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Provider Directory CLEAR CARE® (HMO) Provider Directory • Group Health Cooperative Clear Care® Vital (HMO) • Group Health Cooperative Clear Care® Basic (HMO) • Group Health Cooperative Clear Care® Essential (HMO) • Group Health Cooperative Clear Care® Optimal (HMO) Y0033_H5050_21GHMC_2012-09-15W CMS APPROVED 07-26-2012 FINAL CLEAR CARE® HMO Provider Directory Welcome to Group Health Cooperative’s Clear Care (HMO) Plans This directory is current as of September 11, 2012 Thank you for giving us the opportunity to support you in the pursuit of better health. This directory provides a list of HOW TO SELECT Clear Care (HMO) network providers and pharmacies. To get A PERSONAL PHYSICIAN detailed information about your health care coverage, please see your Evidence of Coverage and Group Health Prescription Drug When you select a personal physician Formulary. In the next few pages, we’ll show you how to use for yourself or a member of your this directory to get the most from your health plan. family, you’ve just made one of the most important decisions when it The network providers listed in this directory have agreed comes to your health. to provide you with your health care. You may go to any of our You can select a personal network providers listed in this directory; however, some services physician from this directory, or go may require a referral. We call the pharmacies on this list our to ghc.org/medicare and choose one ”network pharmacies“ because we have made arrangements online. Since availability is subject to with them to provide prescription drugs to Plan members. In change, please call Customer Service to most cases, your prescriptions are covered only if they are filled confirm a doctor’s status or to get help at a network pharmacy or through our mail order pharmacy in selecting a doctor. You can change service. Once you go to one, you are not required to continue physicians at any time, for any reason. going to the same pharmacy to fill your prescription. You can Just log on to ghc.org/medicare or go to any of our network pharmacies. call Customer Service for help. The service area for our Clear Care (HMO) plans include the Experts agree that maintaining a following counties in Washington: Island, King, Kitsap, Lewis, personal relationship with your doctor Skagit, Snohomish, Spokane, Thurston, Whatcom, and parts of is important throughout life—when Mason (98524, 98528, 98546, 98548, 98555) and Grays Harbor you’re young, as you have a family, and (98541, 98557, 98559, 98568).* as you age. And the time to get started All network providers and pharmacies may not be listed in is right now, before you need care. this directory. For the most current list of providers and Sometimes a doctor, specialist, clinic, or pharmacies or for additional information, visit our website at other plan provider you are using might ghc.org/medicare or call Customer Service. leave the plan. If this happens, you will have to switch to another provider who is part of the Clear Care (HMO) plan. If you have questions If your personal physician leaves Call Customer Service at 1-888-901-4600 or visit Group Health, we will let you know ghc.org/medicare. Both resources make it easy to choose and help you switch to another a personal physician, get directions to medical centers and personal physician to continue pharmacies, and much more. your care and covered services. *denotes partial county i | 1.888.901.4600 | ghc.org/medicare CLEAR CARE® (HMO) Provider and Pharmacy Directory Personal physicians Choose a personal primary care physician from this chapter. They’ll help to guide and monitor your health care needs, from prevention to specialty care to hospitalization. Specialty care This chapter lists all Group Health specialists, including those you may self-refer to and those that require a referral from your personal physician. To see a specialist that requires a referral, your personal physician will assess your condition and authorize treatment, if necessary. Behavioral Health Services This chapter lists our mental health and chemical dependency service locations, and also outlines the steps required to access this care. Urgent care This chapter lists Urgent Care facilities. Use urgent care when you require immediate care and you cannot access your personal physician. Hospitals If you require hospitalization, your personal physician will authorize your stay at a hospital listed in this chapter. In the event of any emergency, please go to the nearest hospital. The emergency rooms listed in this chapter should only be used for medical emergencies, which usually involve severe illness or injury. Call your personal physician or the Consulting Nurse helpline if you are unsure if your condition is an emergency. ii | 1.888.901.4600 | ghc.org/medicare CLEAR CARE® (HMO) Provider and Pharmacy Directory Pharmacies NOTE: If you have