Medicare: Quality Assurance Policies & Procedures

Friday Health Plans of Colorado is committed to our Members and the Communities within  which we serve. We are dedicated to improving the quality of life through the delivery  of healthcare coverage and programs to our Members. Living and working in rural  communities, we understand the challenges of ensuring access to healthcare.

Friday Health Plans of Colorado strives to ensure that its members receive the utmost  Quality Management and Utilization Management.   Friday Health Plans ensures that the programs are organized, productive, and  comply with established goals and objectives. Friday’s goals with  regard to our care management program include keeping care local where  appropriate as well as ensuring care returns to our local providers at  appropriate times, making it easier on our members and their families. We aim  to make healthcare more available and affordable while at the same time  providing exceptional service. In order to achieve this we build strong  partners in our communities and in supporting the needs of our Members.

Quality  Management ensures that the organization monitors the level of care provided by  the plan and its health care providers, identifies problems, chooses and  examines solutions to those problems, regularly monitors the solutions  implemented, and refines solutions as needed for continued improvement.  Friday Health Plans believes that our Members have the right to quality healthcare  services as close to home as possible.

Utilization  Management is our systematic program for monitoring, evaluating, and improving the  appropriateness and accessibility of health care services provided by the plan  to all its members.

Additional  information about our Quality Improvement Program is available upon request.  Please contact member services to request this information at 719-589-3696 or  1-800-475-8466, TTY users should call 1-800-659-2656.

Friday Health Plans of Colorado is a health plan with a Medicare Contract. Enrollment in Friday’s Medicare cost plan depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

You are eligible to enroll if you are entitled to Medicare Part A and/or enrolled in Medicare Part B and you live in the Friday Health Plans of Colorado service area. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. Eligible beneficiaries can enroll in Friday Health Plans at any time.

You can use any doctor who is part of Friday’s network. You may also go to doctors outside of our network. We may not pay for services you receive outside of our network, but Medicare will pay for its share of charges it approves. You will be responsible for paying the Medicare deductible and coinsurance for those services, unless they were authorized in advance by Friday Health Plans.

Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits.

Information is available in alternative formats or languages. Please call 1-800-475-8466 (TTY users should call 1-800-659-2656) for details. Se puede presentar la información acerca del plan en un formato o idioma distinto. Para solicitar un documento en español, favor de llamar a Atención al Cliente, al número telefónico indicado debajo.

Friday Health Plans of Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

For more information, contact Customer Service at 719-589-3696 if calling from within the San Luis Valley or at 1-800-475-8466 if calling from outside the San Luis Valley. (TTY users should call 1-800-659-2656). Hours are 8:00 am to 8:00 pm, 7 days a week , Oct 1 – Feb 14, and 8:00 am to 8:00 pm., Monday through Friday, Feb 15 – Sep 30.  (Para asistencia en Español, llame al 719-589-3696 o al 1-800-475-8466).

Information is current as of 03/2018. Please contact our Customer Services department to verify that you have the most up to date information.

H0657_2018 Website Changes pending

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