Member FAQs

What Every Harbor Health Member Should Know

A Quick Reference to Frequently Asked Questions. If you have additional questions, please call us at 1-844-427-2671

   

Need to Choose a PCP?

Call us at 1-844-427-2671 for help. We can send you a copy of the Provider Directory or you can view it online.

The Provider Directory lists:

  • Names of PCPs, Specialists, Hospitals and Ancillary providers (such as drug stores, medical suppliers, home health care)
  • Addresses
  • Language spoken
  • Phone numbers
  • Any hospital affiliation
  • Days and hours open

You can go to the Provider Directory or call Harbor's Member Services to obtain the following information on participating providers:

  • Name, address, telephone numbers
  • Professional qualifications
  • Specialty
  • Medical school attended
  • Residency completion
  • Board certification status
Need to See an OB/ GYN?

You may see an OB/GYN for annual well-woman examinations and routine OB/GYN care without a referral from their PCP.

Request a Change in My PCP

Call us at 1-844-427-2671. Remember: Your assignment to a new PCP will be effective on the first day of the following month if requested by the 15th of the current month.

  • You should verify the effective date of change with us when you request the change
  • While the change is being made, you should continue to see your current PCP
Need to Make an Appointment?
  • Call your PCP’s office during regular business hours to set up an appointment
  • Tell them you are a Harbor Health member
  • Tell them why you need to see your PCP
  • Call your PCP early in the morning for an appointment for same day
  • Have your mihealth and Harbor Health Plan ID card available when you call your PCP
  • Leave a message if you reach their answering machine
Need to See a Specialist?

Ask your PCP for a referral. Your PCP will give it to the specialist.

You can go to the Provider Directory or call Harbor's Member Services to obtain the following information on participating providers:

  • Name, address, telephone numbers
  • Professional qualifications
  • Specialty
  • Medical school attended
  • Residency completion
  • Board certification status
Need a Referral or Authorization?

Please remember:

  • You must need the medical care
  • Your PCP must approve your visit to a specialist or other provider
  • You must have a referral from your PCP
  • A referral from your PCP is also necessary for all follow-up care after emergency treatment
  • Your PCP will arrange for a second opinion if it is needed
Get Sick or Hurt While Out of Town?

If you have a medical emergency and are outside Macomb, Wayne, or Oakland Counties:

  • You may go to the nearest hospital. No referral or prior authorization is needed for emergencies
  • Call your PCP to obtain an authorization for all other out of area medical care needs
  • If you cannot get in touch with your PCP, call Harbor Health Plan at 1-844-427-2671
  • Routine care obtained outside of the Harbor’s service area (Macomb, Wayne, or Oakland counties) may not be covered
Have a Serious or Life Threatening Emergency?

If you have an emergency that is so serious or life threatening that delay might cause death or permanent harm: 

  • Go to the nearest emergency room or call 9-1-1
  • You do not have to call us or your PCP
Need Transportation?
  • Call 9-1-1 if you have a true medical emergency
  • If you need non-emergency transportation such as a ride to get to your doctor’s appointment, please call us at 1-844-427-2671. We will need to ask you some questions and time to schedule your ride
Need a Prescription Filled?

Call us at 1-844-427-2671 if you:

  • Have any questions about your drug coverage
  • Need to know the Pharmacy nearest to you
  • Want a copy of the Drug List (formulary) or Provider Directory
Need a List of Providers for Eye Care?

Visit any of the locations in the Provider Directory to get your vision services and check-ups

Call us at 1-844-427-2671. We cover routine eye tests, lenses and frames. You can visit any of the locations in the Provider Directory to get your vision services and check-ups

Need Mental Health Care?

Talk to your PCP or call us at 1-844-427-2671. We cover up to 20 visits per year for outpatient mental health services

Go to the nearest emergency room if you have a mental health emergency

Think You are Pregnant?

Call your PCP right away and have a pregnancy test

When you are sure you are going to have a baby:

  • Your PCP can help you choose a maternity care provider
  • It is important for the health of your baby to see your maternity care provider as early as possible. Don’t delay!

Have a Newborn Baby?

Call your DHS caseworker to enroll your newborn baby in the Medicaid program. You can also enroll your baby in your Harbor Health.

You will get a new ID card for your baby.

Need to report changes in your family size, name, address or phone number?

Report the changes by calling us at 1-844-427-2671

Changes in your family size must be report to Harbor Health and also be reported to DHS

Need to File a Grievance or Appeal?

Call us at 1-844-427-2671 or file a complaint directly with the State of Michigan within 90 days of denial, reduction or termination of a service.

Suspect Fraud and Abuse?

If you have any information about fraud and abuse or think that someone may have used your I.D. card, please contact Harbor Health. You can report fraud and abuse without giving your name by calling our Compliance Hotline at 1-866-832-5469. All calls are private.

Or you can call the State of Michigan at 1-855-MI-FRAUD (643-7283) or send a letter to Office of Health Services Inspector General, PO Box 30062, Lansing, MI 48909-7562. You can also use the Online Complaint Form at: michigan.gov/fraud

Want to Grant Others Access to Your Information?

If you want a family member or friend to ask Harbor Health for your personal health information, you must give us written permission.

Was Your ID Card Stolen?

Call us immediately at 1-844-427-2671

Need Further Help or Answers to Questions?

Need help or have questions (diabetes, to quit smoking, asthma)? Call us at 1-844-427-2671 and we will provide help.

Receive a Claim?

Do not ignore a bill or throw it away. If you get a bill, you should send it to Harbor Health Plan right away. Include a short note which includes the member's name, ID number and phone number as we may need to reach out for questions. Send a copy of the bill to Harbor Health Plan, Inc at P.O. Box 441970, Detroit, MI 48244-1970.

Sometimes Harbor will reject payment for a bill if the service was not approved or covered. If this happens and you disagree with the rejection, call Member Services at (844)-427-2671.

Need care after normal business hours?

If you need After-Hours care:

  • Call your provider as they may have an after-hours service or nurse on call to assist you. They can refer you to a provider who is open, an urgent care, set up an appointment for you in the morning or refer you to an Emergency Room
  • Go to an Urgent Care if you are having issues finding one you can call Harbor's Member Services (844-427-2671) and they can assist
  • Call Harbor's Member Services (844-427-2671) for assistance in locating after hours care
How to obtain your benefit information?

New technology: Harbor wants to make sure that you have access to high quality healthcare and new health technologies. Harbor works with the State and Federal governments, and providers to research this. If you have any questions or concerns on what new technologies are covered, please contact Harbor as 1-844-427-2671

Medicaid Benefits: The Medicaid Benefits that are covered are listed in your Harbor Health Plan Handbook. If you have any questions, concerns, or do not have the Handbook available, please contact Harbor at 1-844-427-2671

Healthy Michigan Benefits: The Healthy Michigan Benefits and Copay structure are located in your Harbor Health Plan Handbook. If you have any questions, concerns, or do not have the Handbook available, please contact Harbor at 1-844-427-2671