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Clear Spring Health HMO Plan Provider Directory

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Clear Spring Health HMO Plan Provider Directory Clear Spring Health HMO Plan Provider Directory This directory is current as of December 1, 2019. This directory provides a list of Clear Spring Health’s current network providers. This directory is for the Virginia Service Area: Alleghany, Amelia, Appomattox, Augusta, Bath, Buena Vista City, Caroline, Charles City, Chesterfield, Clarke, Colonial Heights City, Covington City, Craig, Cumberland, Danville City, Dinwiddie, Emporia City, Essex, Franklin, Franklin City, Galax City, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Harrisonburg City, Henrico, Highland, Hopewell City, Isle of Wight, King and Queen, King William, Lexington City, Lunenburg, Madison, Mathews, Mecklenburg, Montgomery, Nelson, New Kent, Nottoway, Petersburg City, Pittsylvania, Poquoson City, Powhatan, Prince George, Pulaski, Radford City, Rappahannock, Richmond, Richmond City, Roanoke, Roanoke City, Rockbridge, Rockingham, Salem City, Southampton, Staunton City, Surry, Sussex, Warren, and Waynesboro City county. To access Clear Spring Health’s online provider directory, you can visit www.clearspringhealthcare.com. For any questions about the information contained in this directory, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. Out-of-network/non-contracted providers are under no obligation to treat Clear Spring Health members, except in emergency situations. Please call our Member Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of- network services. Our plan has people and free interpreter services available to answer questions from disabled and non-English speaking members. We can also give you information in Braille, in large print, or other alternate formats at no cost if you need it. We are required to give you information about the plan’s benefits in a format that is accessible and appropriate for you. To get information from us in a way that works for you, please call Member Services or contact Office for Civil Rights. H8293_P053-101119_C Clear Spring Health has a contract with Medicare to offer HMO and PPO plans. Enrollment in Clear Spring Health depends on contract renewal. 1 Table of Contents Section 1 – Introduction .............................................................................................................. 3 What is the service area for Clear Spring Health? .................................................................. 5 How do you find Clear Spring Health providers in your area? .............................................. 5 Section 2 – List of Network Providers ........................................................................................ 6 Primary Care Providers (PCPs) ............................................................................................... 6 Specialists ...............................................................................................................................23 Hospitals .................................................................................................................................83 Skilled Nursing Facilities (SNFs) ......................................................................................... 84 Outpatient Mental Health Providers ...................................................................................... 85 Other Ancillary and Facility Providers.................................................................................. 91 2 Section 1 – Introduction This directory provides a list of Clear Spring Health’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). You may choose a PCP by selecting a PCP from within the plan Provider Directory and calling Member Services to inform them of the change. The Provider Directory may be downloaded from the plan website at www.clearspringhealthcare.com, or requested from Member Services. Member Services may also check to see if a specific Provider you are requesting is within the network. Please call member Services at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. A PCP should be your first point of contact for undiagnosed health concerns or health problems and routine health care needs. In addition to providing you care, your PCP will help arrange or coordinate the covered services you get as a plan member. This includes your x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions, and follow-up care. Referrals are not required with Clear Spring Health HMO plans, but your PCP should be your primary resource to use when seeking specialist and hospital care and coordination of your medical services. 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. In cases where out-of-network providers submit a bill directly to you, you should not pay the bill but should submit it to Clear Spring Health for processing and determination of your liability, if any. Please send the bill to the following address: Clear Spring Health: P.O. Box 4048 Scranton, PA 18505 You may get covered emergency medical care whenever you need it from the nearest hospital or provider. You don’t need to get approval first from Clear Spring Health or your doctor. If you have an emergency, Clear Spring Health will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. 3 After the emergency is over, you are entitled to follow-up care to be sure your condition continues to be stable. Your follow up care will be covered by our plan. 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 Clear Spring Health will be responsible for the costs. 4 What is the service area for Clear Spring Health? The counties in our service area are listed below. This directory is for the Virginia Service Area: Alleghany, Amelia, Appomattox, Augusta, Bath, Buena Vista City, Caroline, Charles City, Chesterfield, Clarke, Colonial Heights City, Covington City, Craig, Cumberland, Danville City, Dinwiddie, Emporia City, Essex, Franklin, Franklin City, Galax City, Giles, Gloucester, Goochland, Greene, Greensville, Halifax, Hanover, Harrisonburg City, Henrico, Highland, Hopewell City, Isle of Wight, King and Queen, King William, Lexington City, Lunenburg, Madison, Mathews, Mecklenburg, Montgomery, Nelson, New Kent, Nottoway, Petersburg City, Pittsylvania, Poquoson City, Powhatan, Prince George, Pulaski, Radford City, Rappahannock, Richmond, Richmond City, Roanoke, Roanoke City, Rockbridge, Rockingham, Salem City, Southampton, Staunton City, Surry, Sussex, Warren, and Waynesboro City county. How do you find Clear Spring Health providers in your area? The Clear Spring Health Provider Directory contains participating providers within our service area. There are provider sections in the directory, such as participating hospitals and specialists, where we list facilities and providers within our service area to provide you with comprehensive network information. There is also an alphabetical index of our network providers in the back of the directory for your convenience. If you have questions about Clear Spring Health or require assistance in selecting a PCP, please call our Member Service Department at 877-384-1241, we are open 8:00 am to 8:00 pm Monday – Friday from April 1 – September 30 and 8:00 am to 8:00 pm Monday – Sunday from October 1 – March 31. TTY users should call 711. You can also visit www.clearspringhealthcare.com. 5 Primary Care Providers Reed MD, John Bath (PCPs) 53 S. Medical Park Drive , Fishersville, VA 22939 Hot Springs North Carolina 540-332-5687 Crosby MD, Scott 106 Park Dr Nurse Practitioner Staunton Hot Springs, VA 24445 Durham Becker NP, Susan 540-839-7000 42 Lambert Street , Suite 511 Durham 106 Park Drive Staunton, VA 24401 Hot Springs, VA 24445 Kashdan NP, Daniel 540-886-6259 540-839-7000 12801 Iron Bridge Rd Diduch MD, Barry Durham, VA 23831 Ortiz MD, Veronica 804-748-9071 851 Statler Blvd. 106 Park Drive Staunton, VA 24401 Hot Springs, VA 24445 Virginia 540-245-7470 540-839-7000 Emergency Medicine Johnson MD, Frank Rizk DO, Levi 42 Lambert Street , Suite 511 106 Park Drive Henrico Staunton, VA 24401 Hot Springs, VA 24445 540-886-6259 Glen Allen 540-839-7000 Frederick MD, Jon Landauer MD, Diane Stall MD, Tamra 9851 Brook Rd 42 Lambert St 106 Park Dr Glen Allen, VA 23059 Staunton, VA 24401 Hot Springs, VA 24445 804-281-0275 540-885-6789 540-839-7137 Stevens NP, Emily Family Medicine Botetourt 42 Lambert Street , Suite 511 Albemarle Staunton, VA 24401 Lexington 540-886-6259 Esmont Arnold MD, Colleen Stuarts Draft 55 Comfort Way , Ste 1 Hedian DO, Katherine Lexington, VA 24450 2256 Irish Rd Le
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