2021 Medicare VIP Prime HMO and HMO-POS Provider Directory RICHMOND This page is intentionally left blank. EmblemHealth Medicare VIP Prime HMO and HMO-POS Provider Directory This directory is current as of 08/02/2021. This directory provides a list of EmblemHealth Medicare VIP Prime HMO and HMO-POS current network providers. This directory is for Richmond County. To access our plan’s online provider directory, you can visit emblemhealth.com/ medicare. For any questions about the information contained in this directory, please call our Customer Service Department at 877-344-7364, 8 am to 8 pm, seven days a week. TTY users should call 711. EmblemHealth Plan, Inc., EmblemHealth Insurance Company, EmblemHealth Services Company, LLC and Health Insurance Plan of Greater New York (HIP) are EmblemHealth companies. EmblemHealth Services Company, LLC provides administrative services to the EmblemHealth companies. This document may be available in alternate formats such as large print and Braille. Y0026_201155_C i EmblemHealth Medicare VIP Prime HMO and HMO-POS Provider Directory Section 1 – Introduction This directory provides a list of our plan’s VIP Prime network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). Please read this section if you are a member of EmblemHealth VIP Premier (HMO) Group and EmblemHealth Group Access Rx (PPO). You will have 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. The term “PCP” will be used throughout this directory. Your PCP is your primary care provider who can provide and coordinate all of your care, including specialist visits, hospital admissions, and more. You may choose your PCP by using the provider directory or getting help from Customer Service. The “network providers” listed in this directory have agreed to provide you with your health care/vision services. You may go to any of our network providers listed in this directory; however, some services may require a referral or prior authorization. If you have been going to one network provider, you are not required to continue to go to that same provider. In some limited instances, you may get covered services from non- network providers. With the exception of emergency care at an emergency room, you will need a referral or prior authorization before seeking services from a non-network provider. Note that in the case of an emergency, you should go to the nearest emergency room. Please check your Evidence of Coverage for more details on specific referral requirements and more details about your plan benefits. 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 our plan will be responsible for the costs. Please read this section if you are a member of EmblemHealth VIP Go (HMO-POS). If you are enrolled in EmblemHealth VIP Go (HMO-POS), you may receive some covered services from out-of-network providers if those providers agree to accept our plan’s terms and conditions of payment. You also do not need a referral to see your provider. You are able to see out-of-network providers for the many services under your Point-of- Service (POS) benefit including: • Primary care • Specialty care • Inpatient and outpatient hospital services • Durable medical equipment and supplies • Renal dialysis • Skilled nursing facilities • Home health care • Others ii EmblemHealth Medicare VIP Prime HMO and HMO-POS Provider Directory As a member of the HMO-POS plan, you do not have to choose a network provider to be your primary care provider (PCP). Choosing a PCP is an option. We always recommend that you have a PCP to help coordinate all your health care needs, including specialist visits, hospital admissions, and more. You may choose your PCP by using the provider directory or getting help from Customer Service. In some cases, excluding emergency and urgent care, it may cost you more to get care from out-of-network providers. You must use network providers for some services; for example, inpatient and outpatient mental health, and dental and supplemental vision services. For more information about when you can use out-of-network providers and what your costs will be, please look in your Evidence of Coverage. What to do if you get a bill from a provider? There may be times when you get a bill from a provider for the full cost of medical care you received. In many cases, you should send this bill to us instead of paying it. We will look at the bill and decide whether the services should be covered. If we decide they should be covered, we will pay the provider directly. You may also get services from out-of-area providers in