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2021 Medicare Advantage Provider Directory

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2021 Medicare Advantage Provider Directory 2021 Medicare Advantage Provider Directory FirstCarolinaCare Insurance Company’s FirstMedicare Direct plans are HMO and PPO plans with a Medicare contract. Enrollment in FirstMedicare Direct plans depend on contract renewal. This document is available in other formats such as large print. Y0094_21_11246_C FirstMedicare Direct POS Plus FirstMedicare Direct POS Standard FirstMedicare POS Choice FirstMedicare Direct PPO Plus FirstMedicare Direct PPO Premier New Hanover Health FirstMedicare Select New Hanover Health FirstMedicare Platinum 2021 Medicare Advantage Provider Directory This directory is current as of 10/1/2020 This directory provides a list of FirstMedicare Direct’s current network providers. This directory is for the following North Carolina Counties: Brunswick, Buncombe, Chatham, Henderson, Hoke, Lee, Madison, McDowell, Montgomery, Moore, New Hanover, Pender, Richmond, Scotland, Transylvania, and Yancey. To access FirstMedicare Direct’s online provider directory, you can visit www.FirstMedicare.com. For any questions about the information contained in this directory, please call our Member Services at (877) 210-9167 or by TTY/TDD 711, 8 a.m. – 8 p.m., Local Time, 7-days a week. From April 1 – September 30, voicemail will be used on weekends and holidays. This document is available in other formats such as large print. Y0094_21_11246_C_FMD Approved 10/13/2020 1 Table of Contents Section 1-Introduction…………………………………………………………….......………3 What is the service area for FirstMedicare Direct?................................................................4 How do you find FirstMedicare Direct providers in your area?.............................................4 Section 2- List of Network Providers……………………………………………………........6 Part I…………………………………………………………………………….........……..10 This section includes network providers convenient to members enrolled in FirstMedicare Direct POS Plus, FirstMedicare Direct POS Standard, FirstMedicare POS Choice, FirstMedicare Direct PPO Premier and FirstMedicare Direct PPO Premier residing in the following counties: Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland. Part II…………………………………………………………………………………........136 This section includes network providers convenient to members enrolled in FirstMedicare Direct POS Plus and FirstMedicare Direct POS Standard residing in the following counties: Buncombe, Henderson, Madison, McDowell, Transylvania and Yancey. Part III………………………………………………………………………………..…… 175 This section includes network providers convenient to members enrolled in New Hanover Health FirstMedicare Select and New Hanover Health FirstMedicare Platinum residing in the following Counties: Brunswick, New Hanover and Pender. Part IV………………………………………………………………………………..…… 348 This section includes network providers convenient to members enrolled in FirstMedicare Direct smartHMO and FirstMedicare Direct preferredPLUS (HMO) residing in the following county: New Hanover. ALPHABETICAL INDEX………………………………………………………….……..374 Y0094_21_11246_C_FMD Approved 10/13/2020 2 Section 1 – Introduction This directory provides a list of FirstMedicare Direct’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). We encourage you 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 can help you arrange or coordinate your covered services. This includes x-rays, laboratory tests, therapies, specialists, hospital admissions, and follow-up care. Your PCP also contacts other plan providers for updates about your care and/or treatment. In some cases, your PCP or provider will need to get prior authorization (prior approval). Since your PCP will provide and coordinate your health care, you should have all of your past medical records sent to your new PCP’s office. The law requires us to protect your privacy of medical records and personal health information. For more information about privacy, see your Evidence of Coverage. The network providers listed in this directory have agreed to provide you with your health care/vision/dental services. You may go to any of our network providers listed in this directory; however, some services may require a prior-authorization. If you have been going to one network provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-network providers. Out-of-network providers are under no obligation to treat FirstMedicare Direct enrollees, except in emergencies. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call Member Services at (877) 210 - 9167, or by TTY/TDD 711, 8 a.m. – 8 p.m., Local Time, 7-days a week. From April 1 – September 30, voicemail will be used on weekends and holidays. You may also refer to your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services. Point-of service (POS) offers additional covered benefits through an out-of-network service area Please refer to your EOC for specific information regarding these covered benefits. If you are a member of the following plans - FirstMedicare Direct POS Plus, FirstMedicare Direct POS Standard, FirstMedicare Direct POS Choice, FirstMedicare Direct PPO Plus, FirstMedicare Direct PPO Premier, New Hanover Health FirstMedicare Direct Select and New Hanover Health FirstMedicare Direct Platinum, you will receive the lowest out of pocket cost when you use network providers. You can see any provider, in or out of network, in emergency or urgent care situations. If you obtain routine care from out-of-network providers your costs will be higher. You may also refer to your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services. If an out-of-network provider sends you a bill, you should not pay the bill; you should submit the bill to the plan for processing and determination of enrollee liability, if any. Y0094_21_11246_C_FMD Approved 10/13/2020 3 If you have a medical emergency, get help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP. As soon as possible, make sure that our plan has been told about your emergency. You or someone else should call to tell us about your emergency care, usually within 48 hours. The number to call is located on the back of your membership identification card. Please note, with the exception of emergencies, it may cost more to get care from out-of-network providers. What are the service areas for FirstMedicare Direct POS Plus, FirstMedicare Direct POS Standard? • Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland counties • Buncombe, Henderson, Madison, McDowell, Transylvania and Yancey counties What are the service areas for FirstMedicare Direct POS Choice, FirstMedicare Direct PPO Plus and FirstMedicare Direct PPO Premier? • Chatham, Hoke, Lee, Montgomery, Moore, Richmond and Scotland counties What are the service areas for New Hanover Health FirstMedicare Select and New Hanover Health FirstMedicare Platinum? • Brunswick, New Hanover and Pender How do you find FirstMedicare Direct providers that serve your area? To find the section of the directory that contains network providers convenient to you, you can use the plan name information printed on the right edge of the pages to find the section of providers in your area. Check the plan name on your ID card if you do not know your FirstMedicare Direct plan name. Once you find your section, providers are listed by County and then by Specialty as described below in Section 2. You may also find provider information on the Web at www.FirstMedicare.com. If you have questions about FirstMedicare Direct or require assistance in selecting a PCP, please call our Member Services at (877) 210-9167 or by TTY/TDD 711, 8 a.m. – 8 p.m., Local Time, 7-days a week. From April 1 – September 30, voicemail will be used on weekends and holidays. You can also visit www.FirstMedicare.com. Y0094_21_11246_C_FMD Approved 10/13/2020 4 Section 2 – List of Network Providers Once you are in the Section of the directory corresponding to your local network, you can find a provider within your service area by searching by Specialty, County, Practice name, or Provider name. If you know the name of a provider, you also can search in the index by name to find the page number; however, be sure to note if the provider is in your local network to determine if you will need a prior authorization or referral. Our provider directory is organized as follows: Primary Care Providers County (Listed alphabetically) Practice Name Street Address City, State and Zip Code Phone Number Individual providers affiliated with the practice (Listed alphabetically) OB/GYN Providers County (Listed alphabetically) Practice Name Street Address City, State and Zip Code Phone Number Individual providers affiliated with the practice (Listed alphabetically) Behavioral Health Providers County (Listed alphabetically) Provider or Practice Name Street Address City, State and Zip Code Phone Number Individual providers affiliated with the practice (Listed alphabetically) Y0094_20040_C_FMD Approved_10/10/2019 5 Specialist Providers
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