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Benefits Overview

Access to quality medical services is just one of the many Iowa Medicaid benefits that Iowa Total Care provides to eligible individuals and families in the state. You can view some of the basic health care services that are covered by Iowa Health Link (Medicaid) below or contact us today for more information.

Get Iowa Health Link Benefits from Iowa Total Care

Iowa Total Care’s Medicaid plans offers comprehensive health care benefits and services that suit the needs of families and individuals throughout Iowa. View some of Iowa Medicaid member services and benefits from Iowa Total Care below.

Please refer to the Member Handbook (PDF) for a complete list of benefits and services available to you.  

Preventive care visits are covered by Iowa Total Care. This means visiting the doctor for a regular check-up, rather than waiting until you are sick.

Iowa Total Care covers an annual physical for adults.

As an Iowa Total Care member, you can choose who you see for your health care needs from our network of doctors and providers. We have many for you to choose from. View our online provider directory for a list of our providers. If you need help choosing a doctor, call Member Services at 1-833-404-1061 (TTY: 711).

Iowa Total Care can help you find behavioral health providers, find local resources, plan an appointment and find transportation. Call Member Services at 1-833-404-1061 (TTY: 711). You can also refer to your Member Handbook for more information on your Behavioral Health benefits.

Protect your eyes with services such as eye exams and prescription eyewear. You can visit our Vision Care website for more information. You can also refer to your Member Handbook.

Care coordination and disease coaching are part of your health benefits and are provided to you at no cost. Iowa Total Care pays for these services. We provide services for many conditions, such as asthma, diabetes, COPD, high-risk pregnancy and many more. Call Member Services at 1-833-404-1061 (TTY: 711).

Our Nurse Advice Line is ready to answer your health questions 24 hours a day – every day of the year. It is staffed with Registered Nurses. Call 1-833-404-1061 (TTY: 711). This option will be available 7/1/2019.

Through our Community Health Services (CHS) Department, we can help you get the support you need. A CHS team member can talk to you over the phone. They can also visit your home. They can talk to you about things like how to choose a doctor, plan benefits and living healthy. They can also connect you to community social service programs. These programs will help you with food, housing and clothing.

Iowa Total Care covers Non-Emergency Medical Transportation (NEMT) for medically necessary, covered services, such as doctor appointments, dialysis, and counseling appointments. You can set up transportation by calling Member Services at 1-833-404-1061 (TTY: 711).

Interpreter services are provided free of charge to you during any service or grievance process. This includes American Sign Language and real-time oral interpretation.

If you need something translated into a language other than English, please call Iowa Total Care at 1-833-404-1061 (TTY: 711). We can also provide things in other formats such as Braille, CD or large print.

If you need an interpreter for your medical appointment, contact Iowa Total Care before your appointment. We will arrange for an interpreter to be at your appointment.

Iowa Total Care is proud to work with SafeLink Wireless to offer you this special, federal program. As a member of our plan, you get all the same benefits of a SafeLink phone, plus unlimited inbound text messages and calls to Iowa Total Care member services. There is no added cost for these extras. Some limitations may apply.

How to Enroll:

Utilization Management

We want to make sure you get the right care and services. Our utilization management process is designed to make sure you get the treatment you need.

We will approve all covered benefits that are medically necessary. Our Utilization Management (UM) Department checks to see if the service needed is a covered benefit. If it is a covered benefit, the UM nurses will review it to see if the service requested meets medical necessity criteria. They do this by reviewing the medical notes and talking with your doctor.

Iowa Total Care does not reward practitioners, providers or employees who perform utilization reviews, including those of the delegated entities. Utilization Management’s decision making is based only on appropriateness of care, services and existence of coverage. Iowa Total Care does not specifically reward practitioners or other individuals for issuing denials of coverage. Financial incentives for UM decision makers do not encourage decisions that result in underutilization.

Iowa Total Care reviews services to ensure the care you receive is the best way to help improve your health condition. Utilization review includes:

Iowa Total Care reviews services to ensure the care you receive is the best way to help improve your health condition. Utilization review includes:

Preservice or prior authorization review

Iowa Total Care may need to approve medical services before you receive them. This process is known as prior authorization. Prior authorization means that we have pre-approved a medical service.

To see if a service requires prior authorization, check with your PCP, the ordering provider, or Iowa Total Care Member Services. When we receive your prior authorization request, our nurses and doctors will review it. If prior authorization is not received on a medical service when required, you may be responsible for all charges.

Concurrent review

Concurrent utilization review evaluates your services or treatment plans (like an inpatient stay or hospital admission) as they happen. This process determines when treatment may no longer be medically necessary. It includes discharge planning to ensure you receive services you need after your discharge from the hospital.

Retrospective review

Retrospective review takes place after a service has already been provided. Iowa Total Care may perform a retrospective review to make sure the information provided at the time of authorization was correct and complete. We may also evaluate services you received due to special circumstances (for example, if we didn’t receive an authorization request or notification because of an emergency).

Adverse determinations and appeals
 
An adverse determination occurs when a service is not considered medically necessary, appropriate, or because it is experimental or investigational. You will receive written notification to let you know if we have made an adverse determination. In the notice, you will receive detailed information about why the decision was made, as well as the process and time frame you should follow for submitting appeals.