUT the card. (They’ll just have to look on the computer or make a phone call.) If anyone refuses to provide care to your child because you don’t have the card, call TennCare Advocacy at 1 (800) 722-7474 right away. They’ll remind the doctor or drugstore of your child’s right to medical care AND make sure they know how to check your child’s TennCare status in the future.
Note: Your MCO depends on where you live. Have you moved to another part of the state? You may need to change MCOs! Call 1 (866) 311-4287 to report your new address and get a new MCO.
East TN MCOs:
United Health Care/Americhoice East 1 (800) 209-0034 (formerly John Deere)
Blue Care 1 (800) 468-9698
PHP 1 (800) 747-0008
TennCare Select 1 (800) 263-5479Middle Tennessee MCOs
VHP 1 (800) 316-2273
Amerigroup not yet available! Check back in January!
Americhoice not yet available! Check back in January!
TennCare Select 1 (800) 263-5479West Tennessee MCOs
Unison 1 (800) 414-9025 (formerly Better Health)
U.A.H.C. 1 (800) 876-9758 (formerly Omnicare)
TLC Family Care 1 (800) 473-6523
TennCare Select 1 (800) 263-5479Premier Behavioral Systems 1 (800) 325-7864
TN Behavioral Health 1 (800) 447-7242The Benefits of TennCare for Children under 21:
Know your rights AND responsibilities! Kids on TennCare can get free well child check-ups, eye exams, dental exams, and all medically necessary follow up! This is called TENNderCARE. It’s a great program of benefits, but it’s YOUR responsibility to take advantage of the coverage! Just call your child’s doctor and ask for a TENNderCARE exam. For a schedule of free well-child check-ups and vaccines, visit the TENNderCARE website! www.tennessee.gov/tenncare/tenndercare/index.html
Your Child’s Primary Care Doctor:
Your child on TennCare has already been assigned to a doctor, clinic, or nurse practitioner. To find out who this is, look on your child’s TennCare card for the letters “PCP”. This stands for Primary Care Provider. The card should tell you the name and phone number of the Doctor’s office. You will go to this doctor when your child needs a well-child exam (see Benefits above) AND whenever your child is sick. Of course, in a true emergency, you should always go to the closest Emergency Room. Otherwise, you can call the doctor’s office to speak to a nurse, get advice, or schedule an appointment with the PCP.
Finding a New Doctor or Specialist:
Do you need to find a new doctor or a specialist that accepts TennCare? Call the MCO listed on your child’s TennCare card. (See MCO Phone Numbers). They should help you find the doctors you need. Usually they will refer you to a website. However, if you don’t have easy internet access, they should send you a list in the mail. Still need more help? Call TennCare Advocacy at 1 (800) 722-7474. They can tell you which MCO your child has, help you find a new doctor, and solve TennCare problems. To learn more about TennCare Advocacy, visit www.tenncareadvocacy.org.
Your child on TennCare can get two free cleanings and dental exams a year, but your child won’t be assigned to a dentist! To find a dentist , call Doral Dental at 1 (888) 233-5935 OR visit www.doralusa.com. Using your zip code, they’ll give you the names of TennCare dentists in your area.
Finding a Counselor, Therapist, or Treatment Center:
Your child on TennCare has already been assigned to a Behavioral Health Organization! The BHO is responsible for mental health care. Call the BHO when your child needs a mental health assessment, counseling, therapy, or drug or alcohol treatment. They can help you find a counselor, therapist, or treatment center. Usually they will refer you to a website. If you don’t have easy internet access, they should send you a list in the mail. Still need more help? Call TennCare Partners Advocacy Line (T-PAL) at 1 (800) 758-1638 or visit www.tpal.org. They can help you find mental health care providers and use your TennCare to get the needed services.
Parenting can be hard. Do you need extra support? Call Tennessee Voices for Children at 1 (800) 670-9882 or visit www.tnvoices.org. They can tell you about available support services, parent workshops, and programs in your area. (IMPORTANT: You don’t have to have TennCare to get help from Tennessee Voices. Their resources are available to anyone!)
Do you need to switch to a new MCO or BHO? Call the Family Assistance Service Center: 1 (866) 311-4287. Let them know which MCO or BHO would work best for your child and why. For example, if the doctor your child sees has changed health plans. OR you have moved, and the doctors who accept your health plan are too far away. OR there is a particular doctor you would like your child to see, but that doctor doesn’t work with your current plan. If your request is NOT granted, and you have a good reason for needing to change, call TennCare Advocacy at 1 (800) 722-7474. They may be able to help solve the problem.
Getting Your Child’s Medication:
Children on TennCare have full coverage for prescription drugs. (Note: Unlike most adults on TennCare, children have no limit on the number of prescriptions that can be filled per month.) You can go to any participating pharmacist to get your child’s prescriptions filled. You should be able to get prescriptions filled even if you don’t have your child’s TennCare card with you! The drugstore can look your child up in the TennCare System using your child’s Date of Birth and Social Security Number. If you have any trouble getting your child’s prescriptions filled, call TennCare Advocacy at 1(800) 722-7474. They’ll work with the pharmacy to solve any problems.
Staying Safe! Pharmacy Tips for Parents!
- First, be sure you understand the instructions! Giving your child too much medicine can be VERY DANGEROUS, or even FATAL.
