2021 Provider & Pharmacy Directory Directorio De Proveedores Y Farmacias
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2021 Provider & Pharmacy Directory Directorio de Proveedores y Farmacias San Bernardino County This Provider & Pharmacy Directory was updated on 04/2021. For more recent information or other questions, please contact Golden State Medicare Health Plan at 1-877-541-4111 or, for TTY users, 711, 8 AM to 8 PM, 7 days a week from October 1 – March 3. From April 1 – September 30, hours are 8 AM — 8PM Monday through Friday (7 days a week for Connected Care Select members) or visit www.gsmhp.com. Changes to our pharmacy network may occur during the benefit year. A n updated Provider & Pharmacy Directory is located on our website at www.gsmhp.com. You may also call Member Services for updated provider. Connected Care (HMO) Provider Directory This directory is current as of 04/01/2021. This directory provides a list of Golden State Medicare Health Plan’s current network providers. This directory is for San Bernardino County. To access Golden State Medicare Health Plan’s online provider directory, you can visit www.gsmhp.com. For any questions about the information contained in this directory, please call our Member Service Department at 1-877-541-4111, 8 AM to 8 PM, 7 days a week from October 1 - March 3. From April 1 - September 30, hours are 8 AM - 8PM Monday through Friday (7 days a week for Connected Care Select members). TTY/TDD users should call 711. Golden State Medicare Health Plan is an HMO with a Medicare contract. Enrollment in Golden State Medicare Health Plan depends on contract renewal. The Provider and Pharmacy Network may change at any time. You will receive notice when necessary. This document may be available in an alternate format such as large print. Directorio de proveedores del plan Este Directorio está vigente a partir del 04/01/2021. Este Directorio ofrece una lista de los proveedores de la red actuales de Golden State Medicare Health Plan. Este Directorio es para el Condado de San Bernardino. Para acceder al Directorio de proveedores en línea de Golden State Medicare Health Plan, puede visitar www.gsmhp.com. Si tiene preguntas sobre la información incluida en este Directorio, llame a nuestro Departamento de servicios 1-877-541-4111, de 8 a.m. a 8 p.m., los 7 días de la semana desde el 1 de octubre hasta el 31 de marzo. Del 1 de abril al 30 de septiembre, atendemos de 8 a.m. a 8 p.m. de lunes a viernes (los 7 días de la semana para miembros de Connected Care Select). Los usuarios de TTY/TDD deben llamar al 711. Golden State Medicare Health Plan es un plan HMO con un contrato con Medicare. La inscripción en Golden State Medicare Health Plan depende de la renovación del contrato. La red de proveedores y farmacias puede cambiar en cualquier momento. Usted recibirá un aviso cuando sea necesario. Este documento puede estar disponible en un formato alternativo como letra grande. I Table of Contents / Índice Section 1 – Introduction .............................................................................................................. III Sección 1 – Introducción ........................................................................................................... IV What is the service area for Golden State Medicare Health Plan? ...................................... VI ¿Cuál es el área de servicio de Golden State Medicare Health Plan? ................................ VI How do you find Golden State Medicare Health Plan providers that serve your area? .......VII Cómo encontrar a los proveedores de Golden State Medicare Health Plan que atienden en su área ............................................................................................................................. VII Section 2 – List of Network Providers / Sección 2: Lista de proveedores de la red.................VII Primary Care Providers/ Proveedores de atención primaria (PCPs) ..................................... 1 Specialists / Especialistas ..................................................................................................... 27 Hospitals / Hospitales ........................................................................................................... 91 Skilled Nursing Facilities / Centros de enfermería (SNFs)................................................... 93 Outpatient Mental Health Providers / Proveedores de salud mental para pacientes ambulatorios.......................................................................................................................... 98 Ancillary Services / Servicios auxiliares ............................................................................. 107 2021 Pharmacy Directory .................................................................................................... RxI Directorio de Farmacias de 2021........................................................................................ RxII II Section 1 – Introduction This directory provides a list of Golden State Medicare Health Plan’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. Your PCP is a physician who meets state requirements and is trained to give you basic medical care. Your PCP will also coordinate the rest of the covered services you get as a member of our Plan. For example, in some situations your PCP must give you approval in advance before you can use other providers in the plan’s network, such as specialists, hospitals, skilled nursing facilities, or home health care agencies. This is called giving you a “referral.” Your PCP will provide most of your care and will help you arrange or coordinate the rest of the covered services you get as a member of our Plan. Selection of a PCP also determines your selection of specialists, hospitals, and facilities. When a PCP is in more than one Independent Physician Association (IPA) or Medical Group, you must also select which IPA/Medical group you would like. If you would like to receive services from a Golden State Medicare Healthcare network provider that is not affiliated with your IPA/Medical Group, you may have to change your PCP. The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory; however, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers. Other providers are available in our network. We cover certain health care services that you get from non-contracted providers. These include: care for a medical emergency, urgently needed care, renal dialysis that you get when you are outside the plan’s service area, care that has been approved in advance by Golden State Medicare Health Plan, and any services which were covered through the appeals process. If a non-contracted provider asks you to pay for covered services, contact us at: Golden State Medicare Health Plan c/o Claims Department P.O. Box 10729 Newport Beach, CA 92658 1-877-541-4111 You should never pay any non-contracted providers more than what the plan is allowed by Medicare. The provider has a right to get his/her fees but does not have a right to get them from you. Ask the non-contracted provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If you get a bill for services, you can send the bill to us for payment (address listed above). We will pay your non-contracted provider for our share of the bill and will let you know what, if anything you must pay. A “medical emergency” is when you, or any other prudent layperson with an average knowledge of health and medicine, believe that you have a medical symptom that requires immediate III medical attention to prevent loss of life, loss of limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain, or a medical condition that is quickly getting worse. If you have a medical emergency: • Get help as quickly as possible. Call 911 for help or go to the nearest emergency room hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP. • We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. You should also have someone call your PCP at the number listed on your membership card as soon as reasonably possible. After the emergency is over you are entitled to post stabilization care to be sure your condition continues to be stable. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow. You must use network providers except in emergency or urgent care situations or for out-of- area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Golden State Medicare Health Plan will be responsible for the costs. Sección 1: Introducción Este Directorio ofrece una lista de los proveedores de la red de Golden State Medicare Health Plan. Para obtener información detallada sobre su cobertura de atención médica, consulte su Evidencia de cobertura (Evidence of Coverage, EOC). Tendrá que