Welcome! We are happy to have you as a member. We know that health insurance can be confusing, so in addition to the information you have received in the mail, we have collected some resources that should help you get the care you need from us.
If you have a general question, you may call Customer Service toll-free at 1-866-261-1286 or send your Care Coordinator a message at CareCoordination@empowerhcs.com.
- Looking for a provider in our network? Search our provider directory.
- Need to choose a Primary Care Provider (PCP)? If you don’t already have one who is in our network, we urge you to choose a PCP as soon as possible. To select or change your PCP call Customer Service toll free at 1-866-261-1286 or contact your Care Coordinator at CareCoordination@empowerhcs.com.
- Want to find out if the medications you take are covered by your plan? Learn more about your pharmacy benefit and view our Formularies (list of covered medications) on our Pharmacy page.
Our Utilization Management Procedures
Utilization management (UM), sometimes called utilization review, is the evaluation of the medical necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities under your health plan.
- Empower covers all medically necessary Medicaid Services.
- Most routine services, such as a visit with a PCP or specialist, do not need a prior authorization (PA). You may need a PA for certain procedures or surgeries, exceptions to the formulary (drug list), and requests for services outside of our provider network.
- When you do need a PA, your provider makes the request for you. You do not need to contact Empower about this.
- If you are admitted to a hospital, the facility must tell Empower Healthcare Solutions.
- We offer Care Coordination services to all Empower members. This ensures that you receive appropriate and timely care.
Find complete utilization management information in your Member Handbook.