situations where emergency or urgently needed care is needed. Our plan covers emergency and urgently needed care anywhere in the world. If you experience a medical emergency, call for help or go to the nearest emergency room or hospital. Call for an ambulance if you need it. You do not need to get an approval or a referral first. After the emergency is over, you can get follow-up care until your condition is stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, and your plan does not have out-of-network benefits, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow. What is the service area for EmblemHealth Medicare HMO and HMO-POS plans? The counties in our service area are listed below: Albany, Bronx, Broome, Columbia, Delaware, Dutchess, Greene, Kings, Nassau, New York, Orange, Putnam, Queens, Rensselaer, Richmond, Rockland, Saratoga, Schenectady, Suffolk, Sullivan, Ulster, Warren, Washington, and Westchester. Check your Evidence of Coverage (EOC) to see where your plan is available. iii EmblemHealth Medicare VIP Prime HMO and HMO-POS Provider Directory How do you find EmblemHealth HMO and HMO-POS providers that serve your area? You can find a provider by looking in this directory or going online at emblemhealth.com/ medicare. We do everything possible to keep our directories up to date, but our network can change from time to time. Before selecting your provider, we ask that you call to confirm that he or she is still participating in the plan’s network and with your Medicare plan, and if he or she is accepting new patients. You can do this by contacting the provider at the phone number listed in the directory. If you have questions about our plan or need help selecting a PCP or finding another provider close to where you live, please call our Customer Service Department at 877-344-7364, 8 am to 8 pm, seven days a week. TTY users should call 711. You can also visit emblemhealth.com/medicare. iv EmblemHealth Vendors The vendors listed below are partners with EmblemHealth and provide certain services on our behalf. Beacon Health Options The names of the providers listed and the information about them are furnished and managed by Beacon Health Options, which has a contract with EmblemHealth. This allows you to find a Beacon Health Options provider as part of your in-network benefit. The accuracy of these listings is confirmed annually by Beacon Health Options. EyeMed Vision Care The names of the providers listed and the information about them are furnished and managed by EyeMed Vision Care, which has a contract with EmblemHealth. This allows you to find EyeMed provider services as part of your in-network benefit. The accuracy of these listings is confirmed annually by EyeMed. Y0026_ 124657r Accepted 9/18/16 v ATTENTION: If you speak other languages, language assistance services, free of charge, are available to you. Call 1-877-411-3625 (TTY/TDD: 711). Español (Spanish) ATENCIÓN: Si usted habla español, tiene a su disposición, gratis, servicios de ayuda para idiomas. Llame al 1-877-411-3625 (TTY/TDD: 711). 中文 (Traditional Chinese) 注意：如果您講中文，我們免費為您提供相關的語言協助服務。請致電 1-877- 411-3625 (TTY/TDD: 711)。 Pусский (Russian) ВНИМАНИЕ! Если Вы говорите на русском языке, Вам доступны бесплатные услуги переводчика. Звоните по тел. 1-877- 411-3625 (служба текстового телефона, TTY/TDD: 711). Kreyòl Ayisyen (Haitian Creole) ATANSYON: Si ou pale Kreyòl Ayisyen, gen sèvis èd nan lang gratis ki disponib pou ou. Rele nimewo 1-877-411-3625 (TTY/TDD: 711). 한국어 (Korean) 주의: 귀하가 한국어를 사용하는 경우, 귀하에게 언어 지원 서비스가 무료로 제공됩니다. 1-877-411-3625(TTY/TDD: 711)로 전화하십시오. Italiano (Italian) ATTENZIONE: Se parli italiano, sono disponibili servizi gratuiti di assistenza linguistica. Chiama il numero 1-877-411-3625 (TTY/TDD: 711). (Yiddish) אידיש אכטונג׃ אױב איר רעדט אידיש, שּפראך הילף סערװיסעס, אהן קײן ּפרײז, זײנען דא צו באקומען פאר אײך. רופט .)TTY/TDD: 711( 1-877-411-3625 বা廬লা (Bengali) দষ্টিৃ আক쇍ষণ: আপষ্টি যষ্টদ বা廬লা ভা쇍াভা쇍ী হি, তাহলল আপিার জিয ভা쇍া সহায়তা পষ্টরল쇍বা巁ষ্টল, ষ্টবিামূললয, উপলব্ধ আলে। 1-877-411-3625 (TTY/TDD: 711) িম্বলর ফ াি ক쇁ি। Polski (Polish) UWAGA: Dla osób mówiących po polsku dostępna jest bezpłatna pomoc językowa. Proszę zadzwonić pod numer 1-877-411-3625 (TTY/TDD: 711). (Arabic) العربية العربية ُيرجى اﻻنتباه: إذا كنت تتكلم اللغة العربية، تتوفر لك خدمات المساعدة اللغوية مجاناً. اتصل بالرقم 1-877-411-3625 .)TTY/TDD: 711( Y0026_126476 Accepted 8/29/16 Group Health Incorporated (GHI), HIP Health Plan of New York (HIP), HIP Insurance Company of New York and EmblemHealth Services Company, LLC are EmblemHealth companies.