2019 Careoregon Advantage Plus (HMO-POS SNP) Provider Directory
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2019 CareOregon Advantage Customer Service CALL: 503-416-4279 or toll-free 888-712-3258 Provider Directory TTY/TDD: 711 HOURS OF OPERATION: every day, 8 a.m. to 8 p.m. CareOregon Advantage Plus (HMO-POS SNP) For Oregon counties: Clackamas, Columbia, Jackson, Multnomah, Tillamook and Washington facebook.com/careoregon twitter.com/careoregon careoregonadvantage.org H5859_PS2019_1080_NM COA-18422-0820 Multi Language InterpreterIntroduction Services H5849_4036_CO_2018 CMS Accepted Multi Language Insert H5849_4036_CO_2018 08/28/17 CMS Accepted 3 Introduction Discrimination is Against the Law in another way on the basis of race, color, national origin, age, disability, or sex, you can CareOregon Advantage complies with file a grievance with: applicable Federal civil rights laws and does not discriminate on the basis of race, Grievance Coordinator color, national origin, age, disability, or sex. 315 SW Fifth Ave CareOregon Advantage does not exclude Portland, OR 97204 people or treat them differently because Toll-free: 888-712-3258 of race, color, national origin, age, disability, TTY/TDD: 711 or sex. Fax: 503-416-1313 Email: MedicareEnrollmentServices@ CareOregon Advantage: careoregon.org Provides free aids and services to people You can file a grievance in person or by with disabilities to communicate effectively mail, fax, or email. If you need help filing a with us, such as: grievance, Customer Service is available to • Qualified sign language interpreters help you. • Written information in other formats You can also file a civil rights complaint with (large print, audio, accessible electronic the U.S. Department of Health and Human formats, other formats) Services, Office for Civil Rights, electronically Provides free language services to people through the Office for Civil Rights Complaint whose primary language is not English, Portal, available at https://ocrportal.hhs.gov/ such as: ocr/portal/lobby.jsf, or by mail or phone at: • Qualified interpreters U.S. Department of Health • Information written in other languages and Human Services 200 Independence Avenue, SW If you need these services, contact Room 509F, HHH Building CareOregon Advantage Customer Service Washington, D.C. 20201 If you believe that CareOregon Advantage 800-368-1019, (TDD) 800-537-7697 has failed to provide these services or discriminated Complaint forms are available at http:// www.hhs.gov/ocr/office/file/index.html 5 CareOregon Advantage Plus (HMO-POSIntroduction SNP) Plan Provider Directory This directory is current as of September 2018. CareOregon Advantage Plus is an HMO-POS SNP with a Medicare/Medicaid contract. This directory provides a list of CareOregon Enrollment in CareOregon Advantage Plus Advantage Plus’s current network providers. depends on contract renewal. This directory is for our service area, which This information is available in a different includes Clackamas, Columbia, Jackson, format, including large print. Please call Multnomah, Tillamook and Washington Customer Service at the number listed above counties in Oregon. if you need plan information in another format To access CareOregon Advantage Plus’s or language. online provider directory, you can visit careoregonadvantage.org/providersearch. For any questions about the information contained in this directory, please call our Customer Service Department at 503-416- 4279 or toll-free 888-712-3258, daily, 8 a.m. to 8 p.m. TTY/TDD users should call 711. 2019 COA PLUS PROVIDER DIRECTORY 09/12/2018 H5859_PS2019_1080_NM 1 TableIntroduction of Contents Section 1 – Introduction Section 2 – List of Network Providers What is the Point of Service (POS) Primary Care Physicians..........................................9 benefit and how to use it ........................................5 Specialists ................................................................. 40 What should you do if you have bills from non-network providers that Hospitals ..................................................................103 you think should be paid by CareOregon Advantage? .......................................6 Urgent Care Facilities ..........................................105 What is the service area for Skilled Nursing Facilities (SNF) .......................... 113 CareOregon Advantage? ....................................... 7 Vision Providers ...................................................... 115 Getting care when traveling or away from the plan’s service area .................................. 