Frequently Asked Questions

Please see our FAQs Related to General Health Care Services:

Your doctor is in charge of making sure that you get all of the medical care that you need. Your doctor will take care of you and help you manage your health care needs. Your PCP must approve all of your medical care, including non-life threatening emergency room visits. Also, your doctor must approve visits to specialists such as surgeons.

If you do not call us to choose your doctor, you will be assigned to the Health Choice Arizona doctor who is closest to your home. You will receive a letter telling you who your doctor is. Please call us as soon as possible if you want to change your doctor. If you would like help with choosing a PCP, please call Member Services at 1-800-322-8670, Monday – Friday 6 a.m. – 6 p.m.

To change your PCP, choose a PCP from the Provider Directory, then call Member Services at 1-800-322-8670 and let us know your choice. You can also call us for help with making a choice. The change will be made on the day we get your request we receive your request. We will send you a letter to confirm that the change has been made.

If you do change your doctor, it is important for you to have your medical records sent to your new doctor so that he or she can give you the best care possible. You can request one copy of your medical records from each of your doctors.

Your co-payment will vary from $0.00 to $5.00 and from Non-Mandatory Copay to a Mandatory Copay depending on your DES eligibility level. Some services do not have a co-pay. Please call Member Services at 1-800-322-8670 for any questions.

Health Choice Arizona contracts with many different pharmacies in Arizona. Click here to search for a participating pharmacy in your area in the Provider Directory. If you do not see the pharmacy of your choice, please call Member Services at 1-800-322-8670.

Your PCP is in charge of all your health needs. If you need to see a specialist your PCP will call the specialist and make the appointment for you, or they can give you a referral so that you can make the appointment yourself. Some services will require approval from Health Choice Arizona.

FAQs Emergency Care

If you believe you or someone you know is having a life-threatening medical emergency, you should dial 9-1-1 to get medical care immediately. You do not have to contact your primary care provider (PCP) or get permission for services in an emergency.

 

Health Choice Arizona covers emergency care that you get from non-plan providers when you are outside the plan’s service area but still in the United States, if the emergency care provider is willing to register with AHCCCS and bill Health Choice Arizona. If you need urgent care while you are outside the plan’s service area, please call your doctor. Your doctor will give you advice about what you should do.

FAQs Related to Medical Bills and Claims

In most cases, no. As long as you were enrolled with Health Choice Arizona when you saw the provider and the provider is in the Health Choice provider network, you do not have to pay for covered services unless you have a co-pay. For information on the AHCCCS website about co-pays, click here.

If your doctor is in the Health Choice provider network and you get a bill from your doctor, please send the bill to Health Choice for review. We will be happy to tell your doctor that, as a Health Choice Arizona member, you do not have to pay for covered services. If you paid for covered services while enrolled with Health Choice, your provider should refund your money, minus any copay amount to you.

We may reimburse you for the cost of drugs if you purchased your medications during “Prior Period Coverage” before joining Health Choice Arizona . Prior Period Coverage is the time between when you became eligible for AHCCCS and when you joined Health Choice Arizona. We can only reimburse you for the cost of the drugs through Health Choice Arizona, which may be less than what you paid at the drug store.

If you paid for prescription drugs and you think you should not have to, send your receipts and the pharmacy labels to Health Choice Arizona.

We must receive the receipts and labels within six months from the date you paid for the drugs. We will review. After we review, we will let you know if we can reimburse you.

FAQs Related to Complaints (Grievances)

If you have a question or problem, please call 1-800-322-8670 and ask to talk to a Member Services representative. We are here to help you. If you have a specific complaint about your medical care, the Member Services Representative will help you. You can also submit your question, problem or complaint via email at comments@healthchoiceaz.com

You can also tell a Member Services representative that you want to file a written or oral grievance. To learn more about grievances, please visit our Grievances and Appeals page.

Please tell a Member Services representative you want to file a written or oral grievance. To learn more about grievances, please visit our Grievances and Appeals page.

Please call Member Services and speak to a representative about making a complaint.

FAQs Related to Dental Services

It is very important for your child to see a dentist every 6 months. This will aid in preventing oral disease. For further information on preventative dental services, please see our Member Handbook.

Regular dental visits help your child stay cavity-free. Teeth cleanings remove debris that build up on each tooth, irritate gums and cause decay. Fluoride treatments will strengthen teeth and stop decay.

The dentist will check your child’s teeth and mouth. The teeth will be cleaned and polished, followed by the application of a fluoride solution.

