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Provider Directory North Directorio De Proveedores Stars & Stars Plus Provider Directory North Directorio de Proveedores Stars & Stars Plus 1301 International Parkway Suite 400 Sunrise, Florida 33323 1-866-796-0530 TDD/TTY 1-800-955-8770 SunshineHealth.com ©2015 Sunshine State Health Plan. All Rights Reserved. FL-HKN REV. A 09.15 SunshineHealth.com WELCOME TO SUNSHINE HEALTH’S HEALTHY KIDS! Welcome to Sunshine Health! Sunshine Health gives you quality healthcare that is convenient and easy to use. Our main goal is making sure your child gets high-quality healthcare. This is our Provider Directory. The next few pages have information on how to use the Directory. Let us know if you have questions. Interpreter services are provided free of charge to you. This includes sign language. We also have a telephone language line to help with translations. You can call Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770). Sunshine Health’s Healthy Kids network is always growing. You can get a current list of doctors by calling Member Services. The number is1-866-796-0530 (TDD/TTY 1-800-955-8770) or visit our website at www.sunshinehealth.com. EASY TO USE Getting benefits from Sunshine Health is easy. We believe the best way for your child to stay healthy is to have a good relationship with his or her primary care doctor (PCP). That is why you pick your child’s PCP. When your child needs care, all you have to do is call his or her PCP for an appointment. Tell the office that your child is covered by Sunshine Health. It’s that simple. CHOOSING YOUR PCP Please choose your child’s PCP from our list. This PCP has the job of taking care of your child and sending him or her to other doctors when needed. You can have all of your enrolled children see one PCP or you may pick a different PCP for each of your children. You can choose: · Pediatricians (they only see children) · Family practice doctors (they see children and adults) · A provider working in a clinic (RHC/FQHC) If you need help or don’t see your doctor listed in the Directory, call Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770). BEHAVIORAL HEALTH Behavioral Health refers to mental health, alcohol, and drug abuse services. Sunshine Health’s Behavioral Health provider, Cenpatico, has mental health professionals that can help your child. They are listed in this Directory. You can also call Cenpatico at 1-800-716-5650, 24 hours a day, seven days a week. You do not need a referral from your child’s PCP for Behavioral Health services from an in-network provider. 1 P a g e FAMILY PLANNING Sunshine Health members can get family planning services without a referral from their PCP. You can also go to any family planning clinic that takes our Healthy Kids coverage. Call Member Services if you need help choosing a family planning provider at 1-866-796-0530 (TDD/TTY 1-800-9558770). ACCESSIBILITY If your child uses a wheelchair, walker or other aid, and needs help getting into the doctor’s office, please call before you arrive. If you would like help talking with the doctor about your child’s special needs, call Member Services at 1-866-796-0530 (TDD/TTY 1-800-955-8770). TAKING CARE OF YOUR CHILDREN We want you to make appointments for your child. We want you to make them for regular check-ups. Benefits with Sunshine Health include: • Screenings • Diagnostic x-rays • Lab tests • Eye exams IF YOUR CHILD HAS TO BE HOSPITALIZED If your child needs to go to the hospital, his or her PCP, or a specialist will admit them to a hospital where he or she is affiliated. The in-network hospitals are listed in this Directory. REFERRALS TO SPECIALISTS Your child’s PCP MUST coordinate referrals to specialists, hospitals, and other providers. IMMEDIATE AND EMERGENCY CARE If your child has a serious illness or injury that needs immediate attention, first call your PCP. They know your child’s medical history best. With Sunshine Health, you have access to medical services 24 hours a day, 365 days a year. In case of a possible life-threatening emergency, call 911 or go to the nearest emergency room. If your child is admitted to the hospital, please call or have someone else call Sunshine Health within 48 hours to let us know about your child’s medical situation. Some examples of emergencies are: • Severe pain of any kind • Change in mental status • Change in neurological status • Pregnancy complications • Chest pain 2 P a g e • Poisoning • Acute allergic reactions • Severe shortness of breath • Abdominal pain • Multiple episodes of vomiting or diarrhea • Persistent bleeding • Injuries that cause loss of function to a body part • Symptoms of substance