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2016 Provider and Pharmacy Directory Directorio De Proveedores

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2016 Provider and Pharmacy Directory Directorio De Proveedores Directorio de Proveedores y Farmacias de Proveedores Directorio and Pharmacy Directory 2016 Provider 2016 To contact the Member Service Department, call 1-877-891-6447. If you’re hearing impaired, call TTY 711. Department hours are 8 a.m.–8 p.m., 7 days a week. Elderplan is an HMO plan with Medicare and Medicaid contracts. Enrollment in Elderplan depends on contract renewal. The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Para comunicarse con el Departamento de Servicio para los miembros, llame al 1-877-891-6447. Si tiene problemas auditivos, llame al TTY 711. 2016 El horario del Departamento es de 8 a. m. a 8 p. m., los siete días de la semana. Elderplan es un plan HMO que tiene contratos con Medicare y Medicaid. La inscripción en Elderplan depende de la renovación del contrato. La red de farmacias o la red de proveedores pueden cambiar en cualquier momento. Usted recibirá un aviso cuando sea necesario. Provider and Pharmacy Directory Directorio de Proveedores y Farmacias Elderplan Plus Long-Term Care (HMO SNP) Richmond H3347_EP15516_Accepted H3347_EPS15516_Accepted Elderplan Plus Long‐Term Care Provider Directory This directory provides a list of Elderplan’s network providers. This directory is for Richmond County, New York. This directory is current as of October 2015. 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 Elderplan’s network providers in your area, you can visit www.elderplan.org or call our Member Service Department at 1‐800‐353‐3765, between 8:00 A.M. and 8:00 P.M. 7 Days a week. TTY users should dial 711. Elderplan is an HMO plan with a Medicare and New York State Medicaid program contract. Enrollment in Elderplan depends on contract renewal. This information is available for free in other languages. Please call our Member Service number at 1‐800‐353‐3765 (TTY: 711 for the hearing impaired). Esta información puede estar disponible en diferentes idiomas o formatos. Si necesita obtener información en otro formato o idioma, comuníquese con el Servicio de Atención al Cliente al número que se menciona anteriormente. This document may be available in an alternate format such as larger print, or audio. Please contact our Member Service number at 1‐800‐353‐3765 for additional information. Elderplan has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until 12/31/2016. NCQA’s approval is based on a review of Elderplan Model of Care. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This plan is available to anyone with Medicare and Medicaid who is determined eligible for long term care using an eligibility assessment tool designated by New York State and needs community‐based long‐term care services for more than 120 days (e.g. in home nursing, therapies, home aide, personal care; Consumer Directed Personal Assistance Service; private duty nursing; or Adult Day health care). H3347_EP15516_Accepted Page/Página 1 Section 1—Introduction This directory provides a list of Elderplan’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. This directory is sorted by specialty, in order for you to easily find a plan provider that is in your area and that fits your medical needs. The Table of Contents at the front of this directory will show you where each provider type is listed in this book. The Index pages at the back of the directory will show you where you can find a particular individual provider or facility. 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 services from your PCP. The “network providers” listed in this directory have agreed to provide you with health care, vision and dental services. 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 to go to that same provider. In some cases, you may get covered services from non‐network providers. If an out‐of‐network provider sends you a bill directly to you, you should not pay the bill, but should submit it to the plan to the address provided below, for processing and determination of enrollee liability, if any. Medical Claims: Elderplan Attn: Member Service 745 64th Street Brooklyn, New York 11220 If you have a medical emergency: Get medical help as quickly as possible. Dial 911 for help or go directly to the nearest emergency room. In any emergency, you never need to contact any plan providers, even your own PCP, for either permission (‘authorization”) or referral. However, as soon as possible, you or someone else should contact your PCP or Elderplan about your emergency. Your PCP or Elderplan will need to be involved in following up on your emergency care. Your PCP’s telephone number appears on your Elderplan membership card. To contact Elderplan, please call Member Service at 1‐800‐353‐3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users please dial 711. You can get covered emergency medical care whenever you need it, anywhere in the world. H3347_EP15516_Accepted Page/Página 2 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. 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 Elderplan will be responsible for the costs. What is the service area for Elderplan? The Counties in our service area are listed below. The five boroughs of New York City, Nassau, Suffolk, Westchester, and Monroe County. How do you find Elderplan providers in your area? This directory is sorted by specialty, in order for you to easily find a plan provider that is in your area and that fits your medical needs. The Table of Contents at the front of this directory will show you where each provider type is listed in this book. The Index pages at the back of the directory will show you where you can find a particular individual provider or facility. This directory only includes providers in Richmond County. The Provider/Pharmacy directories for other counties are available and will be provided to members upon requests. You may contact Elderplan Member Service at 1‐800‐353‐3765, between 8:00 A.M. and 8:00 P.M., 7 days a week; TTY users should dial 711 to request a copy of a Provider/Pharmacy directory for another county. If you have questions about Elderplan or require assistance in selecting a PCP please call our Member Service Department at 1‐800‐353‐3765, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711. Or, visit www.Elderplan.org. H3347_EP15516_Accepted Page/Página 3 Section 2 – List of Network Providers This Elderplan provider directory contains: 58 Hospitals 184 Primary Care Providers 1099 Specialists 35 Dentists 108 Outpatient Mental Health 8 Skilled Nursing Facility 51 Ancillary Providers 14 Other Ancillary Providers 104 Pharmacies H3347_EP15516_Accepted Page/Página 4 Elderplan Plus Long‐Term Care 2016 Pharmacy Directory This pharmacy directory was updated on October 2015. For more recent information or other questions, please contact Elderplan Member Services at 1‐800‐353‐3765 or for TTY users should dial 711 between 8:00 A.M. and 8:00 P.M., 7 days a week or, visit www.Elderplan.org. Introduction This booklet provides a list of Elderplan’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Elderplan’s formulary. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Elderplan only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non‐network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of October 2015. For the most current listing, please contact us. Our contact information appears on the front and back cover pages. Changes to our pharmacy network may occur during the benefit year. An updated Pharmacy Directory is located on our website at www.elderplan.org. You may also call Member Services for updated provider information. This plan is available to anyone who has both Medical Assistance from the State and Medicare.
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