PROVIDER and PHARMACY DIRECTORY Directorio De Farmacias Y Proveedores
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2015 PROVIDER AND PHARMACY DIRECTORY Directorio de farmacias y proveedores Cigna-HealthSpring® Illinois Provider and Pharmacy Directory / Directorio de farmacias y proveedores Cook, DuPage, Kane, Will Counties / Condados, IL For more information, please contact Cigna-HealthSpring Customer Service at 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8 a.m. - 8 p.m., or visit www.cignahealthspring.com. Para más información, favor de ponerse en contacto con el Departamento de servicio al cliente de Cigna-HealthSpring al 1-800-668-3813 o, para usuarios TTY, 711, 7 días de la semana, o bien visite www.cignahealthspring.com. This Provider and Pharmacy Directory was updated on 08/24/2014. Este Directorio de proveedores y farmacias se actualizó el 08/24/2014. © 2014 Cigna 15_D_67_IL_67 Y0036_15_19958aBL_FINAL_7 Approved 08252014 Y0036_15_19958aBL_FINAL_7 Cover Provider Pharmacy IL.indd 2 9/5/14 2:51 PM Cigna-HealthSpring HMO Plan Provider Directory This directory provides a list of Cigna-HealthSpring’s network providers. This directory is for Cook, DuPage, Kane, Will Counties, IL. This directory is current as of August 2014. 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 Cigna-HealthSpring’s network providers in your area, you can visit www.cignahealthspring.com or call our Customer Service Department at 1-800-668-3813, 7 days a week, 8 a.m. – 8 p.m. TTY users should call 711. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc. Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal. This information is available for free in other languages. Please call our customer services number at 1-800-668-3813 (TTY 711), 7 days a week, 8 a.m. – 8 p.m. Esta información está disponible de forma gratuita en otros idiomas. Favor de contactar a nuestro Departamento de servicio al cliente al 1-800-668-3813 (TTY 711), 7 días de la semana, 8 a.m. – 8 p.m. This document may be available in other formats such as Braille, large print or other alternate formats. Contact the plan for more information. Y0036_15_19958aBL_FINAL_7 Approved 08252014 15_D_67_IL_67 Section 1 – Introduction This directory provides a list of Cigna-HealthSpring’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 our network providers who are listed in this directory to be your Primary Care Provider (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your healthcare coverage from your PCP. Your PCP is a physician who is trained to provide general medical care. Your PCP can also coordinate the rest of the covered services you need. The “network providers” listed in this directory have agreed to provide you with your healthcare, vision, and dental 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 POS Plans: While you are a member of our plan, you may use providers outside of the network. Your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency care, out-of-area urgent care, or out-of-area dialysis services. You don’t need to get a referral, but you may need prior authorization for some plans* when you get care from out-of- network providers. In non-emergent situations, please tell out-of-network providers that you are a Cigna-HealthSpring member before you see them to ensure that they will see Cigna-HealthSpring members. Our payment for out-of-network services is based on the Medicare Allowable Amount. If the out-of-network provider charges more than the Medicare Allowable Amount, you may be liable for the difference between the Medicare Allowable Amount and the provider’s total charge. (*Cigna-HealthSpring Premier (HMO-POS) does require prior authorization for out-of-network providers.) Cigna-HealthSpring offers a Point-of-Service (POS) option. The POS option allows you to use out-of-network area providers. You must notify Cigna-HealthSpring prior to using out-of-network area providers. If you use an out-of-network area provider for non- emergent services, your out-of-pocket costs may be higher. If you do not notify the plan prior to using an out-of-network provider, you will be responsible for 100% of the cost(s) billed. Neither Cigna-HealthSpring nor Medicare will pay for these services. Please refer to your Evidence of Coverage for details. Even though your PCP is trained to handle the majority of common health needs, there may be a time when you need more specialized treatment. In those situations, you may see a plan specialist. Specialists are doctors who are trained to provide health services for a specific disease or part of the body. For some types of specialists, you will need to obtain a “referral” from your PCP before you can schedule an appointment with the specialist. Below is a list of provider specialty types that require referrals from your PCP before you can schedule an appointment with them. Please note: Some provider types may have been added or removed from the list after this directory was printed. You should check with your PCP or call Customer Service at the phone number on the cover to see if a referral is required to see a specialist or other provider. Note that a referral is different from “prior authorization”, which is required before certain services procedures can be performed. Allergy & Immunology Medical Genetics Physical Therapy Anesthesiology Medical Oncology Plastic Surgery Audiology Nephrology Podiatry Cardiovascular Disease Neurosurgery Proctology Cardiovascular Surgery Neurology Prosthodontics Chiropractor Occupational Therapy Pulmonary Disease Colon and Rectal Surgery Ophthalmology Radiology Dermatology Oral Surgery Respiration Therapy Endocrinology Orthopedic Surgery Rheumatology Gastroenterology Otolaryngology Speech Language Pathologist General Surgery Pain Management Speech Therapy Gynecologic Oncology Pediatric Cardiology Sports Medicine Hand Surgery Pediatric Endocrinology Thoracic Surgery Hematology Pediatric Hematology-Oncology Urology Hematology/Oncology Pediatric Rehabilitation Medicine Vascular and Interventional Infectious Disease Pediatric Surgery Vascular Surgery Maxillofacial Surgery Physical Medicine/Rehabilitation In addition, each PCP has certain plan specialists and hospitals they use for referrals. This means that the Cigna-HealthSpring specialists or hospitals you can use may depend on which PCP you select. If there are specialists or hospitals that you want to use, it is important to find out if your chosen PCP refers to them. Cigna-HealthSpring has different types of Primary Care Provider relationships. We have contracts with Independent Physician Associations and clinic based providers. The following paragraphs describe the relationship these providers have with Cigna- HealthSpring. Advocate Medical Group Advocate Medical Group are community-based medical practices that offer unique programs and services to keep patients healthy. These include: convenient appointments, walk-in care, online appointment and community outreach and events. Advocate Medical Group includes forty (40) sites located throughout Chicago and the surrounding suburbs. If you select a Primary Care Physician (PCP) who belongs to Advocate Medical Group you should be aware that your PCP will refer you only to specialist and hospitals affiliated with Advocate. You will receive all your care, including gynecological and specialty care from physicians and hospitals within the Advocate Medical Group network. Senior Care Partners, Inc. Senior Care Partners is an Independent Practice Association operated by North American Medical Management-Illinois. Senior Care Partners was established to provide a contracting opportunity between Cigna-HealthSpring of Illinois and the Physician communities in Cook and adjoining collar counties. The IPA is locally controlled with key physician participation. It provides an integrated, clinically oriented delivery system to Medicare Beneficiaries and their physician providers. Senior Care Partners’ operations are Primary Care centered and provide for a positive relationship between Medicare beneficiaries electing care through one of its physicians. There may also be times when you get a bill from a provider for the full cost of medical care you have received. In many cases, you should contact Customer Service or 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. (Please note that we cannot pay a provider who has opted out of the Medicare program. Check with your provider before receiving services to confirm that they have not opted out of Medicare.) If we determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the entire cost. You may get emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health.