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2016 Provider/Pharmacy Directory PDF

400 Pages·2016·1.46 MB·English
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Preview 2016 Provider/Pharmacy Directory

HealthNow New York SelectSaver HMO (HMO-POS) 2016 Provider/Pharmacy Directory This directory was updated on June 6, 2016. For more recent information or other questions, please contact us, HealthNow New York Customer Service, at: 1-888-787-2390 or, for TTY users 711 October 1-February 14 8 a.m. to 8 p.m., 7 days a week February 15-September 30 8 a.m. to 8 p.m., Monday-Friday or visit healthnowny.com/medicare HealthNow New York is a Medicare Advantage plan with a Medicare contract. Enrollment in HealthNow New York depends on contract renewal. The pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Y0086_MRK1613 Accepted HealthNow New York SelectSaver HMO-POS Plan Provider/Pharmacy Directory This directory provides a list of SelectSaver HMO-POS's network providers and pharmacies. The directory is for Monroe and Wayne counties, New York. This directory is current as of June 6, 2016. 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 SelectSaver HMO-POS’s network providers in your area, you can visit www.healthnowny.com/medicare or call our Customer Service Department at 1-888-787-2390. TTY users should call 711, October 1-February 14 8 a.m. to 8 p.m., 7 days a week. February 15-September 30 8 a.m. to 8 p.m., Monday-Friday. TTY users should call 711. HealthNow New York is a Medicare Advantage plan with a Medicare contract. Enrollment in HealthNow New York depends on contract renewal. This document may be available in other formats such as Braille, large print or other alternate formats. The pharmacy network and/or provider network may change at any time. You will receive notice when necessary. Y0086_MRK1613 Accepted HN_SSHMO_06/05/2016 Section 1 - Introduction This directory provides a list of SelectSaver HMO-POS’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and SelectSaver HMO-POS’s formulary. SelectSaver HMO-POS You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your health care coverage from your PCP. Participating SelectSaver HMO-POS providers are listed in the directory. 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. In some cases, you may get covered services from non-network providers. If you are a member of SelectSaver HMO-POS, you have the option to obtain care outside of the service area for an additional cost. There is a limit to what our plan will cover under your Point-of-service (POS) benefit. Not all services are available under your Point-of-service (POS) benefit. Please reference your Evidence of Coverage (EOC) for more details. If your service does not fall under the Point-of-service benefit you must use a plan provider. The exception to this rule is for emergency or urgently needed care situations or for out-of-area renal dialysis. We will cover this care out-of-network when network providers are temporarily unavailable or inaccessible. If you obtain routine care that is not covered under your Point-of-service benefit from out-of-network providers, neither Medicare nor SelectSaver HMO-POS will be responsible for the costs. When you receive a bill from a non-contracted Medicare participating provider, you are only responsible for paying your share of the cost, not for the entire cost. You should submit the bill to the plan first to determine what your share of the cost will be. To get detailed information about out of area coverage and emergency coverage; including, the processes and procedures to obtain emergency services, please see your Evidence of Coverage. 2 Pharmacies We call the pharmacies on this list our "network pharmacies" because we have made arrangements with them to provide prescription drugs to plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by SelectSaver HMO-POS. In most cases, your prescriptions are covered under SelectSaver HMO-POS only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription. You can go to any of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage. All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of June 6, 2016. For the most current list, please contact us. Our contact information appears on the front and back cover pages. You can go to all the pharmacies on this list, but your costs for some drugs may be lower at pharmacies in this list that offer preferred