Member Services

At Health Choice Generations (HMO D-SNP), members are our number one priority. Our mission is to treat you with the utmost respect and dignity while providing you safe, effective, quality healthcare.

One way to accomplish this is to provide members with outstanding customer service. Health Choice Generations has formed a team of knowledgeable, experienced Member Services representatives. Member Services’ sole purpose is to help resolve any questions or problems.

A few examples the Health Choice Generations Member Services team can assist with:

  • Check eligibility and/or benefits
    • Determine benefit and financial responsibility for a specific service or treatment from a specified provider or institution.
  • Request a replacement ID Card
  • Member Demographic updates (such as change of address or phone number/contact information)
  • Assistance with locating a provider
  • Pharmacy benefit information
    • Determine financial responsibility for a drug, based on the pharmacy benefit
    • Check the status on denials or appeals [Or, Initiate the exceptions process for Medicare]
    • Order a refill for an existing, unexpired mail-order prescription
    • Find the location of an in-network pharmacy in close proximity based on zip code search
    • Determine the availability of generic substitutes
  • Change a primary care practitioner, as applicable
  • Prior Authorization information (Medical Services)
    • Determine how and when to obtain referrals and authorizations for specific services, as applicable.
    • Check the status on denials or appeals
  • Check Claims Status (non-payment of a claim)

Our Member Services Department is open 8 a.m. – 8 p.m., 7 days a week and can be reached by calling 1-800-656-8991. TTY users should call 711. Or, you may e-mail Member Services at

For additional information related to your Pharmacy benefit, or prescription drugs, you may also visit the Prescription Drug Information page

Prior Authorizations

Some medical tests or services require prior authorization before they are scheduled.  Your provider requests prior authorization on your behalf.  A prior authorization, commonly called a ‘PA’, is not a promise Health Choice will cover the cost of the service.

 A PA request is a form your provider fills out and sends to Health Choice. Our prior authorization department will review the request and make a decision. A decision for a standard request is made within 14 calendar days and a decision for an expedited request is made within 3 calendar days. You and your provider will be notified if the service is approved or denied.

 If you have a question about prior authorizations, Member Services can help you. Call us at 1-800-656-8991 (TTY 711). Our Member Services Department is open 8 a.m. to 8 p.m., 7 days a week. You can also contact us by e-mail at

Your Health Care Buddy

Health Choice Generations understands the importance of individualized care. That is why we assign every member their very own health care buddy. Your health care buddy will contact you regularly throughout the year to help you with your health care needs including, finding a doctor and helping you make appointments.

Your buddy is just a phone call away!


Last Updated: 06/19/2020

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