Get the Most from Your Coverage
You Deserve Quality Health Care. You also need clear facts about your plan. Iowa Total Care sets goals for quality care. It checks these goals to help you get the care you need.
This page is part of our Quality Program. The program helps make your care and services better. This page tells you about your plan and the help you can get.
Contact Member Services to learn more about the Quality Program.
Know Your Rights
As a member, you can expect these things from Iowa Total Care:
- You can use all services that are open to members.
- You will be treated with care and respect.
- You can get a copy of your health record.
- Your health information will be kept private. We have rules to keep your records safe.
- You can get an interpreter or written translation at no cost to you.
You can also take these steps to get the most from your plan:
- Ask questions if you do not know your rights.
- Go to your planned visits.
- Take your Member ID Card to each visit.
- Tell your doctor if you got care in an emergency room.
See your Member Handbook for the full list of rights and duties.
How we keep your personal details safe
You may choose to share facts about yourself. These facts may include your race, ethnic group, language, sexual orientation, gender identity, or disability. They may also include aids or other help you need. We work to keep these facts safe. We may:
- Keep paper files in locked cabinets.
- Keep digital files on secure devices.
- Keep digital files in folders that need a password.
The law may let us use or share these facts. We may share them with your doctors, other care teams, or state and public health groups. We may use them to help plan your care, meet your language or access needs, make services better, study gaps in care, and run the health plan. This work may include:
- Plan programs to help members.
- Plan and send member messages.
- Tell your care team about your language needs.
- Study gaps in health and care.
We will not use your race, ethnic group, or language (REL) facts, or your sexual orientation and gender identity (SOGI) facts, to set your rate, decide your benefits, or approve you for coverage. We will not share these facts with people who are not allowed to see them.
Getting the Care You Need
Your PCP is the doctor you see for checkups and basic care. Your PCP can help you find other types of doctors. You can also use the Find-a-Provider tool at findaprovider.iowatotalcare.com.
As children grow up, they should move from a child doctor to an adult doctor. Teens may need fewer checkups than young children. Still, they should see their PCP at least once a year. These visits help them stay up to date on shots. Teens with diabetes, asthma, or another health issue should not miss visits. Call Iowa Total Care if you need help finding an adult doctor.
You should be able to make a visit with your PCP and get care when you need it. You may wait longer to see some doctors, such as specialists. Call Iowa Total Care if you cannot get a visit soon enough.will arrange for an interpreter to be at your appointment.
You can get free interpreter help when you talk with Iowa Total Care or doctors. You can also get this help during a complaint or appeal. This help includes American Sign Language. It also includes live spoken help from trained medical interpreters. Our interpreters can speak English and the member’s other language well.
You can also ask for help tied to a disability. This may include sign language, Braille, large print, a trained reader, or other aids. Call Iowa Total Care at 1-833-404-1061 (TTY: 711) to ask for help.
If you need an interpreter for a doctor visit, call Iowa Total Care before the visit. We will set up an interpreter for you.
You should get safe drugs and the right care for your health
The needs. Your plan may not cover every drug. Some drugs need approval before the plan will pay for them. The Preferred Drug List (PDL) is located on our Member handbook, Manuals, and Forms webpage. It is kept up to date and lists covered drugs. Ask your doctor or pharmacist to check the PDL and answer your drug questions.
The utilization management (UM) team checks your health records. The team may also talk with your doctor. This helps the team decide if your plan covers a service. Money does not guide this choice. Doctors and staff do not get a reward for saying no to care. Each UM choice is based on:
- Whether you need the service for your health.
- Whether the service works well.
- Whether the service is right for you.
New drugs, tests, and types of care come out each year. A team of doctors and other experts checks them. The team decides if your plan will cover them. Your plan covers care you need for your health. It may not cover each new service for every member.
If your plan says no to a service, you can appeal. We will send you a letter that tells you how. We review each appeal based on your request, health needs, and benefits.
Care Management helps members who need more support with their health. Some members have more than one health issue or see more than one doctor. Some need help getting services their doctor ordered. A care manager can help you learn about your health needs, work with your doctors, and get the care you need.
Get More Information
Your Member Handbook has facts about your plan and benefits. It also lists key phone numbers.You can also contact Member Services at
1-833-404-1061 (TTY: 711). You can get an interpreter or written translation if you need it.
Member Services to get:
- A paper copy of your Member Handbook, Privacy Notice or anything on IowaTotalCare.com
- Help finding a doctor and making an appointment.
- Help speaking with a care manager.
- Help with an appeal for a service that’s been denied.
- Help with a ride to your appointment.
The Iowa Total Care website also has helpful facts and tools. You can find your Member Handbook, Find-a-Provider tool, and the Preferred Drug List. You can also use it to help you manage your health.
It is free and easy to make an online member account. With your account, you can:
- Find or change your PCP.
- Ask for a new Member ID Card or print a temporary ID Card.
- View or change your personal details.
You can also send a message to Iowa Total Care from your account.