ABOUT THE OCO
WHAT IS ONE CARE?
One Care is a health care insurance option for some adults with disabilities living in Massachusetts who are eligible to receive both Medicare and MassHealth services. With One Care, there is one plan, one card, and one person to coordinate your health care. One Care covers all of the services a person gets with Medicare and MassHealth. This includes medical, prescription drug, behavioral health and community support services. Medicare and MassHealth have joined together with two health plans to offer One Care.
These plans are:
- Commonwealth Care Alliance
- Tufts HealthPlan Unify
WHAT IS THE ONE CARE OMBUDSMAN?
The One Care Ombudsman (OCO) is an independent office that helps individuals, including their significant others and representatives, to address concerns or conflicts that may interfere with their enrollment in One Care or their access to One Care health benefits and services.
WHAT DOES THE OCO DO?
The OCO helps resolve service and benefit issues and conflicts in a variety of ways:
Provide information. OCO staff answer questions about One Care - from the enrollment process to specific benefits and rights.
Investigate. OCO staff dig a little deeper to understand the problem, discuss options and find potential solutions.
Mediate. OCO staff can bring together people who want to discuss potential solutions to One Care problems.
Discuss options. The OCO helps individuals find and consider options for resolving problems.
Grievance/appeal process. If the member chooses, OCO staff can work with One Care members and their plan to try to resolve a concern before filing a grievance or an appeal. While the OCO cannot represent a member in grievance or appeal proceedings, the OCO can explain how to file an appeal and what to expect during the appeal process.
Make referrals. The OCO can refer individuals to information, problem resolution resources, including formal grievance and appeal processes and legal services.
HOW Do we provide OCO Services?
- Listen. OCO staff listen in order to understand an issue from all sides.
- Maintain confidentiality. The OCO will not reveal personal information without the individual’s permission unless there is a serious and imminent threat to health and safety of the individual or others.
- Remain neutral. OCO staff will not judge or decide who is right or wrong, or make decisions.
THE OCO STAYS NEUTRAL.
The OCO will not serve in any other role that would compromise their neutrality.
The OCO will not represent a member in a grievance or appeal proceeding.
Who operates the OCO program?
The One Care Ombudsman is an independent program operated by The Disability Policy Consortium.