The following steps will help your child avoid calories and have healthy teeth:

  1. Beware of frequent snacking.
  2. Brush effectively twice a day with fluoride toothpaste.
  3. Floss once a day.
  4. Have sealants applied when appropriate.
  5. Seek regular dental checkups.

Preventative dentistry for children includes:

  1. tooth brushing instruction
  2. fluoride treatment
  3. dental sealants
  4. teeth cleaning

Preventative dentistry means a healthy smile for your child. Children with healthy mouths chew more easily and gain more nutrients from the foods they eat. They learn to speak more quickly and clearly. They have a better chance of good general health, because disease in the mouth can endanger the rest of the body. A healthy mouth is also more attractive, giving children confidence in their appearance.

Preventative dentistry begins with the first tooth. Visit your dentist when the first tooth comes in. You will learn how to protect your infant’s dental health. The earlier the dental visit, the better the chance of preventing dental disease and helping your child belong to the cavity-free generation.

FAQs Related to Prescription Drug Benefit

Our pharmacy network includes many pharmacies in your area. It is likely that your local pharmacy is in or network. A directory of contracted pharmacies is available on our website.

If you are not sure if your pharmacy is in our network, call Member Services.

If your pharmacy is not in our network, you can transfer your prescriptions to a new pharmacy.

Follow these two steps:

  1. Locate a pharmacy in our network:
    • Visit our website and choose the Find a Doctor/Pharmacy tab or
    • Contact Member Services, and we will find a pharmacy for you.
  2. Tell your new pharmacy that you want to have your prescriptions transferred. Give them the contact information for your current pharmacy. The new pharmacy will contact your current pharmacy and make the transfer.

You should always go to a pharmacy in the Health Choice Arizona network. A pharmacy that is not in our network cannot help you fill your prescription or help with drug benefits.

If you use a pharmacy that is not in our network, you will have to pay the full cost of the drugs. Your drugs may not be eligible for reimbursement; this means you will not get paid back if you pay out of pocket for your medication.

If your pharmacy is not in the Health Choice Arizona network, please give us their name, address and phone number. We will contact them to see if they will join or network.

Yes, you will receive a new Medicaid ID card from Health Choice. It is important that you bring your new ID card to the pharmacy to get your prescription drugs. 

(Follow guidelines in your Member Handbook)

If you currently receive your medication from Orchard your pharmacy will change to Briova.  Your services will not be interrupted.  (These medications are usually to treat complex medical conditions)

Please refer to the Health Choice list of covered drugs, also called a formulary. You can find the list on our website. If you would like a printed copy, please call Member Services.

Your pharmacy will tell you. You will still be able to get your drugs in the same visit. Your pharmacy will get approvals from Health Choice and your Behavioral Health Agency.

A formulary is a list of drugs that are safe and economical. An independent committee of doctors and pharmacists develop the Health Choice formulary. The independent committee reviews and updates the formulary regularly to include new drugs and treatments.

The formulary contains a wide range of drugs. The Food and Drug Administration (FDA) have approved all drugs on the formulary.

Health Choice covers all drugs listed in the formulary. Health Choice will not cover drugs not listed in the formulary.

A brand name drug is protected by a patent. The patent protects the drug so that only one drug company can make it.

When the patent for a brand name drug ends, other drug companies can make a version of the drug. This is called a generic drug. A generic drug is a chemical copy of the brand name drug. The color or shape may be different, but the active ingredients are the same.

Some drugs require prior authorization. Specific criteria must be met before Health Choice Arizona can cover these drugs.

The pharmacist will find out if a drug requires prior authorization when the pharmacist submits your prescription for approval. Your pharmacist may submit the request for prior authorization at that time.

In some situations, your pharmacist may not have all the information to get the drug approved. When that happens, your doctor will contact Health Choice Arizona to request prior authorization.

If your drugs needed prior authorization, Health Choice will honor the authorization until it expires.

In some cases, you may need to get a new prior authorization:

  1. Some drugs that did not previously require prior authorization may require it after July 1, 2017. If your drugs need prior authorization, you have sixty days to ask your doctor to submit a request. To find out if your drugs need prior authorization, you can:
    • Visit the member section of the Health ChoiceAZ website. Click on the Prescription Drugs tab and view the new formulary.
    • Call Member Services, and we would be happy to help you.
  2. If your existing prior authorization expires, you will need a new authorization. You can ask your doctor to submit a new authorization request. You can call your pharmacy to find out when your authorization expires.