Who is MDwise?
MDwise is an Indiana-based, nonprofit health plan. MDwise signs a contract with the State of Indiana to offer health coverage to Hoosier Healthwise members. MDwise provides the doctors and medical services to Hoosier Healthwise members who choose or are assigned to MDwise as their health plan.
How is MDwise different than Hoosier Healthwise?
Hoosier Healthwise is the name of the State of Indiana’s health insurance program. It is one of the Medicaid programs available to Hoosiers that qualify or are eligible. There is a separate company that operates the Hoosier Healthwise Helpline. This company is different from MDwise.
How do I change my health plan?
Hoosier Healthwise members have 90 days from the date that they start with MDwise to change their health plan. We hope that you will never want to leave MDwise. But if you do want a doctor outside of our plan, we will connect you to the right place to make that change within the first 90 days (open enrollment period). After 90 days, you cannot change to another plan for 12 months or one year, unless you have a “just cause” reason. See page 27 of the MDwise member handbook for more information on Open Enrollment and “just cause” reasons.
How do I change my doctor?
If you are a MDwise member, call MDwise customer service to change your doctor. We have a current list of doctors we can mail to you. Or you can go to Find a Doctor to print out a list. We hope you will never want to leave the MDwise health plan. But if you do want a doctor outside of our plan, we will connect you to the right place to make that change.
Do I have to renew my Hoosier Healthwise coverage?
Yes. The State will send a letter in the mail when it’s time to renew. Follow the instructions in the letter you receive. It will tell you what steps you need to take to keep Hoosier Healthwise coverage. If you don’t call them, they will stop your health coverage.
MDwise will also send you a reminder letter when it’s time to renew your Hoosier Healthwise coverage.
What if I called to choose a doctor but did not get the doctor I chose?
There are many reasons why a doctor selection may not have been approved. It is important to watch for a letter confirming your choice. If you do not get one within 10 days of making a selection, call MDwise to be sure you get the doctor you chose.
Why did my doctor get changed?
MDwise or Hoosier Healthwise will always try to send you a letter before your doctor is changed. If you find that your doctor is changed and you want a different doctor, call MDwise right away. We may be able to help you understand what happened. We can help you choose a doctor you want.
How soon can I get an appointment to my doctor?
It is very important to see your doctor in the first 90 days of joining MDwise. For your first appointment you may have to wait up to two months if you are not sick. If you are sick with something like a fever or earache, you should be able to get an urgent care appointment within one day. If you are not feeling well or have a non-urgent care issue, you should be able to see your doctor within three days. The most important thing to do is to call your doctor’s office. Tell them who you are. Then tell the appointment person that you have been assigned to your doctor. Let them know why you need to see the doctor.
How do I find a dentist, eye doctor, foot doctor or chiropractor?
Dental, vision, podiatry (foot doctor), family planning and chiropractic care are self-referral services. This means that you can go to any dentist or other provider that accepts Medicaid/Hoosier Healthwise. Your MDwise doctor can often help by suggesting a doctor for you. Some services you get from these providers will need an okay (or authorization) from MDwise. The doctor you select should know what to do to get an okay for the services that you need. For a list of these types of doctors, search the Indiana Medicaid website. Or you can call 1-800-889-9949. You can also contact the Indiana Family Helpline at 1-800-433-0746 for other Medicaid/Hoosier Healthwise providers.
How can I see a specialist?
Your doctor or primary care provider (PMP) manages all of your medical care. You must see your doctor before he/she can refer you to a specialist. He/ she can refer you to a specialist if there is a medical reason. Your doctor will be able to tell you which specialist you can see. MDwise can help your doctor find a specialist if he does not know of one for you.
How do I get my baby on Hoosier Healthwise?
The Presumptive Eligibility (PE) program offers prenatal care services to low-income pregnant women who do not receive Medicaid or Hoosier Healthwise. If you are pregnant and need health coverage, contact a qualified provider and ask for help applying for PE and Hoosier Healthwise.
You must be a U.S. citizen and live in Indiana to participate. Certain legal immigrants can participate too. Also, your family income must be below a certain amount.
If you are already on Hoosier Healthwise Package A or B while you are pregnant, your new baby will also be eligible for Hoosier Healthwise. You must report your baby’s birth to your caseworker. At birth your baby will be assigned to MDwise if you are a MDwise member. It is important to choose a MDwise doctor for your baby before you deliver. Your baby will be covered for one year.
Why can’t I get my prescription filled?
There can be several reasons why your prescription may not get filled right away at your pharmacy. If you are having a problem, you can call 1-855-577-6317. If you still need help you can call MDwise customer service. We can tell the pharmacy where to call for help. Even after hours, MDwise has a process in place to direct the pharmacy to the right place for help to fill prescriptions for emergencies.
You may have to pay $3 for each of your prescriptions. This amount is called a co-pay. There are times in which you do not have a co-pay such as:
- Services for members under the age of 18.
- Services related to a pregnancy.
- Services related to family planning (birth control and preventive supplies).
- Services while in an emergency room or nursing home.
- Services while in a hospital.
Hoosier Healthwise Package C members pay $3 for each generic drug and $10 for each brand name drug.
How do I get my member ID card?
All MDwise Hoosier Healthwise members will receive a member ID card from MDwise. If you have lost or misplaced your ID card, you can request a new one by calling MDwise customer service at 1-800-356-1204 or 317-630-2831 in the Indianapolis area.
Who should I call when I change my address and/or phone number?
This is very important. MDwise mails important information to members all the time. If we do not have your address, the important information will not get to you. Also, there are times that MDwise or your doctor’s office or nurses need to call you. If we do not have a current phone number, you may miss important phone calls about your health. If you do not update your address with us when you move, you could miss important notices about renewing your health coverage/benefits.
Why did I get a bill when I have MDwise coverage?
There are several reasons why you may get a bill from a doctor or medical provider, even though you are on the MDwise plan. It is important to call the billing agency on your bill right away. Please make sure to give them your Hoosier Healthwise number. If the agency already has that information, call MDwise. Your representative will need to ask you for some information. MDwise will then call the billing agency and help get the bill paid. If you are responsible for paying the bill MDwise can let you know.