2016 Medical Provider Directory

2016 Medical Provider Directory MedMutual Advantage PPO Plans Northwest Ohio 2060 East Ninth Street Cleveland, OH 44115-1355 © 2015 Medical Mutual of Ohio H4497_PDI6_2016_Jun15 CMS Accepted Z7979-MCA 6/15 Provider Directory (Northwest Ohio) MedMutual Advantage Select PPO Plan MedMutual Advantage Preferred PPO Plan MedMutual Advantage remium PPO Plan This directory provides a list of MedAdvantage PPO network providers. This directory is for our MedAdvantage PPO network, offered to MedMutual Advantage PPO plan members. This directory lists providers in the following northwest Ohio counties: Allen, Ashland, Auglaize, Crawford, Defiance, Erie, Fulton, Hancock, Hardin, Henry, Huron, Lucas, Mercer, Ottawa, Paulding, Putnam, Richland, Sandusky, Seneca, Van Wert, Williams, Wood and Wyandot. Additional provider directories are available for northeast Ohio; southeast and central Ohio; and southwest Ohio. Please call us at the number below to request a copy. This directory is current as of August, 2015. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. Before making an appointment, please contact your provider and verify that the provider participates in our network and if applicable, is accepting new patients. To get the most up-to-date information about MedAdvantage HMO network providers in your area, you can visit MedMutual.com/Medicare or call our Customer Service department at (800) 982-3117. We are open 8 a.m. to 8 p.m. seven days a week from October 1 to February 14 (except Thanksgiving and Christmas), and 8 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 1 p.m. Saturdays from February 15 through September 30 (except holidays). Our automated telephone system is available 24 hours a day, seven days a week for self-service options. TTY users should call 711. MedMutual Advantage HMO and PPO plans are offered by Medical Mutual of Ohio under a contract with Medicare. Enrollment in these plans depends on contract renewal. This directory is available in a different format for the visually impaired by calling us at the number listed above. H4497_PDI6_2016_Jun15 CMS Accepted i Z7979-MCA 6/15 Section 1: Introduction This directory provides a list of MedAdvantage PPO network providers. To get detailed information about your healthcare coverage, please see your Evidence of Coverage. You can find a list of pharmacies that offer Part B and Part D drugs in our pharmacy directory. Check with your pharmacy to see if it offers the services you need to fill a prescription. Use this directory to stay in the MedAdvantage PPO provider network. This means that you’ll pay less out of pocket and get the most value from your health plan. Be sure to check the directory to see if your doctor is in our network. If not, we have many excellent care providers you can choose from. We strongly encourage you to select a primary care provider, although it is not required. With a primary care provider, you’ll have a doctor who knows your medical history and can coordinate your care. Having a primary care provider means you’ll have a clinical expert partnering with you to help you make important medical decisions. The network providers listed in this directory have agreed to provide you with your healthcare services. You may go to any of our network providers listed in this directory. 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 physicians/providers are available in our network. See our northeast Ohio; southeast and central Ohio; and southwest Ohio provider directories. How do I submit a claim? Most network providers will submit a claim for you. However, if you go to a doctor, hospital or provider that is not in our network, ask them to submit a claim for you on a standardized claim form. If the provider will not submit the claim for you, contact our Customer Care Center or log into our secure member site, My Health Plan, for a claim form. (You can register for My Health Plan at MedMutual.com/member.) Complete the claim form and attach an itemized bill that includes the diagnosis, procedure, date of service, charge, and doctor’s or facility’s name and address. Submit the completed form to our office within the timeframe stated in your Summary of Benefits. Where do I find a claim form? You can find medical, dental, vision and other claim forms by logging into My Health Plan and looking on the Resources & Tools tab or by calling Customer Care. ii Obtaining care after normal office hours When you are ill, injured or feeling like you need immediate care, always call your primary care provider (PCP) first. Your PCP can assess your symptoms and direct you the right place to get care. If your PCP’s office is closed and you need prompt but not emergency medical attention, go to a network urgent care facility or other convenience clinic, which may cost less than an emergency room visit. You can find an urgent care facility in our network by looking under the Hospitals and Urgent Care Centers section of this directory. Symptoms that may require an urgent care or convenience clinic include: n Signs of the flu n Signs of a sprain n Signs of a sinus, ear or bladder infection What is an emergency? In an emergency, symptoms are severe and serious enough that a person who has no medical training, with an average knowledge of health and medicine, could reasonably expect that, without immediate medical attention, the result would be any of the following: n Placing the health of the individual in serious jeopardy n Serious impairment to bodily functions n Serious dysfunction of any body part or organ Examples of emergencies are shock, chest pain, choking, poisoning, unconsciousness, severe pain, uncontrolled bleeding, hallucinations, delusions and attempted harm to oneself or others. Getting emergency care During a medical emergency, go to the nearest emergency room or, if necessary, call 911. Contact your doctor within 24 hours of the emergency to arrange follow-up care with a network provider if necessary. If you are admitted to a hospital, our Utilization Management department will work with your doctor to review your care. You do not need to contact us for prior approval for emergency care. iii Section 1: Introduction (cont.) Using out-of-network providers Out-of-network providers are providers that are not part of the MedAdvantage PPO network. If you use out-of-network providers, you may have to pay more. Members do not need prior authorization for out-of- network services. However, benefits will be at a reduced level except for ambulance services; emergency care; including post-stabilization care; urgently needed care; renal dialysis (kidney); and any services that were ordered covered through an appeals process. What is the service area for MedMutual Advantage PPO plans? The counties in our service area are listed below: n Allen n Hardin n Richland n Ashland n Henry n Sandusky n Auglaize n Huron n Seneca n Crawford n Lucas n Van Wert n Defiance n Mercer n Williams n Erie n Ottawa n Wood n Fulton n Paulding n Wyandot n Hancock n Putnam And additional counties in northeast Ohio; southeast and central Ohio; and southwest Ohio. How do you find MedAdvantage PPO providers in your area? As a member of Medical Mutual, you have access to a provider directory that gives you a list of plan providers. This provider directory lists the plan providers by county and by specialty. You can also search for a specific provider using the index in the back of the directory. The directory is available by logging into My Health Plan at MedMutual.com/member. You can also request a hard copy by calling Customer Care. If you have questions about MedMutual Advantage PPO plans, please call our Customer Service department at (800) 982-3117. We are open 8 a.m. to 8 p.m. seven days a week from October 1 to February 14 (except Thanksgiving and Christmas), and 8 a.m. to 8 p.m. Monday through Friday and 9 a.m. to 1 p.m. Saturdays from February 15 through September 30 (except holidays). Our automated telephone system is available 24 hours a day, seven days a week for self-service options. TTY users should call 711. Or, visit MedMutual.com/Medicare. iv TABLE OF CONTENTS HOSPITALS AND URGENT CARE CENTERS ......................................................................................3 PRIMARY CARE PHYSICIANS .............................................................................................................12 OBSTETRICAL AND GYNECOLOGICAL PHYSICIANS...................................................................52 SPECIALTY CARE PROVIDERS ...........................................................................................................58 MENTAL HEALTH FACILITIES .........................................................................................................154 MENTAL HEALTH PROVIDERS .......................................................................................................155 ANCILLARY FACILITIES ....................................................................................................................178 ANCILLARY PROVIDERS ..................................................................................................................183 LABORATORIES ...................................................................................................................................185

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