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Medicare Provider and Pharmacy Directory

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Medicare Provider and Pharmacy Directory 7385 MHPproviderDirCvr_Layout 1 9/18/13 6:09 PM Page 1 Medicare Provider and Pharmacy Directory For more information, please contact Medica HealthCare Plans at 1-800-407-9069 or, for TTY users, 1-800-517-6923, Monday – Sunday 8:00am – 8:00pm, or visit www.medicaplans.com. This Provider and Pharmacy Directory was updated on September 1, 2013. Para mayor información, sírvase contactar a Medica HealthCare Plans al 1-800-407-9069 o, los usuarios de TTY, al 1-800-517-6923, de Lunes a Domingo entre las 8:00 a.m. y las 8:00 p.m., o visítenos en www.medicaplans.com. Esta Guía de Proveedores y Farmacias fue actualizada el 1º. de Septiembre del 2013. Y066_H5420_PD2014 CMS Accepted Medica HealthCare Plans MedicareMax (HMO), MedicareMax (HMO-POS) and MedicareMax Plus (HMO-POS SNP) Plans Provider Directory This directory provides a list of the Medica HealthCare Plans network providers. This directory is for Miami-Dade County and Broward County, Florida. This directory is current as of September 1, 2013. 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. To get the most up-to-date information about the Medica HealthCare Plans network providers in your area, you can visit www.medicaplans.com or call our Member Service Department at 1-800-407-9069, Monday – Sunday 8:00am – 8:00pm. TTY users should call 1-800-517-6923. Medica HealthCare is insured through UnitedHealthcare Insurance Company and its affiliated com- panies, a Medicare Advantage organization with a Medicare contract. Enrollment in the plan depends on the plan’s contract renewal with Medicare. This document may be available in an alternate format such as Braille, larger print or audio. Please call our Member Services Department for more information. This information is available for free in other languages. Please call our customer service number at 1-800-407-9069, TTY 1-800-517-6923, 8 a.m. - 8 p.m. local time, 7 days a week. *Indicates physicians that also take Medicaid. Y0066_H5420_PD2014 CMS Accepted Medica HealthCare Plans 9/13 Page 1 TABLE OF CONTENTS Introduction ....................................................................................................3 What is the service area for Medica HealthCare Plans?..............................4 How do you find Medica HealthCare Plans providers in your area? ..........4 Pharmacy Directory .....................................................................................8 Introduction .................................................................................................6 List of Network Providers MIAMI-DADE COUNTY Miami-Dade Hospitals ..............................................................................13 Miami-Dade Primary Care Physicians ......................................................17 Miami-Dade Specialists ............................................................................37 Miami-Dade Psychiatry/Psychology .......................................................112 Miami-Dade Ancillary Services ..............................................................133 Miami-Dade Pharmacies .........................................................................145 BROWARD COUNTY Broward Hospitals ...................................................................................165 Broward Primary Care Physicians ...........................................................167 Broward Specialists .................................................................................175 Broward Psychiatry/Psychology..............................................................239 Broward Skilled Ancillary Services ........................................................257 Broward Pharmacies ................................................................................265 Page 2 Medica HealthCare Plans 9/13 Section 1 – Introduction This directory provides a list of the Medica HealthCare Plans network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP).. The term “PCP” will be used throughout this directory. Generally, you must get your health care coverage from your PCP. Your PCP can also 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. Your PCP can also give you a referral to see a specialist. In some cases, your PCP 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 coverage. You may go to any of our network providers listed in this directory however, some services may require a referral. 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. For Medica HealthCare Plans MedicareMax (HMO POS) and Medica HealthCare Plans MedicareMax Plus (HMO POS SNP): You have a Point-of-Service (POS) benefit option which allows you to see non- contracted providers for covered services. The POS benefit is only available for use within the Service Area of the plan and the same level of cost sharing applies to in-network and POS services. As with in-network services, some will require a referral from an in-network provider, and all POS services require prior authorization from the plan for payment purposes. Not all types of services are eligible for coverage under the POS benefit and there may be a yearly limit to the amount the plan will pay for POS covered services. See Chapter 4, Section 2.1 of your Evidence of Coverage for more information on the POS benefit. You can also contact the Member Services Department for more information on how to access your POS benefit. If a non-contracted provider submits a bill directly to you, do not pay the bill and submit it to Medica HealthCare Plans. We will process the claim and make a determination of your liability (if any). Contact the Member Services Department for more information on how to submit bills from non-contracted providers to us. Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area you must use plan providers for urgent care. When out of the service area urgent care may be obtained from the first available provider. In addition, when out of the service area you can obtain dialysis treatment from any qualified dialysis provider. If you obtain routine care from out-of- network providers without prior authorization from Medica HealthCare Plans, neither Medicare nor Medica HealthCare Plans will be responsible for the costs. You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Medica HealthCare Plans will be responsible for the costs unless the services have been prior authorized by Medica HealthCare Plans. Medica HealthCare Plans 9/13 Page 3 What is the service area for Medica HealthCare Plans? The counties in our service area are listed below. Miami-Dade County and Broward County, Florida How do you find Medica HealthCare Plans providers in your area? The directory is separated by county. To find a provider in your area, please refer to the section that corresponds to the county in which you reside. You can also visit www.medicaplans.com and use the search function to identify plan providers by zip code. Or, you can call the Member Services Department at 1-800-407-9069, Monday – Sunday 8:00am – 8:00pm. TTY users should call 1-800-517-6923. If you have questions about Medica HealthCare Plans, or require assistance in selecting a PCP, please call our Member Services Department at 1-800-407-9069, Monday – Sunday 8:00am – 8:00pm. TTY users should call 1-800-517-6923. Or, visit www.medicaplans.com. Page 4 Medica HealthCare Plans 9/13 Medica HealthCare Plans MedicareMax (HMO), MedicareMax (HMO-POS) and MedicareMax Plus (HMO-POS SNP) Plan Guía de Proveedores Esta guía proporciona una lista de los proveedores de la red de Medica HealthCare Plans. Esta guía es para los Condados de Miami-Dade y Broward, Florida. Esta guía fue actualizada a partir del 1º. de Septiembre del 2013. Es posible que algunos de los proveedores de la red hayan sido agregados o eliminados de nuestra red después de la fecha en que esta guía fue impresa. No garantizamos que cada proveedor incluido en la guía siga aceptando nuevos participantes. Para obtener la información más actualizada sobre los proveedores de la red de Medica HealthCare Plans en su área, sírvase visitarnos en www.medicaplans.com o llame a nuestro Departamento de Servicios al Cliente al 1-800-407-9069, de Lunes a Domingo entre las 8:00 a.m. y las 8:00 p.m. Los usuarios de TTY, sírvanse llamar al 1-800-517-6923. Medica HealthCare está asegurada a través de UnitedHealthcare Insurance Company y sus
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