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Apple Health + behavioral health

We provide all your Apple Health benefits, like care from a PCP you choose, prescriptions and much more — at no cost to you. But we know being healthy is about more than just doctor visits, so the benefits and services we offer are designed to make a difference in your life.

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What you get through Apple Health + behavioral health

The road to good health starts with having quality doctors and health benefits to turn to when you’re sick.

Your Apple Health benefits include things like:

  • Care from a primary care provider (PCP) you choose
  • Preventive care, like checkups and screenings
  • Specialist referrals
  • Emergency care
  • Prescription medicine
  • X-rays, labs and other tests
  • Immunizations (shots)
  • Eye exams
  • Family planning services
  • Quit for Life stop smoking program
  • Disease management for asthma, diabetes and other conditions
  • Case management for those with certain chronic conditions
  • Medically Intensive Children’s Program (MICP) — nursing support for children with complex medical needs 
  • And more

To learn more about Apple Health benefits, see our member handbook/visit the Health Care Authority (HCA) website. There are no copays or coinsurance for services included in your plan.

What you get through Amerigroup

We’re about more than just doctor visits. We give our members lots of no-cost extras — benefits beyond what you expect.

For adults:

  • Eyeglasses for members ages 21-64 (one pair, up to $100 per year)
  • A smartphone with monthly minutes, data and unlimited text messages
  • Acupuncture treatments (three sessions per year from a doctor in our plan)
  • GED testing for members ages 17 and older
  • Light box that helps prolong daylight during winter months for members with seasonal affective disorder (SAD) (ages 19 and older)
  • Peer support — we pay the registration and annual fees for members who want to become (or renew as) Peer Support counselors
  • Life transition kit for members who are either homeless, moving out of an institution and into the community or enrolled in a local employment program that includes:
  • First aid supplies
  • A travel toothbrush
  • Toothpaste
  • Mouthwash
  • Dental floss
  • An emergency blanket
  • An emergency resource card with phone numbers


For kids:

  • Boys & Girls Club membership for kids ages 6-18 (at participating clubs)
  • Sports physicals for members ages 7-18
  • Healthy Families program — support and nutrition and exercise coaching for families with children ages 7-17
  • YMCA membership to the YMCA in Wenatchee (for ages 19 and younger)


For all:

  • myStrength™ web and mobile tools to help improve your mental and emotional health 
  • My Wellness Guide — tools that help you take control of your health by setting goals, creating action plans and tracking progress (Link)
  • First aid and dental hygiene kits when you fill out a personal disaster plan online
  • Membership to one of four national disability advocacy organizations:
  • American Association of People with Disabilities (AAPD)
  • Autistic Self Advocacy Network (ASAN)
  • National Council on Independent Living (NCIL)
  • TASH

For pregnant women and new moms:

  • Taking Care of Baby and Me® rewards program lets you earn rewards just for going to your prenatal and postpartum checkups on time:
  • $10 for completing a prenatal visit in your first trimester or within 42 days
  • $40 for completing at least six prenatal visits
  • $25 for completing a postpartum visit 21-56 days after delivery
  • Electric breast pump (choose one):
  • Medela in Style advanced personal double breast pump
  • Ameda Purely Yours double electric personal pump
  • Ameda Purely Yours ultra pump
  • Circumcision for your newborn (up to $150)

You’ll get most of your health care from your PCP. He or she will get to know you and your health history and refer you to any specialists you need to see.

Your PCP’s name is listed on your ID card. If you’re not happy with him or her, you can switch anytime unless you’re in the Patient Review and Coordination program. To find a PCP in our plan near you, use our  Find a Doctor tool. To change your PCP, log in to your secure account or call Member Services at 1-800-600-4441 (TTY 711). 

As long as the provider is in our plan, you may choose any of the following to be your PCP:

  • Family physician
  • General practitioner
  • Nurse practitioner
  • Physician assistant
  • Pediatrician (for kids)
  • Internal medicine doctor (mostly for adults)
  • Geriatrician (for elderly adults)

Behavioral health issues are very common. Dealing with all of the tasks of a home and family can lead to stress. And stress can lead to:

  • Depression
  • Anxiety
  • Family, marriage, and/or parenting problems
  • Substance use disorder

Your behavioral health benefits include:

  • Evaluation and assessment
  • Group counseling
  • Peer support
  • Education about mental health, treatments and medications
  • Rehab case management
  • And more

Your substance use disorder services include:

  • Withdrawal management (detox)
  • Individual and group counseling
  • Case management
  • And more

To learn more about these benefits Health Care Authority (HCA) website.

