Kaiser Permanente Medicare Plus (Cost) Provider Directory This directory provides a list of Kaiser Permanente’s Medicare Plus network providers. This directory is for the service area of our Mid-Atlantic States Region, which is the following counties and parts of counties (the asterisk * indicates a partially covered county; please see the service area description inside for the ZIP codes in these counties that are inside the service area): District of Columbia; Maryland: The City of Baltimore, and the counties of Anne Arundel, Baltimore, Carroll, Harford, Howard, Montgomery, Prince George’s, Calvert*, Charles*, and Frederick*; Virginia: The cities of Falls Church, Fairfax, Alexandria, Manassas, and Manassas Park; the counties of Arlington, Fairfax, Prince William, and Loudoun. This directory is current as of October, 1, 2012. 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 Kaiser Permanente’s Medicare Plus network providers in your area, you can visit kp.org or call Member Services at 1-888-777-5536, seven days a week, 8 a.m. to 8 p.m. TTY users should call 711. Kaiser Permanente is a health plan with a Medicare contract. This information is available for free in other languages. Please contact Member Services at 1-888-777-5536 (seven days a week, 8 a.m. to 8 p.m.). TTY users should call 711. This document is available in a different format for the visually impaired by calling Member Services at the number listed above. H2150_12_036 SECTION 1 Introduction This directory provides a list of Kaiser Permanente Medicare Plus network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. The network providers listed in this directory have agreed to provide you with your health care and vision coverage. 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 going to that same provider. Some services may require a referral. If your primary care physician decides that you require covered services from other providers, you will usually be referred to a MAPMG physician. Should you require services not available within MAPMG or where such services do not meet regulatory requirements for access, you might be referred to an associated provider in the community for that service. You must have an authorized referral for specialists and non-plan providers for us to cover the services and/or supplies provided. In some cases, you may get covered services from non-network providers. Use this directory to learn about selecting your PCP and getting referrals. These processes are described in detail on the following pages. H2150_12_036 1 Our Provider Network: The Mid-Atlantic Permanente Medical Group In the Mid-Atlantic Permanente Medical Group, P.C., there are almost 1,000 expertly skilled physicians who practice in Kaiser Permanente medical centers. The group includes physicians from major specialties and subspecialties, alternative and complementary medicine, and behavioral health. Each physician meets strict standards to become and remain a Permanente physician. They are rigorously screened and expertly trained. Each is board certified or, for newly hired physicians, required to become board certified within five years of hire. They are re-credentialed every three years, every two years for certain specialties. Permanente physicians promote a healthy lifestyle, disease prevention, education, and open communication. Improving patient health using these approaches, combined with management of chronic diseases, is a cornerstone of Permanente medicine. Our physicians respect your opinions and you are encouraged to work collaboratively with your doctors about your treatment. You benefit from your own physicians’ experience and from the experience of thousands of Permanente physicians across the country who communicate with each other about the best ways to practice medicine and the latest developments in care, research, and technology. When you choose a Permanente physician, you can be confident that he or she has immediate access to your medical information so that you get the right care at the right time—care that is personalized, affordable, and coordinated. Your doctors are part of a single, integrated medical group connected by the largest civilian electronic medical record system in the world. This enables them to easily consult about your health with other doctors, pharmacists, nurses, and other Kaiser Permanente health professionals locally and across the country. IT’S TOUGH TO BECOME ONE OF OUR DOCTORS. Only one in 10 who applies is accepted as a Permanente doctor. Permanente physicians promote a healthy lifestyle, disease prevention, education, and open communication. Improving patient health using these approaches, combined with management of chronic diseases, is a cornerstone of Permanente medicine. 2 H2150_12_036 The electronic medical record system also provides information about your health to any Kaiser Permanente caregiver who can see your medical record. That means your optician can remind you that you’re due for preventive care. Most of the prescriptions written by Permanente physicians are sent electronically to our medical center pharmacies, so they can be fi lled fast and you can be on your way. When you speak with an advice nurse, see a Permanente doctor in urgent care in the middle of the night, or stay in a core hospital where Kaiser Permanente physicians are on duty, they can all know you through your secure electronic medical record, which is at their fi ngertips. That same technology connects your Permanente doctor to you. At kp.org, you can email your doctor’s offi ce, read doctor’s instructions, manage appointments, read most lab test results, order most prescription refills, and more. When you receive care, tests, and treatment in a Kaiser Permanente medical center, your care is connected and coordinated in ways that are possible only here. While we’re proud of the many times Permanente physicians have been recognized for the quality of the care they provide, we’re equally proud of the compassion they show to their patients and the zeal they have for helping you be as healthy as you can be. Your Permanente physicians and others at Kaiser Permanente are here to help you be the healthiest you can be so you can live life to the fullest. H2150_12_036 3 Your primary care physician Establishing a relationship with a physician and seeing him or her regularly is important so you get consistent and personalized care. You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician/Provider (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care coverage from your PCP. Your PCP partners with you to help you live the healthiest life possible. He or she coordinates your care, orders needed tests, and consults with specialists, pharmacists, and others, as needed. Adults should select a PCP who specializes in internal medicine or family practice. You may also choose a family practitioner to care for your entire family. When you have a PCP, you always have a physician who knows you, understands your health goals and preferences, and advocates for you. Women up to age 75 will choose a personal obstetrician/gynecologist (ob/gyn) in addition to their PCP. Note: In addition to Permanente physicians, you may also choose from among affi liated physicians for primary care and obstetrics/gynecology in some areas. Affiliated physicians are in private practice in the community, located in areas more distant from Kaiser Permanente medical centers. Each Permanente PCP and ob/gyn has a panel of patients composed of members who have either selected or been assigned to that physician. Occasionally, we must temporarily close a physician’s panel to new patients because of high demand to see that physician. If, when choosing your PCP, you are told the physician you have selected is not accepting new patients, we will try to offer you another physician who is a member of your originally requested physician’s health care team. 4 H2150_12_036 Your doctor’s offi ce, plus added convenience You may choose to receive care in any of our medical centers in Maryland, Virginia, and the District of Columbia (more are opening in 2013—see page 20). Wherever you visit your Permanente physician, convenience is built into your medical center. Lab Vision care Urgent care Your doctor’s offi ce Pharmacy Specialty care services Specialty doctors Radiology Minor injury clinic Because Kaiser Permanente staff and physicians respect your time, convenience extends beyond the walls of your medical center. You can set telephone appointments with your doctor to save trips to his or her office and whenever you need medical advice, specially trained nurses are on call 24 hours a day, seven days a week. We have developed technology that lets your physician schedule a specialist appointment for you during your visit. Online, you can email your doctor’s office, order most prescription refills, read most lab test results, and even read your specifi c benefi ts. Visit kp.org/experience to learn more. H2150_12_036 5 Referrals for specialty care When a plan provider thinks that you need care from a specialist, he or she will usually request an authorized referral (written approval in advance) for you to see a Permanente specialist. Should you require services not available through a Permanente physician, either due to specialty or length of time until an open appointment, you might be referred to an associated provider in the community for that service. You must have an authorized referral for specialty care for us to cover the services and/or supplies provided.