cost sharing. We have marked these pharmacies with 'P' to distinguish them from other pharmacies in our network that offer standard cost sharing. Cost sharing information can be found in the Summary of Benefits. You can get prescription drugs shipped to your home through our network mail order delivery service. For more information, please contact us or see the mail order section of this directory. We also list pharmacies that are in our network but are outside Monroe and Wayne counties, New York, the area in which you live. You may also fill your prescriptions at these pharmacies. For more information, please see the section in this pharmacy directory on Network Pharmacies outside the Monroe and Wayne counties, New York, or call our Customer Service Department at 1-888-787-2390, October 1-February 14 8 a.m. to 8 p.m., 7 days a week. February 15-September 30 8 a.m. to 8 p.m., Monday-Friday. TTY users should call 711. If you have questions about any of the above, including for instructions on how to submit claims for prescriptions that you had to fill at a non-network pharmacy, please see the first and last cover pages of this directory for information on how to contact us. What is the service area for SelectSaver HMO-POS? The counties in our service area are listed below: Monroe and Wayne counties, New York counties. 3 How do you find SelectSaver HMO-POS providers in your area? We've organized this directory of physicians and pharmacies by county so you can easily find a physician or pharmacy whose location is close to your home or place of employment. If you would like to view the full provider/pharmacy directory or are in need of one, simply visit our website at www.healthnowny.com/medicare or call customer service. If you have questions about SelectSaver HMO-POS or require assistance in selecting a PCP, please call our Customer Service Department at 1-888-787-2390. TTY users should call 711, October 1-February 14 8 a.m. to 8 p.m., 7 days a week. February 15-September 30 8 a.m. to 8 p.m., Monday-Friday. TTY users should call 711. Or, visit www.healthnowny.com/medicare. 4 To assist you in using our directory we have illustrated a provider listing. Provider Name & Title 123 Street Address City, State 12345 (999) 999-9999 Other Languages: All provider offices speak PCP # 123456789012 AM/FP English. Only additional languages Other Languages: spoken in provider's office by either the provider éìx n ý-˜%oüA B C D E SB FB P S or provider's office staff are listed Please use this table as a reference for the symbols used throughout this directory PCP # PCP Number: This number identifies the provider in our system. For example, through our automated system, members can change their primary care physicians by indicating the identification number of the physician they want to select. P Preferred pharmacy. S Standard pharmacy. é Wheelchair accessible ì Board certification. A (ì) indicates certification by the ABMS (American Board of Medical Specialties) or American Board of Osteopathic Physicians. The Physician has successfully completed an approved educational program and passed an exam designed to assess the knowledge, skills and experience required to provide quality care in that specialty. You'll notice that some providers are listed as Board Certified in the specialty listed. Board Certification is a voluntary process of additional testing and evaluation in a specialty area that some providers choose to undergo. A physician should not be considered more qualified or unqualified based solely on certification. There are many certification boards in the United States and other countries. To be identified as Board Certified in this directory, a Practitioner must be Board Certified in one of the following Boards: The American Board of Medical Specialties The American Board of Oral & Maxillofacial Surgery The American Board of Podiatric Surgery The American Board of Podiatric & Primary Podiatric Medicine The American Osteopathic Association Board x Current Patients Only n Practitioner is sponsoring physician for mid-level practitioners. Mid-level practitioners available at the office listed include the following practitioners: Nurse Practitioners (NP), Physician Assistants (PA) and Certified Nurse Midwife (CNM). ý 90 day supply at retail pharmacy ˜ Provider is designated as a Patient Centered Medical Home (PCMH) 5 % Member of the Association for Medical Ethics (AME) - AIDS Designated