U2638 Unable to Reach Letter - UCare



FORMTEXT <Date> FORMTEXT <Member Name> FORMTEXT <Member Address> FORMTEXT <City State Zip>Dear FORMTEXT <Member Name>: Your Care Coordinator has been unable to reach you by telephone. I am writing to ask you or an authorized representative to call me at FORMTEXT <phone number>. If you reach my voicemail, please leave a message with your daytime telephone number and a date and time that I can call you. If you are hearing impaired, please call the Minnesota Relay at 711 or 1-877-627-3848 (speech-to-speech relay service). The reason I am trying to reach you is: FORMCHECKBOX Six (6) month check-in FORMCHECKBOX To schedule your annual assessment FORMCHECKBOX Other: FORMTEXT <explanation of other reason> Please call me as soon as you receive this letter. I look forward to speaking with you.Sincerely, FORMTEXT <Care Coordinator Name> FORMTEXT <Care Coordinator Job Title> FORMTEXT <County or Agency Name> FORMTEXT <Phone Number> FORMTEXT <E-mail Address>UCare’s MSHO (HMO SNP) is a health plan that contracts with both Medicare and the Minnesota Medical Assistance (Medicaid) program to provide benefits of both programs to enrollees. Enrollment in UCare’s MSHO depends on contract renewal.MSC+ H2456_021519 DHS Approved (02152019)U2638A (02/19) 0000000000000000 ................
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