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 for a complete list of benefits and services available to you.
See an overview of the programs and services (updated PDF coming soon) 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.
We all have our struggles. Finding support to focus on your emotional health is important.Now you can use web and mobile tools to help you get better and stay mentally strong.myStrength is safe and secure – just for you. It offers personalized resources to improve your mood. Learning to use myStrength’s tools can help you overcome the challenges you face.
Protect your eyes with services such as eye exams and prescription eyewear. Learn about your vision benefits with our Vision Benefits FAQ (PDF). Visit our Vision Care web page 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).
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 Access2Care at 1-877-271-4819.
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, please contact Iowa Total Care 14 days before your scheduled appointment. Most in-person interpretation requests can be arranged 72 hours before your appointment. Members should notify Iowa Total Care at least 24 hours in advance if in-person interpretation services are no longer needed.
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:
- If you already have a SafeLink phone, call 1-877-631-2550 so you can begin receiving the additional SafeLink benefits.
- Visit SafeLink's website to apply online.
- Call SafeLink at 1-877-631-2550 to apply over the phone.
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.
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.