purchased a prescription drug benefit, please review the information in the next page regarding prescription benefits. If you have coverage through the Group Health has contracted with pharmacies that equal or exceed Clear Care Basic (HMO) plan, you are CMS pharmacy access requirements in your area. not covered for most prescription drugs. You might find cost savings This section provides a list of the Clear Care (HMO) contracted by purchasing your prescriptions network pharmacies you can go to. Not all network pharmacies at Group Health pharmacies. For may be listed in this directory. Pharmacies may have been added your convenience, you can also or removed from the list after this directory was printed. To get log on to ghc.org/medicare and current information about Clear Care (HMO) network pharmacies request refills by mail. Shipping and in your area, please visit our Website at ghc.org or call Customer handling is free. Service. For a complete description of your prescription coverage, please see your Evidence of Coverage and/or employer group certificate of coverage. Getting your prescription filled All prescriptions, whether written by a Group Health Medical Centers provider or a Group Health–contracted provider in the community, can be filled at a Group Health Medical Centers pharmacy or at any participating pharmacy in the community. Check this provider directory or ghc.org/medicare for a list of pharmacies. Bring your ID card with your prescription. To fill a mail-order prescription, call the Mail-Order Pharmacy for a mail-order request form or print one out from ghc.org, include a check or your credit card information, and drop the form in the mail. To fax, complete a mail-order request form and fax the form to 1-800-350-1683 or 206-901-4443. You can also buy some over-the-counter medications at our pharmacies at competitive prices. Talk to the pharmacist if you have any questions. Emergency prescriptions after hours It is important that you try to fill your prescriptions at a Group Health Medical Centers pharmacy or Clear Care (HMO)– participating pharmacy while you’re in the Clear Care service area. If this is not possible, you can fill the prescription at a pharmacy of your choice at your expense, keep your receipt, and submit a claim for reimbursement. Please see your Evidence of Coverage or certificate of coverage for your plan rules. iii | 1.888.901.4600 | ghc.org/medicare CLEAR CARE® (HMO) Provider and Pharmacy Directory Group Health will not usually reimburse for refills or medications for chronic conditions as emergency prescriptions when they can be filled during normal business hours. Prescriptions while you’re traveling It’s smart to plan ahead and pack enough medicine before you travel. Be sure to contact your personal physician to arrange for the prescription supply you’ll need while you’re away from home. If you have a prescription drug benefit and need an emergency prescription filled while traveling, you should make every effort to access a Group Health Medical Centers pharmacy or a Clear Care (HMO)–participating pharmacy. If this is not possible, you can fill the prescription at a pharmacy of your choice at your expense, keep your receipt, and submit a claim for reimbursement. Group Health will reimburse you for emergency prescriptions filled at out-of-network pharmacies if this occurs while you are traveling in the United States and territories. Please see your Evidence of Coverage or certificate of coverage for your plan rules. Prescriptions are also covered at an out-of-network pharmacy if: There are other instances where circumstances allow coverage at an out-of-network pharmacy. Please contact Customer Service for more details. iv | 1.888.901.4600 | ghc.org/medicare CLEAR CARE® (HMO) Provider and Pharmacy Directory How to request a reimbursement for out-of-network pharmacy expenses Please submit receipts along with a written statement providing all of the following information: • Description of the circumstances necessitating access to an out-of-network pharmacy or provider • Date of service • Drug name, strength, and National Drug Code (NDC) number • Quantity/day supply • Paid amount Call Customer Service and request a claims form, or you can download one online at ghc.org. Mail the completed form with receipts and a written statement to: Group Health Claims Processing P. O. Box 34585 Seattle, WA 98124-1585 Other facilities This lists other specialty services. You and your personal physician will work together to determine if these services may be of help to you. v | 1.888.901.4600 | ghc.org/medicare CLEAR CARE® (HMO) Provider and Pharmacy Directory MyGroupHealth for Members MyGroupHealth for Members at ghc.org/medicare* puts personal care at your fingertips. All members can use it anytime, day or night, to: • Refill prescriptions and get them at home with no shipping charge.
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