7 Mental Health Providers .....................................128 How do you find CareOregon Advantage Index ..........................................................................150 providers in your area? ...........................................8 3 Introduction This directory provides a list of CareOregon • Emergency services, whether you get these Advantage Plus’s network providers. To get services from network providers or non- detailed information about your health care network providers. coverage, please see your Evidence • Urgently needed care that you get from of Coverage. non-network providers when you are temporarily outside the plan’s service area. You will have to choose one of our network • Renal dialysis (kidney) services you get providers who are listed in this directory to be when you are temporarily outside the plan’s your Primary Care Provider (PCP). The term service area. “PCP” will be used throughout this directory. For more information about covered services Generally, you must get your health care and prior authorization, please see your services from your PCP. Evidence of Coverage. The network providers listed in this directory have agreed to provide you with your health What is the Point of Service (POS) benefit care services. You may go to any of our and how to use it network providers listed in this directory, however, some services may require a prior With CareOregon Advantage Plus’s Point authorization from CareOregon Advantage. If of Service (POS) benefit, you may see you have been going to one network provider, non-network providers who are willing to you are not required to continue going to that provide services under Medicare Part A and same provider. In some cases, you may get B (Original Medicare) and agree to accept covered services from non-network providers. CareOregon Advantage’s payment terms and conditions. Please note: with the Generally, you see your PCP first for most of exception of emergencies or urgent care, your routine health care needs. There are only it may cost more to get care from out-of- a few types of covered services you can get network providers using the POS benefit. on your own from a network provider, without See your Evidence of Coverage for your seeing your PCP first: exact POS benefit information. • Routine women’s health care, which includes breast exams, mammograms, pap tests and pelvic exams. This care is covered without a referral from your PCP. • Flu shots and pneumonia vaccinations. 5 2019 CareOregon Advantage Plus PROVIDER DIRECTORY What should you do if you have bills from CALL non-network providers that you think should be paid by CareOregon Advantage? 503-416-4279 in Portland, Oregon, or toll- free at 888-712-3258. You may call any day In addition to your Point of Service (POS) between 8 a.m. and 8 p.m. These numbers are benefit, we also cover certain health care also on the back cover of this booklet for easy services that you get from non-network reference. Calls to these numbers are free. providers. These include care for a medical emergency, urgently needed care, renal dialysis (kidney) that you get when you are TTY/TDD outside the plan’s service area, care that has 711. This number is on the back cover of been approved in advance by your network this booklet for easy reference. Calls to this provider and any services which were ordered number are free. to be covered through an appeals process. You should never pay any non-network WRITE provider more than what the plan is allowed by Medicare. The provider has a right to get his/ 315 SW Fifth Ave her fees, but does not have a right to get them Portland, Oregon 97204 from you. Ask the non-network provider to bill Or visit our website: us first. careoregonadvantage.org • If you have already paid for the covered services, we will reimburse you for our share of the cost. VISIT • If you get a bill for the services, you can 315 SW Fifth Ave send the bill to us for payment. We will pay Portland, Oregon 97204 your non-network provider for our share of the bill and will let you know what, if anything, you must pay. What is the service area for CareOregon If a non-network provider asks you to pay for Advantage? covered services you get in these situations, please contact us at: The counties in our service area are: Clackamas, Columbia, Jackson, Multnomah, Tillamook and Washington counties in Oregon. 6 Introduction Getting care when traveling or away How do you find CareOregon Advantage from the plan’s service area providers in your area? If you need care when you are outside the This handbook includes names and contact service area, your health care coverage is information of different provider types. Each very limited. The only services we cover when provider type is organized alphabetically by you are outside our service area are care for state, county, city, ZIP code and provider name. a medical emergency, including maintenance Provider types include: care and hospital care after you are stable • Primary Care Physicians (known as post-stabilization care), urgently • Specialists