Mashantucket Pequot Tribal Family Health Plan:
- Plan at a Glance
- Summary Plan Description
- Teladoc
- Pequot Imaging
- Pequot Healthy Weight Program
- Find A Provider
Need help? Contact us at:
- 1-888-779-6872 - TPA
- 1-866-859-5975 - Pharmacy (for Iphone users)
- 1-800-342-5779 - Pharmacy
- Teladoc
- 1-800-835-2362 - Phone Consult
- teladoc.com/mobile - Video Consult
- Tribal Health Services Contact List
Mashantucket Pequot Tribal Family Health Plan (MPTFHP) Frequently Asked Questions
How come my claim was denied for Medicare Explanation of Benefits (EOB)? Pequot Plus Healthcare Benefit Services (PPHBS) has always paid the claims as prime.
The Tribal Elder/Tribal Member is enrolled in the Mashantucket Pequot Tribal Family Health Plan (MPTFHP) and is not an Employee Group Health Plan; therefore, Medicare is the primary carrier and MPTFHP is payer of last resort.
When did this take effect?
Medicare has always been the primary carrier for the MPTFHP, in which membership is based on citizenship and not employment.
If you have questions regarding your MPTFHP:
To address inquiries from a Tribal Elder/Tribal Member and/or a dependent covered under the MPTFHP, Pequot Plus Health Benefit Services (PPHBS) has designated specific team members to handle said inquiries (benefits coverage, status of paid claims, locating a provider or other insurance information, etc.). Concerns and/or inquiries from MPTFHP covered members (whether in person,email or by phone) should be forwarded to the following team members:
- Claims examiner Althnageebah Myles 860-396-6443 or AMyles@prxn.com
- TPA Manager Paula Jett 860-396-6423 or PJett@prxn.com
Can a Tribal Member lose their Medicare Coverage?
If a Tribal Elder/Tribal Member is enrolled in Medicare, Part A (hospital insurance) and Part B (medical insurance), a Tribal Elder/Tribal Member can lose their coverage if they do not make their premium payments. Failure to do so will result in the termination of their Medicare coverage.
What should a Tribal Elder/Tribal Member do upon receiving a provider bill?
Concerns and/or inquiries from MPTFHP covered members (whether in person or by phone) should be forwarded to the following team members to address:
- Claims examiner Althnageebah Myles 860-396-6443 or AMyles@prxn.com
- TPA Manager Paula Jett 860-396-6423 or PJett@prxn.com
My medical status changed; should I inform my providers?
A Tribal Elder/Tribal Member should update their providers upon any change of status.
PPHBS mailed a Other Insurance Form Letter; should I complete the form?
A Tribal Elder/Tribal Member should complete the form. Upon completing the Other Insurance form, it may be mailed, submitted via fax, or verbally provided to any designated specific team members listed below:
- Claims examiner Althnageebah Myles 860-396-6443 or AMyles@prxn.com
- TPA Manager Paula Jett 860-396-6423 or PJett@prxn.com
Mashantucket Pequot Tribal Member and Behavioral Health Frequently Asked Questions
What do I do when I decide to enter Rehab/Detox?
To address inquiries from a Tribal Elder/Tribal Member and/or a dependent covered under the Mashantucket Pequot Tribal Family Health Plan (MPTFHP), Pequot Plus Health Benefit Services (PPHBS) has designated specific team members to handle said inquiries (benefits coverage, status of paid claims, locating a provider or other insurance information, etc.). Concerns and/or inquiries from MPTFHP covered members (whether in person or by phone) should be forwarded to the following team members:
- Paula Jett Manager Administration Services & TM Concierge 475-441-8015 or PJett@prxn.com
- Althnageebah Myles Senior Claims examiner 475-655-0147 or AMyles@prxn.com
How do I know if the services I am receiving will be covered by my benefits?
To address inquiries from a Tribal Elder/Tribal Member and/or a dependent covered under the Mashantucket Pequot Tribal Family Health Plan (MPTFHP), Pequot Plus Health Benefit Services (PPHBS) has designated specific team members to handle said inquiries (benefits coverage, status of paid claims, locating a provider or other insurance information, etc.). Concerns and/or inquiries from MPTFHP covered members (whether in person or by phone) should be forwarded to the following team members:
- Paula Jett Manager Administration Services & TM Concierge 475-441-8015 or PJett@prxn.com
- Althnageebah Myles Senior Claims examiner 475-655-0147 or AMyles@prxn.com
As a reminder:
Please be aware that if you receive services from an Out-of-Network facility, you could be responsible for the balance-up to-charge.
Do I need pre-authorization for Behavioral Health Outpatient Office Visits?
No
Do I need pre-authorization for the following services?
| Inpatient Hospital Treatment | Yes |
| Residential Treatment | Yes |
| PHP (Partial Hospitalization Program)? | Yes |
| IOP (Intensive Outpatient Hospitalization? | Yes |
Do I need pre-authorization for Detox Treatment?
Yes
What number do I call to obtain pre-authorization?
Should I call Customer Service prior to going to a Rehabilitation Facility?
Yes
Should my provider call for pre-authorization prior to my entering a facility?
Yes
What number should my provider call to verify benefits?
- Verify Medical Eligibility 866-596-8447
- Pre-notification (USC) 800-595-6241
- UHIS Direct 866-427-7702
Is it my responsibility to obtain pre-authorization for facility services?
Yes
Is Hartford Health in network for Medical and Behavioral Services?
Yes