2013 select network provider listing

177 Pages·2015·0.94 MB·English

2013 SELECT NETWORK
PROVIDER LISTING

SELECT NETWORK PLAN
This listing includes primary care physicians in the Select Network Plan.
Some plan providers may have been added or removed from the list after this listing
was printed. To get the most up-to-date information about the providers in your area,
you can visit www.emblemhealth.com or call our Customer Service department at
1-877-344-7364, 8 am to 8 pm, daily. TDD users, please call 711.
HIP Health Plan of New York (HIP) is a Medicare Advantage organization with a
Medicare contract. HIP is an EmblemHealth company.
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Introduction
This listing provides primary care physicians in the Select Network. Other doctors or
practitioners are available in our network. A comprehensive list of providers, including
specialists, hospitals and other providers, is available upon request. To get detailed
information about your health care coverage, please see your Evidence of Coverage.
You will have to choose one of our plan providers that are provided in this listing to be your
primary care {physician/provider} (PCP). The term “PCP” will be used throughout this
listing. Generally, you must get your health care coverage from your PCP. Your PCP is your
primary care physician, who can provide and coordinate all of your care, including specialist
visits, hospital admissions and more.
The “plan providers” in this network have agreed to provide you with your health care
coverage. If you have been going to one plan provider, you are not required to continue
going to that same provider. You may go to any of our network providers listed in this
directory. In some cases, you may get covered services from non-plan providers. Please
check your Evidence of Coverage for more details on specific referral requirements and
more details about your plan benefits.
You must use plan providers except in emergency or urgent care situations. If you obtain
routine care from out-of-network providers neither Medicare nor EmblemHealth will be
responsible for the costs.
What is the service area for the Select Network?
The counties in our service area are listed below.
Bronx, Brooklyn, Manhattan, Nassau, Queens, Rockland, Staten Island, Suffolk and
Westchester Counties
How do you find Select Network providers in your area?
You can find a provider by looking in this listing or going online at www.emblemhealth.com.
We do everything possible to keep our materials current, but participation status can change
from time to time. Before selecting your PCP, confirm that he or she is still participating in the
Select Network with the product you are covered by, and is accepting new patients. You can
do this by contacting the provider at the phone number provided in the listing. If you choose
a doctor that is not in the Select Network, you will have higher copays.
If you have questions about the Select Network, please call our Customer Service
department at 1-877-344-7364, 8 am to 8 pm, daily. TDD users, please call 711.
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Provider Listing Key
To find the full name of any participating hospital shown under the physician listing
contained in this listing, please refer to the Hospital Abbreviation Key.
DIRECTORY KEY
Provider’s name Doe, John, MD
01234P Denotes board
certification**
Provider’s ID number
Not accepting new patients
(PRIS)*/provider’s gender1
Provider’s status on
Primary Medical Care accepting new patients3
Specialty/Office name2 123 Main Street
Pleasantville, NY 12345 Office street address1
Office phone number1
1-555 555-5555
Hospital affiliations1 see
Hospital Codes: LUTH, MAIM hospital abbreviation key
Languages spoken
by the practitioner and/ Languages: Italian
or the clinical staff1
The Provider PRIS number is an office location-specific number that a provider uses,
*
along with a Personal Identification Number (PIN) to access HIP’s Interactive Voice
Response (IVR) System and HIP’s Web site at www.emblemhealth.com.
** Practitioners must satisfy the requirements/standards of a nationally recognized
specialty board and receive specialist certification from either ABMS or AOA. Board
certification is verified by ABMS and AOA during the re-credentialing process every
three years.
1 Information is collected from the Provider Application; therefore, it is self-reported
and is validated every three years during the re-credentialing process or sooner based on
provider notification.
2 Information is collected from the Provider Application and validated every three years
during the re-credentialing process. For Board Certified Providers, information is
collected from and verified by ABMS or AOA. For Non-Board Certified Providers,
information is verified from the highest level of training and with the Licensing Board.
3 Acceptance of new patients applies to primary care physicians. Unless otherwise noted,
all physicians are accepting new patients.
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Physician Practices
All Your Health Care Needs Under One Roof
Many of our members choose to receive care from one of our network practices that can
house most, if not all, of your medical services in the same building. You’ll have access to
quality and competent PCPs and key specialists like dermatologists, orthopedists, OB/
GYNs, cardiologists and ophthalmologists, as well as ancillary services such as lab tests,
X-rays and pharmacy services. Plus, many of the practices offer the convenience of
scheduling same-day appointments.
Well-known names such as Preferred Health Partners (in Brooklyn), Queens-Long Island
Medical Group, Manhattan’s Physician Group and Staten Island Physician Practice are
now part of AdvantageCare Physicians. If you choose a PCP from one of these medical
practices, you can expect your doctor to refer you to specialists at the same medical office
unless the care you need is not available there.
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PHYSICIAN PRACTICES