Villagecaremax Medicare Total Advantage (HMO SNP) 2019 Provider & Pharmacy Directory
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H2168_MBR19-56_C VillageCareMAX Medicare Total Advantage (HMO SNP) 2019 Provider & Pharmacy Directory This Provider & Pharmacy Directory was updated on 06/06/2019. For more recent information or other questions, please contact VillageCareMAX Medicare Total Advantage (HMO SNP) Member Services at 1-800-469-6292 or, for TTY users, 711, 8:00 am to 8:00 pm, 7 days a week, or visit www.villagecaremax.org. Changes to our provider and pharmacy network may occur during the benefit year. An updated Provider & Pharmacy Directory is located on our website at www.villagecaremax.org. You may also call Member Services for updated provider information. i VillageCareMAX Medicare Total Advantage (HMO SNP) 2019 Provider Directory This directory is current as of 06/06/2019. This directory provides a list of VillageCareMAX Medicare Total Advantage’s (HMO SNP) network providers. This directory is for New York (Manhattan) county. To access VillageCareMAX Medicare Total Advantage’s online provider directory, you can visit www.villagecaremax.org to view the complete directory or providers in another county. For any questions about the information contained in this directory (hardcopy or online), to request a hardcopy, or to get help finding a provider in another county, please call our Member Service Department at 1-800-469-6292, 8:00 am to 8:00 pm, 7 days a week. TTY/TDD users should call 711. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call 1-800-469-6292 (TTY: 711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-800-469-6292 (TTY: 711). 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電1-800-469-6292 (TTY: 711)。 All providers in this provider directory accept both Medicare and Medicaid. The pharmacy and provider network may change at any time. You will receive notice when necessary. 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 VillageCareMAX Medicare Total Advantage network providers in your area, you can visit www.villagecaremax.org or call our Member Service Department at 1-800-469-6292, during the hours of 8:00 am to 8:00 pm, 7 days a week. TTY users should call 711. This information is available for free in other formats, such as large print, Braille, or audio. Call 1-800-469-6292 (TTY: 711), during the hours of 8:00 am to 8:00 pm, 7 days a week. This plan is available to anyone who has both Medicare and Medicaid. ii VillageCareMAX is a HMO plan with Medicare and New York State Medicaid contracts.. Enrollment in VillageCareMAX depends on contract renewal. iii Table of Contents Section 1 – Introduction .................................................................................................................. v What is the service area for VillageCareMAX Medicare Total Advantage? ........................ vi How do you find VillageCareMAX Medicare Total Advantage providers in your area? ..... vi Section 2 – List of Network Providers ............................................................................................ Primary Care Physicians (617 Providers) ............................................................................... 1 Specialists (3005 Providers) ...................................................................................................46 Hospitals (10 Providers) ........................................................................................................178 Skilled Nursing Facilities (SNF) (11 Providers) ...................................................................179 Outpatient Mental Health Providers (2 Providers) ............................................................... 180 Ancillaries Services (163 Providers) .................................................................................... 181 Non-Emergent Transportation ............................................................................................. 205 Dental (359 Providers) ......................................................................................................... 206 Vision (19 Providers) ........................................................................................................... 234 Audiology (40 Providers) ....,,,.............................................................................................. 236 Acupuncture (83 Providers) ................................................................................................. 238 Pharmacies (622 Providers) .................................................................................................. 247 Index by Provider Name ....................................................................................................... 281 Index by Specialty................................................................................................................. 325 iv Section 1 – Introduction This directory provides a list of VillageCareMAX Medicare Total 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 our network providers who are listed in this directory or an out- of-network provider to be your Primary Care Provider (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care services from your PCP. Your PCP is a healthcare professional, either a physician or Nurse Practitioner, who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. He/she will help in planning your care and ensure that you get necessary services. You can choose an in-network PCP by viewing the list of providers starting on page 1 or choose an out-of-network provider. If you need help in choosing a PCP or to provide your PCP information, please call Member Services at 1-800-469-6292 (TTY: 711), 8:00 am to 8:00 pm, 7 days a week. The call is free. You may change your PCP at any time by calling Member Services. When you change your PCP, we will send you a new Member ID card that includes updated information about your PCP. 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. If you have been going to one network provider, you are not required to continue to go to that same provider. You are able to see out-of-network providers for emergency care, urgently needed care, out-of- area dialysis or when a network provider is not available to provide routine care. You do not need a referral from your primary care provider to see a specialist or other providers in our network or out-of-network. However, prior authorization rules must be followed. You may be responsible for paying the full cost of services if prior authorization is not obtained for certain services. Please see your Evidence of Coverage for more information about the services that require prior authorization from VillageCareMAX. v If you receive a bill from an out-of-network provider, do not pay the bill. Instead, send the bill to VillageCareMAX for review and we will determine who should be responsible for payment. If the plan is responsible for payment, we will pay the provider directly. If you already paid for the covered services, you can send the bill to us and we will reimburse you for services that are the plan’s responsibility. You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories. If you have an emergency, get help as quickly as possible. Call 911 for help or go the nearest emergency room. You do not need to get prior authorization or referral from your doctor. Contact Member Services within 48 hours to tell us about your emergency care. We will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, 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 VillageCareMAX Medicare Total Advantage? The counties in our service area are listed below: • Bronx • Kings (Brooklyn) • New York (Manhattan) • Queens How do you find VillageCareMAX Medicare Total Advantage providers in your area? You may receive services from any of the providers within our service area. To find a provider near you, search for the type of provider or name of provider by zip code. The providers within this county are listed as follow: • Type of provider (e.g. Specialists, Ancillary Providers) • County • City/Town (alphabetically) • Zip Code • Provider (alphabetically) • Specialty (e.g. Cardiology) If you have questions about VillageCareMAX Medicare Total Advantage or require assistance in selecting a PCP, please call our Member Services Department at 1-800-469-6292, 8:00 am to 8:00 pm, 7 days a week. TTY users should call 711, or visit www.villagecaremax.org. vi Directorio de Proveedores y Farmacias 2019 de Medicare Total Advantage de VillageCareMAX (HMO SNP)