- If you aren’t sure how much medicine to give your child, ask the pharmacist!
- If you aren’t sure how to give your child the medicine, ask the pharmacist!
- If you aren’t sure when to give your child the medicine, ask the pharmacist!
- If you aren’t sure where to keep the medicine, ask the pharmacist!
- Are you afraid your child has taken too much medicine? Don’t wait for something bad to happen. Call the Tennessee Poison Center right away to find out what you should do. 1 (800) 222-1222. If your child already looks weak or ill, call 911 first.
- It can be very dangerous to mix medications, even if they are over-the-counter drugs (OTCs)! Is your child’s doctor prescribing or suggesting a new medicine for your child? OR are YOU planning to give your child an OTC to relieve a headache, fever, nausea, or other symptoms? First, tell a doctor, nurse, or pharmacist EVERYTHING your child is already taking—including over-the-counter (OTC) drugs like cold medicine, Tylenol, Pepto-Bismol, vitamins, etc. Ask if it will be safe for your child to be on both drugs at the same time. Better safe than sorry!
- If you can, go to the same pharmacy each time . That way they’ll have a list of ALL the medicines your child is on. They’ll be able to give you better advice, and they’ll be sure to keep the medicines you need in tock.
- Your child should take ALL the medicine as prescribed, even if she starts feeling better! If you quit taking the medicine before it’s all gone, your child may get sick again. This time, the illness may be even worse than it was the first time! This is especially true with antibiotics and anti-virals. Bacteria and viruses multiply and change very quickly. If you stop taking the medicine before all the bad bacteria and viruses are dead, they have the opportunity to reproduce and become stronger. The new bacteria or viruses may be able to resist the medicine. So always follow the doctors orders!
- Depending on the kind of TennCare your child has (Medicaid or Standard), you may have a small co-pay for some medicines. If you can’t afford the co-pay, ask your child’s doctor if there is a generic drug you can try instead.
If your child needs a particular covered service or treatment AND this care has been ordered or recommended by your child’s primary care provider or other specialist, TennCare is required by law to provide it. If you are having trouble getting needed medical care for your child, call TennCare Advocacy at 1 (800) 722-7474. If you are having trouble getting needed mental health care for your child, call TennCare Partners Advocacy at 1 (800) 758-1638. Both groups can tell you how to file a medical appeal and answer your questions about the appeals process.
Have you gotten a bill from your child’s doctor or dentist for services WHILE your child had TennCare?It’s probably a mistake. Before you pay it, call TennCare Advocacy at 1 (800) 722-7474. As long as your child has TennCare, you shouldn’t have to pay any doctor bills for “medically necessary” care. TennCare Advocacy will work with your doctor and with your health plan to make sure the bill is covered.
Who to Call for Additional Help
There are lots of different TennCare Help Lines. Find out who to call with YOUR question.
Keeping your TennCare
Report! Tell DHS When Your Family Moves!
Call 1 (866) 311-4287 right away to give DHS your new address! They will change your address in the system to make sure you get important TennCare mail. Also, if needed, they will help you change health plans and find doctors in your new area.
Recertify! Keep your TennCare Medicaid
Once a year, children on Medicaid have to prove that they are still eligible. This is called “recertification”. Your recertification papers will be sent to you in the mail. The letter will give you a deadline. You MUST fill out and turn in your papers to DHS by the deadline! If you don’t recertify on time, your children will lose TennCare. Guess what? If you missed the deadline because you didn’t get the packet, your children will still lose TennCare. It is YOUR responsibility to report any address changes to DHS!!! *(Note for children on SSI: You do not have to recertify your Medicaid with DHS. But you may have to do other paperwork for the Social Security Administration. Call 1(800)772-1213 to find out how to keep you child's SSI.)
Roll Over! How to move from TennCare Medicaid to TennCare Standard
Are you about to recertify? Are you afraid your child is going to lose Medicaid? As long as you recertify on time, your child may be able to get TennCare Standard instead. To find out if your child is eligible for TennCare Standard, click here.TennCare Standard has all the same benefits as Medicaid, but you may have a monthly premium and/or a small co-pay for doctor visits or medicine.
Do you think your child should be eligible for a roll over to TennCare Standard? Your DHS worker SHOULD check at recertification. But, follow up to be sure!
- First, be sure to recertify on time! If you miss your recertification deadline, your child will NOT be able to get TennCare Standard.
- Call and ask the worker to check your children for TennCare Standard. If you can’t get your caseworker on the phone, you may want to ask in person. Call 1 (866) 311-4287 to schedule an appointment! Do this before the Medicaid ends.
- Still have questions?Call TennCare Advocacy at 1 (800) 722-7474. They can look to see if DHS has checked your child for Standard. If not, they can work with the DHS supervisor to solve the problem.
Renew! How to keep your TennCare Standard
Now that you have TennCare Standard, you may have a monthly premium. If so, be sure to pay your premiums on time! This will help you keep TennCare. Also, you will have to renew your TennCare Standard from time to time. TennCare will send your renewal packet in the mail. It will be on light blue paper. Remember, “Blue Means Renew!”. When you renew, you are (1) showing that your kids are still eligible for TennCare Standard and (2) showing that you still want TennCare. Be sure to renew on time! And, as always, let DHS know if you move to a new address: 1 (866) 311-4287.
