Member Handbook
WELCOME
Welcome! You have just become part of a team ready to help you with your goals and dreams. This booklet is meant to help you know what it is that we have to offer and to answer questions.
ABOUT SOUTHWEST MICHIGAN BEHAVIORAL HEALTH
Southwest Michigan Behavioral Health is the Prepaid Inpatient Health Plan (PIHP) for eight Michigan counties, and is made up of eight Community Mental Health agencies. Those agencies are: Barry County Community Mental Health (Barry County), Riverwood Center (Berrien County), Pines Behavioral Health (Branch County), Summit Pointe (Calhoun County), Van Buren Community Mental Health (Van Buren County), Woodlands Behavioral Healthcare Network (Cass County), Kalamazoo Community Mental Health and Substance Abuse Services (Kalamazoo County), and Community Mental Health & Substance Abuse Services of St. Joseph County (St. Joseph County). Southwest Michigan Behavioral Health will make sure that services are given to you based on your needs and goals and are within the guidelines of the State plan. Southwest Michigan Behavioral Health makes sure that you and your families are treated with dignity and respect at all times.
Southwest Michigan Behavioral Health also makes sure, that you have a say in how, and what, is given to you throughout the time that you are receiving services, in ways that you can understand. This includes people who are deaf and have a hard time hearing, those who are not able to read, and for those who do not use English as their chosen language.
Southwest Michigan Behavioral Health makes sure that the services that you need and want are available in places that are close to your home. The names and addresses of our network providers are listed in the back of the book.
At Southwest Michigan Behavioral Health we seek to fully support the recovery of the customer by providing the supports and services you need, mixed with your own choices to help you achieve your goals and desires. Your provider will work with you to use the natural supports (like family and friends) around you, plus provider services to give you a new sense of hope and the power to exercise choice and control over your own life.
Southwest Michigan Behavioral Health encourages, and actively asks for, suggestions to improve services from members. You can make suggestions to your provider, directly to Southwest Michigan Behavioral Health and/or to the Member Advisory Council.
We will make sure that:
- You are only asked for information that is needed.
- That people who don’t need to know about your information don’t see it.
- The places where you get your services will keep your information private.
- Information that is shared between providers is done in a way that is private.
- There is a complaint policy and process for plan members that think a provider has not kept their information private.
- That we actively ask for and accept member suggestions.
- Please read Southwest Michigan Behavioral Health’s Notice of Health Information Privacy Practices to learn more about how medical information about you may be used or given to others.
If you have questions and need to get in touch with us, you can call or write your local Member Services Representative, or Southwest Michigan Behavioral Health’s Member Service Department, listed in the back of this handbook
ABOUT THIS MEMBER HANDBOOK
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The following are the contents of the handbook:
- Important Definitions
- Who Is Eligible For Services
- How To Obtain Services
- In An Emergency
- Post-Stabilization Care Services
- Southwest Michigan Behavioral Health Information Privacy Practices
- Reporting Suspected Compliance Violations
- Recipient Rights
- Your Provider Network
- How To Obtain Out Of Network Care
- Language Assistance
- Cultural Sensitivity
- Physical Disabilities, Hearing and Vision
- Member Services
- Member Satisfaction
- When You Are Away From Home
- Prevention
- Person Centered Planning
- Medical Necessity
- Coordination Of Care
- Advance Directives
- Your Mental Health Benefits
- Covered State Medicaid Services
- Alternative Services
- Additional Services-Habilitation Supports Waiver
- Covered Substance Abuse Services
- Alternative Substance Abuse Services
- Changing Providers
- Other Health Insurance Plans
- Keeping Us Informed
- How Authorizations Are Handled
- Grievance and Appeal Process
- Timelines For a Grievance or Appeal
- Need Help Filing A Grievance or Appeal?
- Member Rights and Responsibilities
- List Of Network Providers
- Have Questions? Need Answers?
- Member Services Contact Information