How do I?
Prior authorizations and actions
Certain medications and services may need approval from Senior Whole Health of New York before they’re covered. This is called a prior authorization. Prior authorization is usually required if you need a complex treatment or prescription. Since coverage will not be authorized without it, beginning the prior authorization process early is important. Ask your doctor if a prescription drug or treatment is going to require prior authorization so they can start the process.
For more information about the prior authorization process, please review your Senior Whole Health of New York Member Handbook.
How do I file a complaint or appeal?
We understand there may be times when you aren’t completely happy or satisfied. We try our best to deal with your concerns or issues as quickly as possible and to your satisfaction. You may use either our complaint (grievance) process or our appeal process, depending on what kind of problem you have.
If you choose to authorize a representative, complete and return the Appointment of Representative Form.
How do I request a new ID card?
Once you’re enrolled in Senior Whole Health of New York, you’ll get a member ID card. This card has important information for you and your providers.
Always show your member ID card when you go to a health care provider or pharmacy.
If your member ID card is ever damaged, lost or stolen, call Member Services right away at (877) 353-0185. We will mail you a new card.
How do I follow and use a care plan?
Once you are enrolled in Senior Whole Health of New York, you will work with your care manager on creating your person-centered care plan. Your care plan will include the types of health services that you need and how you will get them. It will also include your goals and preferences.
Together, we work as a team which includes your care manager, your doctor(s) and most importantly you (and a caregiver or family member, if desired). Your care team will work with you to update your care plan when your healthcare needs change, and at least once per year.
How do I enroll in Senior Whole Health of New York?
Enroll Now!
Call (877) 353-0188 (TTY/TDD: 711).
When you call, a Senior Whole Health representative will:
• Speak with you, confidentially, about your health care needs
• Explain how our plans work and help you determine if it’s a good fit for you
• Answer any questions you may have about the plan
Once you’re ready, we’ll put you in contact with New York Medicaid Choice and setup a nurse evaluation and offer a plan of care. If you have not been in a long term care plan for 45 days or longer or you want to join a Medicaid-approved long term care plan for the first time you will also need to have a Conflict-Free Evaluation and Enrollment Center (CFEEC) evaluation. For more information about CFEEC, please visit the New York State Medicaid program’s CFEEC website.
Based on your in-home or virtual visit the assessment nurse will use your comprehensive health assessment to develop a person-centered plan of care based on the assessment of your needs. Once you review and accept your plan of care, you are enrolled in the plan.
How do I renew?
You need to recertify your Medicaid coverage annually. The Human Resources Administration (HRA) or Local Departments of Social Services (LDSS) will send you recertification instructions. You will also receive a reminder in the mail from us. If you need help completing your recertification, please call Member Services at (877) 353-0185.
How do I disenroll in Senior Whole Health of New York?
You can ask to leave SWH of NY at any time for any reason. To request disenrollment, call (877) 353-0185 (TTY/TDD: 711) or you can write to us.
For more information on disenrolling from SWH of NY or transferring to another MLTC plan, please view the disenrollment section to the Member Handbook.