If you need behavioral health or substance use disorder care, you can get it from:

  • Your PCP
  •  A plan Community Mental Health Center or substance use disorder agency
  • Another behavioral health or substance use disorder provider in your plan

You don’t need a referral from your PCP to see a behavioral health specialist in your plan. There are some treatments and services that need preapproval before you can get them. To learn more, talk to your doctor.

Always show your Amerigroup ID card when you get these services.

If you need help in a crisis, call our North Central Washington Crisis Line at 1-800-852-2923 (TTY 711). We’re available 24/7.

You can also call the Washington Recovery Help Line website at 1-866-789-1511 for 24-hour help with mental health and substance abuse issues.

We work with Express Scripts to provide your pharmacy benefits. We offer a wide range of prescriptions and many over-the-counter medicines (with an order from your doctor). There are no copays for your pharmacy benefits.

Find a pharmacy

When you need to fill your prescription, you must go to a pharmacy in our plan. 

Express Scripts Pharmacy Search

Formulary

This searchable formulary lists all the name brand and generic drugs included in your plan. Many of these drugs need preapproval from us before you get them.

If you and your doctor think you need medicine that’s not on our preferred drug list or formulary, you may ask for an exception by:

Search

Preferred drug list

Our preferred drug list (PDL) is a list of proven, commonly prescribed and affordable drugs. Your doctor should choose from this list when he or she writes you a prescription.

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Over-the-counter (OTC) preferred drug list

Drug interactions and side effects

To learn about drug interactions and side effects, visit the Express Scripts website.

Express Scripts reimbursement form

If you paid for a prescription that's normally paid by your pharmacy benefits and would like to be reimbursed, use this form:

Express Scripts online registration instructions

On the Express Scripts website, you can order refills, track prescriptions and more. To sign up, use the instructions below:

Express Scripts mail order form

If you would like your prescriptions delivered to you, use this form:


Your dental benefits are paid by the state (using your ProviderOne card). To learn about these benefits, see the member handbook.

Children and youth under age 21 get:

  • Eye exams every 12 months*
  • Glasses, contact lenses and fittings (these benefits are paid by the state using your ProviderOne card)

Adults age 21 and older get:

  • Eye exams every 24 months*
  • Glasses — one pair per year for members ages 21-64 (up to a $100 value)

*Eye exams can be more frequent if medically needed

You can get rides to and from nonemergency medical appointments. These benefits are paid by the state (using your ProviderOne card). To learn more, see the member handbook.

We put tools and technologies in your hands to make it easier to access care and services. Your Care Plan is a tool for Apple Health Medicaid Apple Health Medicaid + behavioral health and Behavioral Health Services Only (BHSO) Case Management members to help you:

  • Stay connected with your care coordinator
  • Get your care coordinator’s phone number and email address
  • Send secure messages about diagnoses, goals, medicines, services and more
  • View your goals and objectives
  • Check due dates and statuses of goals and objectives
To use this tool:
  • Choose Go to Your Care Plan below
  • Log in or register if you don’t have an account
Continue to Your Care Plan

Certain services may require a referral and/or preapproval. To learn more, visit our referrals and preapprovals page.

Your member resources

We know health care can be confusing. So here are some tools to help you keep track.

Member handbook

The handbook is your go-to guide for all the benefits included in your plan. Read it to learn about:

  • The benefits you get through Amerigroup
  • The benefits you get through the state (using your ProviderOne card)
  • Your ID cards
  • Important phone numbers
  • Your member rights and responsibilities
  • How we protect your privacy
  • How to file complaints, appeals and administrative hearings
  • And more

You can read your member handbook below:

Personalized treatment plan form

Did you know most doctor appointments only last 15 minutes? To get the most of your time, it’s good to be prepared. Fill out this form and bring it with you to your appointment.


myStrength Website

Use myStrength to help improve your mental and emotional health