Get the Most from Your Coverage

Your PCP is the doctor you’ll see for routine checkups and care. Your PCP will help find other types of healthcare providers if you need one. You can also use our Find a Provider tool at findaprovider.iowatotalcare.com.

As children get older, they should change from seeing a pediatrician to seeing an adult doctor. Teens don’t need checkups as often as young kids do, but they should see their PCP at least once a year. Regular visits will help them stay up to date on vaccines. If teens have a condition such as diabetes or asthma, it’s very important that they keep seeing their doctors and not miss a visit. Call Iowa Total Care at 1-833-404-1061 (TTY: 711) if you need help finding an adult provider.

You should be able to schedule an appointment with your PCP and get medical care when you need it. You may have to wait a little longer to get in to see certain other types of providers, like specialists. Call Iowa Total Care at 1-833-404-1061 (TTY: 711) if you can’t get an appointment in a timely manner.

OTHER LANGUAGES & FORMAT NEEDS 

Interpreter services are provided free of charge to you when talking with your health plan or doctors and during the grievance process. This includes American Sign Language and real-time oral interpretation by certified medical interpreters. Our interpreters have demonstrated proficiency in both English and the non-English language of the member. 

If you need something translated into a language other than English, please call Iowa Total Care at 1-833-404-1061 (TTY: 711). We can also provide materials in other formats such as Braille, CD or large print. 

If you need an interpreter for your medical appointment, contact Iowa Total Care before your appointment. We will arrange for an interpreter to be at your appointment.

Iowa Total Care provides free aids and services to help our members communicate effectively. These tools are for members:

• Whose primary language is not English.
• Who are deaf or hard of hearing.
• Who are blind or have low vision.
• Who have a speech disability.
• Who have culturally and ethnically diverse backgrounds.

If you need an interpreter for your medical appointment, please complete a “Language Services Request Form” found on our Language Services webpage.

If you need something translated into a language other than English, please call Iowa Total Care at 1-833-404-1061 (TTY: 711). We can also provide materials in other formats such as Braille, CD or large print.

You should get high quality medications and the right treatment for your conditions. But not all drugs are covered. And some may need to be approved before they’re covered. The Preferred Drug List (PDL) is located on our Member handbook, Manuals, and Forms webpage. It is updated regularly and lists drugs that are covered by insurance. Talk to your doctor or pharmacist to review the PDL and answer questions about your medications.

The utilization management (UM) department looks at your health records and may also talk with your doctor to decide if a service you need is covered. These decisions are not based on financial reasons. And doctors and staff are not rewarded for saying no to care. All UM decisions are based on:

• If the service is medically necessary.
• If the service works well.
• If the service is right for you.

New medicines, tests and procedures come out every year. A team of doctors and other experts decide if new medical care will be covered by Iowa Total Care. Your plan covers care that is medically necessary. Not every new medical service is covered for all members.

If a service is denied, you have the right to appeal that decision. You will be sent a letter explaining how to make an appeal. All appeal requests are decided according to your request, condition and benefits. Visit our Grievances and Appeals webpage to get more information.

Care management is for members who may need extra help taking care of their health. Some people have several health conditions and see more than one doctor. Others need help arranging the services their doctors may have ordered. Working with a care manager helps you understand major health problems, work well with your doctors and get the care you need.