abuse • Psychiatric disturbances • Overdose of medication FOR ADDITIONAL INFORMATION If you want to recommend a doctor who is not part of this Directory for participation with Sunshine Health or if you have questions, please contact: Sunshine Health 1301 International Parkway Suite 400 Sunrise, FL 33323 1-866-796-0530 (TDD/TTY 1-800-955-8770) ABOUT THIS DIRECTORY The following information is collected from doctors’ applications during the initial contracting and credentialing process: • Name • Gender • Practice name • Office location • Phone numbers • Languages • Specialities • Acceptance of new patients • Handicap accessibility • Hospital affiliation 3 P a g e For the most up-to-date information about a provider or hospital, please visit Sunshine Health’s website at www.sunshinehealth.com. You can also call Member Services at1-866-796-0530 (TDD/TTY 1-800-955-8770). Sunshine Health looks forward to serving your child’s healthcare needs! 4 P a g e ¡BIENVENIDO(A) A HEALTHY KIDS DE SUNSHINE HEALTH! ¡Bienvenido(a) a Sunshine Health! Sunshine Health le da atención médica de calidad que es conveniente y fácil de usar. Nuestro objetivo principal es asegurar que su hijo(a) reciba atención médica de alta calidad. Este es nuestro Directorio de Proveedores. Las páginas siguientes tienen información sobre cómo usar el directorio. Déjenos saber si tiene preguntas. Los servicios de intérprete se le ofrecen de manera gratuita. Esto incluye lenguaje de señas. Además tenemos una línea telefónica de idiomas para ayudar con traducciones. Usted puede llamar a Servicios para los Miembros al 1-866-796- 0530 (TDD/TTY 1-800-955-8770). La red Healthy Kids de Sunshine Health siempre está creciendo. Puede obtener una lista actualizada de médicos llamando a Servicios para los Miembros. El número es 1-866-796-0530 (TDD/TTY 1-800-955-8770) o visite nuestro sitio web en www.sunshinehealth.com. FÁCIL DE USAR Es fácil obtener beneficios de Sunshine Health. Creemos que la mejor manera en la que su hijo(a) puede mantenerse sano(a) es teniendo una buena relación con su médico de atención primaria (PCP, siglas en inglés). Es por esto que usted elige el PCP de su hijo(a). Cuando su hijo(a) necesite atención médica, todo lo que tiene que hacer es llamar a su PCP para una cita. Informe al personal del consultorio que su hijo(a) está cubierto(a) por Sunshine Health. Es así de simple. CÓMO ELEGIR A SU PCP Por favor elija al PCP de su hijo(a) de nuestra lista. Este PCP tiene como tarea cuidar de su hijo(a) y enviarlo(a) a otros médicos cuando sea necesario. Puede hacer que todos sus hijos inscritos vean a un PCP o puede elegir un PCP distinto para cada uno de sus hijos. Usted puede elegir: · Pediatras (solo atienden a niños) · Médicos de familia (atienden a niños y adultos) · Un proveedor que trabaje en una clínica (RHC/FQHC) Si necesita ayuda o no ve a su médico en el directorio, llame a Servicios para los Miembros al 1-866-796-0530 (TDD/TTY 1-800-955-8770). SALUD DEL COMPORTAMIENTO Salud del comportamiento se refiere a servicios de salud mental y para abuso de alcohol y drogas. El proveedor de salud del comportamiento de Sunshine Health, Cenpatico, cuenta con 5 P a g e profesionales en salud mental que pueden ayudar a su hijo(a). Aparecen en este directorio. Además puede llamar a Cenpatico al 1-800-716-5650, las 24 horas del día, los 7 días de la semana. No necesita una referencia del PCP de su hijo(a) para obtener servicios de salud del comportamiento de un proveedor dentro de la red. PLANIFICACIÓN FAMILIAR Los miembros de Sunshine Health pueden recibir servicios de planificación familiar sin una referencia de su PCP. Además puede ir a cualquier clínica de planificación familiar que acepte nuestra cobertura de Healthy Kids. Llame a Servicios para los Miembros al 1-866-796-0530 (TDD/TTY 1-800-955-8770) si necesita ayuda para elegir un proveedor de planificación familiar. ACCESSIBILIDAD Si su hijo(a) usa una silla de ruedas, andador u otras ayudas y necesita asistencia para ir al consultorio del médico, llame antes de llegar. Si le gustaría tener ayuda para hablar con el médico acerca de las necesidades especiales de su hijo(a), llame a Servicios para los Miembros al 1-866-796-0530 (TDD/TTY 1-800-955-8770). CÓMO CUIDAR A SUS HIJOS Queremos que haga citas para su hijo(a). Queremos que las haga para controles regulares. Los beneficios con Sunshine Health incluyen: • Pruebas de detección • Radiografías diagnósticas • Análisis de laboratorio • Exámenes de los ojos SI SE TIENE QUE HOSPITALIZAR A SU HIJO(A) Si su hijo(a) necesita ir al hospital, su PCP o un especialista lo(a) internará en un hospital al que esté afiliado.
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