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Provider Directory (866) 704-0109 (888) 823-1910 VANTAGE MEDICARE ADVANTAGE CONTACT MEMBER SERVICES Local: 2017 (318) 361-0900 Toll-Free: PROVIDER DIRECTORY (866) 704-0109 (888) 823-1910 TTY Local: (318) 361-2131 TTY Toll-Free: (866) 524-5144 Call seven days a week 8:00 A.M. - 8:00 P.M. CST. After February 14, 2017, Monday - Friday 8:00 A.M. - 8:00 P.M. CST. An answering service will operate on weekends and holidays. CURRENT AS OF: 08/01/2017 H5576_1080_01r1_CY2017 VHP1534 080516 VANTAGE MEDICARE ADVANTAGE HMO/HMO-POS Plans Provider Directory This directory provides a list of Vantage Medicare Advantage’s network providers. This directory is for members who live in the Louisiana parishes listed on page 2. This directory is current as of August 1, 2017. 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 Vantage Medicare Advantage’s network providers in your area, you can visit www.VantageMedicare.com or call our Member Services department at (866) 704-0109, 8 a.m. – 8 p.m., seven days a week from October 1, 2016 through February 14, 2017. For all other dates, Member Services may be reached from 8 a.m. – 8 p.m., Monday through Friday. TTY users should call (866) 524-5144. Vantage Health Plan, Inc. (Vantage) is a health plan with a Medicare contract. Enrollment in Vantage Health Plan, Inc. depends on contract renewal. This document is available in other formats such as large print. Table of Contents Section 1 – Introduction…………………………………………………………………….1 What is the service area for Vantage Medicare Advantage?.....................................2 How do you find Vantage Medicare Advantage providers in your area?....................3 Language Assistance & Disclaimers…………………………………………………….4 Section 2 – List of Affinity Health Network Providers (number of providers)……...8 Hospitals (6)……………………………………………………………………………..…9 Medical Home-Primary Care Providers (168)….………………………………………9 Specialists (91)…………………………………………………………………………..15 Ancillary Services (16)…………………………………………………………………..18 Skilled Nursing Facilities (3)…………………………………………………………….19 Mental Health (Outpatient) (8)…….…..……..…………………………………………19 Section 3 – List of Standard Network Providers (number of providers)………….20 Hospitals (99)…………………………………………………………………………….21 Medical Home-Primary Care Providers (1,943)…..…………………………………..24 Specialists (2,539)……..………………………………………………………………...93 Ancillary Services (1,480)………..……………………………………………………191 Skilled Nursing Facilities (85)………………………………………………………….347 Mental Health (Outpatient) (555)…………………………………………….……….349 Pharmacies Providing Outpatient Prescription Drugs………………………………374 Introduction This directory provides a list of Vantage Medicare Advantage’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. You will have to choose one of the network providers who are listed in this directory to be your Medical Home-Primary Care Provider (MH-PCP). The term “MH-PCP” will be used throughout this directory. Generally, you must get your health care coverage from your MH-PCP. The MH-PCP may be a provider who specializes in Family or General Practice, Internal Medicine or Pediatrics. The MH-PCP will be the provider who will provide, arrange or authorize all routine medical care that you may need while you are a member of our plan. If you have questions about selecting or changing your medical home-primary care provider, please call Vantage’s Member Services Department. 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; however, some services may require a prior authorization from us. 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. Most Vantage Medicare Advantage plans offer a point-of-service (POS) option for certain services. This means all services obtained from out-of-network providers require prior authorization (except emergency services, urgently needed care and kidney dialysis outside the Vantage’s service area). Most services from out-of-network providers are subject to a higher cost share (fifty percent (50%) coinsurance after a $350 deductible). However, in most cases, services obtained from out-of-network providers will be treated as in-network if prior authorization has been obtained, and in-network cost sharing will apply. Vantage will notify you in writing if an authorized service from an out-of-network provider will not be treated as in-network. Please refer to your Evidence of Coverage (EOC) to see if the plan in which you are enrolled has the POS benefit. If you receive a bill directly from an out-of-network provider related to emergency care or other services, you should not pay the bill. Please send the bill with a note explaining the circumstances to Vantage Medicare Advantage, 130 DeSiard Street, Suite 300, Monroe, LA 71201. Vantage will review the bill and determine your