QUEST Integration – Enabling Services (Social and Support Services)

Original Effective Date:

08/01/1994

Current Effective Date:

01/01/2015

HMSA can provide or arrange for social and support services to help members deal with social and economic pressures that can affect their health.

Language Translation Services

The QUEST Integration Member Handbook is available to members in English, Ilocano, Korean, Chinese (Traditional), and Vietnamese. HMSA’s multicultural staff can communicate with members in these and various other languages. We also can arrange for interpretation services through community-based agencies to help members communicate with their PCP or other providers whether it be by language interpretation, sign language services, or other specialized communication methods, such as large print, audio format, or Braille. Members and providers are polled on the languages spoken in their home or office so that we can match members to providers who speak the same language.

When interpretation services are required, requests for assistance must be submitted in advance of a scheduled appointment to allow sufficient time to make the necessary arrangements. Retroactive requests submitted after a visit has taken place will not be honored.

To request interpretation services, contact:

QUEST Integration Provider Service

P. O. Box 3520

Honolulu, HI  96811-3520

Phone:

1-808-948-6486 (Oahu)

1-800-440-0640 (toll-free Neighbor Islands)

TTY (Text Telephone):

1-877-447-5990

Transportation Services

When a member is not able to use public transportation due to unusual circumstances, and there is no other way of visiting a medical provider, HMSA can arrange for ground transportation. See Transportation – Ground (Non-Emergent) for coverage criteria.

Education and Assistance Services

Member Services representatives help members understand their QUEST benefits and how to access those benefits. Our staff can help members learn to live with chronic conditions and practice self-care at home. We counsel members who are non-compliant or exhibit inappropriate behavior such as missing appointments or not following doctors’ orders. Community resources also provide counseling services as needed.

Members who do not require long term services and support (LTSS) but who require some assistance in receiving needed care to diagnose and/or treat a medical condition, may benefit from the assistance that HMSA QUEST Integration staff and paraprofessional staff of our partner agencies can provide. We will work with members and providers to assist with timely access and delivery of healthcare, continuity of care, and coordination of services.

If you need assistance with a patient with special health care needs or who needs long term care, referral for Health Coordination Services with a Service Coordinator may be more appropriate. See QUEST Integration – Health Coordination Services. For help with patients who are not candidates for Health Coordination Services, please call QUEST Integration Provider Service at 1-808-948-6486 on Oahu or toll-free from the Neighbor Islands at 1-800-440-0640.

• Provider Support
  • Help locate a specialist within a specific geographical area
  • Arrange for specialized medical care not available on the member’s home island or in the state, including related services such as lodging, meals and transportation
  • Assist the PCP coordinate the care of seriously ill patients with medical specialists, social workers and community resources
  • Arrange additional services to support and manage high-risk or high-cost cases
  • Refer members for care coordination with other programs or agencies that provide services which are not covered by QUEST Integration
  • Counsel and educate QUEST Integration patients who are abusive or non-compliant
  • Help resolve problems with QUEST Integration patients who do not keep appointments (provide documentation of missed appointments)
  • Provide continuity of care when members transition to other programs or QUEST Integration plans, or are discharged on medications that normally require precertification.
• Member Support
  • Help members understand their QUEST Integration plan benefits and the medical care prescribed for them to ensure they make informed decisions about their health care and follow self-care instructions
  • Assure that each member has a PCP and assist with PCP and plan changes
  • Make advance arrangements for translation services as needed and transportation if appropriate
  • Coordinate or provide support services to help members obtain medical care or deal with social, economic or emotional problems
  • Remind members of EPSDT screenings that are due so that arrangements for timely screenings are made and kept

Revision History