Centers o Accepting Developmental Disabled Patients Only ü Accepting Native American Patients Only A Location is not wheelchair accessible. Provider will refer to a local hospital that is wheelchair accessible. Please contact the office for additional details. B Location is not wheelchair accessible. Provider will perform services at member's residence. Please contact the office for additional details. C Location is not wheelchair accessible. Provider will refer to a local clinic that is wheelchair accessible. Please contact the office for additional details. D Location is not wheelchair accessible. Provider will service member at a facility that is wheelchair accessible. Please contact the office for additional details. E Location is not wheelchair accessible. Provider will refer to another office or location that is wheelchair accessible. Please contact the office for additional details. Primary Care Physician (PCP) Abbreviations AM - Adolescent Medicine GER - Geriatric Medicine IM - Internal Medicine FP - Family Practice GP - General Practice PED - Pediatrics 6 TABLE OF CONTENTS PRIMARY CARE 13 Interventional Cardiology 72 Orthopedic Surgery 75 PHYSICIANS - Totals by Neurology 72 Otolaryngology 75 County Obstetrics/Gynecology 72 Pediatric Nephrology 76 PRIMARY CARE 14 Occupational Therapy 72 Physical Medicine & Rehab 76 PHYSICIANS Ophthalmology 72 Physical Therapy 76 ALLEGANY 14 Optometry 72 Podiatry 76 Orthopedic Surgery 72 Pulmonary Disease 77 CAYUGA 14 Otolaryngology 72 Radiation Oncology 77 GENESEE 15 Pain Management 72 Radiology 77 LIVINGSTON 16 Physical Therapy 72 Radiology/MRI 78 MONROE 18 Pulmonary Disease 72 Residential Treatment 78 Radiology 72 Facility ONONDAGA 45 Skilled Nursing Facility 73 Skilled Nursing Facility 78 ONTARIO 56 Transportation (Land) 73 Sleep Medicine 78 ORLEANS 57 Urology 73 Speech Therapy 78 OSWEGO 57 Sports Medicine 79 CAYUGA 73 Urology 79 SENECA 59 Allergy & Immunology 73 STEUBEN 59 Audiology 73 GENESEE 79 Cardiovascular Disease 73 Allergy & Immunology 79 WAYNE 60 Certified Nurse Midwife 73 Audiology 79 WYOMING 62 Chiropractor 73 Cardiovascular Disease 79 YATES 63 Dermatology 73 Certified Nurse Midwife 79 SPECIALISTS & OTHER 64 Diabetic Education 73 Child Neurology 79 PARTICIPATING Services Chiropractor 80 PROVIDERS - Totals by Dialysis Facility 73 Dermatology 80 County and Specialty Durable 74 Diabetic Education 80 Medical/Respiratory Services SPECIALISTS & OTHER 71 PARTICIPATING Equipment Dialysis Facility 80 PROVIDERS Endocrinology & 74 Durable Medical Equipment 80 Metabolism Gastroenterology 80 ALLEGANY 71 Gastroenterology 74 Audiology 71 General Surgery 80 General Surgery 74 Cardiovascular Disease 71 Home Health Agency - 81 Gynecology Only 74 Licensed Certified Nurse Midwife 71 Hand Surgery 74 Medical Oncology 81 Chiropractor 71 Hospice 74 Nephrology 81 Community Flu Clinics 71 Infectious Disease 74 Neurological Surgery 81 Diabetic Education 71 Services Nephrology 74 Neurology 81 Durable Medical Equipment 71 Neurological Surgery 74 Obstetrics/Gynecology 81 General Surgery 71 Neurology 74 Oncology/Hematology 82 Home Health Agency - 71 Obstetrics/Gynecology 75 Ophthalmology 82 Certified Occupational Therapy 75 Optometry 82 Home Health Agency - 72 Ophthalmology 75 Orthopedic Surgery 82 Licensed Optometry 75 Orthotics/Prosthetics 82 7 Otolaryngic Allergy 82 Allergy & Immunology 88 Home Infusion/Durable 112 Otolaryngology 83 Ambulatory Surgery Center 89 Medical Equipment Pain Management 83 Audiology 89 Hospice 112 Physical Medicine & Rehab 83 Cardiac Electrophysiology 90 Infectious Disease 112 Physical Therapy 83 Cardiac Surgery 90 Infusion Center 113 Podiatry 83 Cardio Thoracic 90 Interventional Cardiology 113 Pulmonary Disease 83 Cardiovascular Disease 90 Long Term Care Pharmacy 113 Radiation Oncology 83 Certified Diabetic Providers 95 Maternal & Fetal Medicine 113 Radiology 84 Certified Nurse Midwife 95 Medical Genetics 114 Skilled Nursing Facility 84 Child Neurology 98 Medical Oncology 114 Urology 84 Chiropractor 99 Medical Toxicology 116 Vasc Interventional 84 Colon and Rectal Surgery 100 Neonatal-Perinatal 116 Radiology Community Flu Clinics 100 Medicine Vascular Surgery 84 Critical Care Medicine 101 Nephrology 117 Neuro Ophthalmology 118 LIVINGSTON 84 Dermatology 101 Neuro-Oncology 118 Audiology 84 Dermatopathology 103 Neurodevelopmental 118 Cardiovascular Disease 85 Developmental Pediatrics 103 Disability Certified Nurse Midwife 