www.phs.org/Medicaid 9 Presbyterian Health Plan’s Ombudsman Program helps members learn how their insurance works and get the care they may need. How the ombudsman (awm-budz-muhn) can help members: • Aid them with issues or problems (before they go through the grievance or appeal process) • Assist with learning about Presbyterian Health Plan • Help with referrals and resources • Refer or recommend members to care coordination • Teach members about their rights under Turquoise Care What is an ombudsman? An ombudsman is someone who looks into problems and helps to resolve them. They do this without taking anyone’s side. What is the role of the ombudsman? The Presbyterian Turquoise Care ombudsman works for the member to help with member issues through advocacy, support, and research. When should the ombudsman be contacted? Members can contact the ombudsman if they’re having a problem with getting the care they may need or have questions about their care. How can the ombudsman help me? The ombudsman works for the member on issues and is not part of the grievance or appeal process. They work with the member to guide them through the processes. The ombudsman works with the care team to be a voice — to talk about the member’s needs. What does an ombudsman not do? The ombudsman does not take the place of established processes, such as appeals or grievances. The ombudsman will not make final decisions about the member’s care. To reach the Turquoise 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 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. Call the Presbyterian Customer Service Center at the number on your Presbyterian member ID card. Our ombudsman is here to help Presbyterian’s translation and interpretation services
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