liability, if any, based on your Vantage Medicare Advantage Plan. In the event of an emergency, go to the nearest emergency room or the nearest network hospital for treatment. If you need immediate emergency assistance, call 911 or an ambulance service. You do not need a referral from your MH-PCP or a prior authorization to receive treatment for an emergency condition. Call your MH-PCP within 48 hours of the emergency treatment or an admission to the hospital from the emergency room. If your plan does not have a POS benefit, you must use plan providers except in emergency or urgent care situations or out-of-area kidney dialysis services. If you obtain routine care services from out-of-network providers, neither Medicare nor Vantage Medicare Advantage will be responsible for these costs. As stated above, if your plan does have a POS benefit, it may cost more to get care from out-of-network providers. Page 1 What is the service area for Vantage Medicare Advantage? Employer group plans are available in all Louisiana parishes. The service area for each of the following individual Vantage Medicare Advantage plans are listed below by parish. x Vantage Basic Plan (HMO-POS) x Vantage Standard Plan (HMO-POS) x Vantage Premium Plan (HMO-POS) x Vantage Traditional Plus Plan (HMO) x Vantage Dual Special Needs Plan (HMO SNP) Acadia Allen Avoyelles Beauregard Bienville Bossier Caddo Calcasieu Caldwell Cameron Catahoula Claiborne Concordia De Soto* East Carroll* Evangeline Franklin* Grant Iberia Jackson Jefferson Davis La Salle Lafourche Lincoln Madison Morehouse Natchitoches Ouachita* Rapides Red River Richland* Sabine Tensas Terrebonne Union Vermilion Webster West Carroll* Winn *Includes Affinity Health Network benefits x Vantage Capitol Plan (HMO-POS) x Vantage Traditional Plus Plan (HMO) x Vantage Dual Special Needs Plan (HMO SNP) Assumption East Baton Rouge* East Feliciana Iberville Jefferson Lafayette Livingston Orleans Plaquemines Pointe Coupee St. Bernard St. Charles St. Helena St. James St. John the Baptist St. Landry St. Martin St. Mary St. Tammany Tangipahoa West Baton Rouge West Feliciana *Includes Affinity Health Network benefits If your Vantage member ID card includes the Affinity Health Network logo, this means that your cost share will be lower when you receive certain services from Affinity Health Network (AHN) providers. Services with reduced copays are shown on your Vantage Member ID card and/or in your Evidence of Coverage. AHN providers are listed on the Affinity Health Network pages in the first section of this Provider Directory. Page 2 How do you find Vantage Medicare Advantage providers in your area? The Vantage Medicare Advantage network includes providers in all parishes in Louisiana. Vantage Medicare Advantage members may access network providers listed in this provider directory. To find one in your area, use this directory that includes an Affinity Health Network section as well as a Standard Network section. These two networks are sorted by Hospitals, Medical Home-Primary Care Providers, Specialty Care Providers, Ancillary Services, Skilled Nursing Facilities and Outpatient Mental Health Providers. It is further sorted by parish, specialty, and provider’s name alphabetically. If you have questions about Vantage or require assistance in selecting a MH-PCP, please call our Member Services department at (866) 704-0109, 8 a.m. – 8 p.m., seven days a week from October 1, 2016 through February 14, 2017. For all other dates, Member Services may be reached from 8 a.m. – 8 p.m., Monday through Friday. TTY users should call (866) 524-5144. You may also visit us on the web at www.VantageMedicare.com. Page 3 Language Assistance Vantage Health Plan is required by federal law to provide the following information. If you, or someone you’re helping, have questions about Vantage Health Plan, you have the right to get help and information in your preferred language at no cost. To talk with an interpreter, call Member Services, 866-704-0109. ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-866-704-0109 (TTY: 1-866-524-5144). ATTENTION: Si vous parlez français, des services d'aide linguistique vous sont proposés gratuitement. Appelez le 1-866-704-0109 (ATS: 1-866-524-5144). ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-866-704-0109 (TTY: 1-866-524-5144). ATTENZIONE: In caso la lingua parlata sia l'italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-866-704-0109 (TTY: 1-866-524-5144). ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-866-704-0109 (TTY: 1-866-524-5144). ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-866-704-0109 (TTY: 1-866-524-5144). OBAVJEŠTENJE: Ako govorite srpsko-hrvatski, usluge jezičke pomoći dostupne su vam besplatno.
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