85 Diabetic Education 103 Neurological Surgery 118 Services Chiropractor 85 Neurology 119 Diagnostic Pediatrics 103 Dermatology 85 Neuroradiology 125 Dialysis Facility 103 Durable Medical Equipment 85 Nuclear Medicine 125 Durable Medical Equipment 103 General Surgery 86 Obstetrics/Gynecology 125 Durable 104 Hearing Aid 86 Medical/Respiratory Occupational Medicine 134 Home Health Facility 86 Equipment Occupational Therapy 135 Hospice 86 Endocrinology 104 Oncology/Hematology 135 Interventional Cardiology 86 Endocrinology & 104 Ophthalmology 136 Nephrology 86 Metabolism Optometry 139 Neurological Surgery 86 Facial Plastic Surgery 104 Oral & Max Surgery 144 Neurology 86 Gastroenterology 105 Orthopedic Surgery 144 Obstetrics/Gynecology 86 General Surgery 106 Orthotics/Prosthetics 146 Ophthalmology 86 Geriatric Specialist 109 Otolaryngology 147 Optometry 86 Gynecologic Oncology 109 Pain Management 148 Orthopedic Surgery 87 Gynecology Only 109 Pediatric Allergy & 149 Otolaryngology 87 HIV Experienced 110 Immunology Pain Management 87 Hand Surgery 110 Pediatric Cardiology 149 Physical Therapy 87 Head and Neck Surgery 110 Pediatric Critical Care 149 Podiatry 87 Hearing Aid 110 Pediatric Dermatology 150 Pulmonary Disease 87 Hematology 111 Pediatric Endocrinology 150 Radiology 87 Home Health Agency - 111 Pediatric Gastroenterology 150 Skilled Nursing Facility 87 Certified Pediatric 150 Urology 87 Home Health Agency - 111 Hematology/Oncology MONROE 88 Licensed Pediatric Infectious 151 Adolescent Medicine 88 Home Infusion - Licensed 112 Diseases Specialist Pediatric Nephrology 151 8 Pediatric Neurological 151 Cardio Thoracic 192 Neurodevelopmental 211 Surgery Cardiovascular Disease 192 Disability Pediatric Ophthalmology 152 Certified Nurse Midwife 195 Neurological Surgery 211 Pediatric Orthopedic 152 Child Abuse Pediatrics 196 Neurology 211 Surgery Chiropractor 196 Neuroradiology 212 Pediatric Otolaryngology 152 Colon and Rectal Surgery 197 Nuclear Medicine 212 Pediatric Pulmonary 152 Critical Care Medicine 198 Obstetrics/Gynecology 212 Disease Dermatology 199 Occupational Therapy 217 Pediatric Radiology 152 Dermatopathology 199 Oncology/Hematology 217 Pediatric Rheumatology 152 Diabetic Education 199 Ophthalmology 217 Pediatric Surgery 152 Services Optometry 219 Pediatric Urology 152 Dialysis Facility 199 Orthopedic Surgery 222 Physical Medicine & Rehab 153 Durable Medical Equipment 199 Orthotics/Prosthetics 227 Physical Therapy 154 Durable 200 Otolaryngology 227 Plastic Surgery 158 Medical/Respiratory Pain Management 229 Podiatry 159 Equipment Pediatric Critical Care 230 Preventive Medicine 161 Endocrinology 200 Pediatric Endocrinology 230 Pulmonary Disease 162 Endocrinology & 200 Pediatric Gastroenterology 231 Radiation Oncology 163 Metabolism Pediatric 231 Radiology 166 Gastroenterology 201 Hematology/Oncology Reproductive 181 General Surgery 203 Pediatric Infectious 231 Endocrinology Geriatric Specialist 206 Diseases Rheumatology 181 Gynecologic Oncology 206 Pediatric Nephrology 231 Skilled Nursing Facility 182 Gynecology Only 206 Pediatric Ophthalmology 231 Sleep Medicine 183 HIV Experienced 206 Pediatric Orthopedic 232 Speech Therapy 183 Hand Surgery 207 Surgery Sports Medicine 184 Hematology 207 Pediatric Otolaryngology 232 Surgical Critical Care 184 Home Health Agency - 208 Pediatric Physical Medicine 232 Surgical Oncology 184 Certified Pediatric Pulmonary 232 Therapeutic Radiology 184 Home Health Agency - 208 Disease Thoracic Surgery 185 Licensed Pediatric Rheumatology 232 Trauma Surgery 185 Home Infusion - Licensed 208 Pediatric Surgery 232 Urgent Care Center 185 Home Infusion/Durable 208 Pediatric Urology 233 Medical Equipment Urology 185 Physical Medicine & Rehab 233 Hospice 208 Urology Gynecology 187 Physical Therapy 235 Hospice Physicians 208 Vasc Interventional 188 Plastic Surgery 240 Infectious Disease 209 Radiology Podiatry 240 Interventional Cardiology 209 Vascular Surgery 189 Preventive Medicine 242 Maternal & Fetal Medicine 209 Pulmonary Disease 242 ONONDAGA 190 Medical Genetics 209 Radiation Oncology 243 Allergy & Immunology 190 Medical Oncology 210 Radiology 244 Ambulatory Infusion Center 190 Medical Toxicology 210 Radiology/MRI 265 Ambulatory Surgery Center 190 Neonatal-Perinatal 210 Reproductive 265 Audiology 191 Medicine Endocrinology Cardiac Electrophysiology 191 Nephrology 210 Cardiac Surgery 192 9

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