Medicare Select - Provider Directory

224 Pages·2015·1.9 MB·English

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2017 Provider Directory
Medicare Select
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IMPORTANT CONTACT INFORMATION
Read the instructions for using this directory and then complete this page after you have selected your Primary Care Physician (PCP).
Your PCP:
My PCP is: Address:
Clinic Name: Phone:
The availability of practitioners and providers listed If you receive services from a network hospital, the
in this directory changes periodically. Continued hospital may arrange with physicians and other providers,
participation of any one doctor, hospital or other who are not in Unity’s network, to assist in your care.
provider cannot be guaranteed. For the most Unity encourages its network hospitals to hold these
up-to-date list of practitioners and providers, please providers to Unity’s standards for member billing. However,
visit unityhealth.com/findadoctor and select Unity if a hospital does not require its providers to comply with
as your network. If you have questions regarding Unity’s standards, Unity cannot influence the manner or
the status of a practitioner or provider, send a amounts that you may be billed by the provider.
message to Unity Customer Service through
For printed information about hospital affiliations,
MyChart at unitymychart.com, chat with us at
medical group affiliations, board certifications, hospital
unityhealth.com/members or call [phone]
accreditation, gender of each practitioner, languages
weekdays from 7 a.m. to 7 p.m. central time. Please
spoken by practitioner as well as an explanation of each
contact individual clinics for specific clinic hours.
item listed above, its source, any limitations and how
Practitioners and providers are independent contractors often this information is validated, please send a message
and not employees of Unity Health Plans Insurance to Unity Customer Service through the message center
Corporation. within MyChart at unitymychart.com, chat with us online
at unityhealth.com/members or call [phone].
Unity [phone] (toll-free) MyChart unitymychart.com
Customer Service [phone] (local)
[phone] (TDD / TTY Only)
Member Advocate [phone] (toll-free)
[phone] (fax)
Unity Sales [phone] Web Site unityhealth.com
Unity Health Plans Insurance Corporation and its representatives
TM
are not connected with Medicare.
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WELCOME TO UNITY HEALTH INSURANCE CONTENTS
As a managed care organization, Unity Health Insurance’s i Welcome to Unity Health Insurance
goal is to help its members be healthy while managing the
ii Using the Medicare Select
quality and cost of their care. To do this, Unity Health
Provider Directory
Insurance works with a large network of providers who are
(cid:2) Primary Care Physicians (PCPs)
committed to providing quality health care services ranging
(cid:2) Why Choose a PCP?
from preventive care to specialty care. This provider
(cid:2) Selecting a PCP
directory will give you the information you need to –
(cid:2) Tips for Selecting a PCP
(cid:2) Choose a Primary Care Physician (PCP)
(cid:2) Changing your PCP
(cid:2) Access specialty care
iv Understanding Managed Care
(cid:2) Understand the basics of managed care
(cid:2) What is Managed Care?
(cid:2) Be a wise health care consumer (cid:2) What are the Benefits of
Managed Care?
(cid:2) Learn how Unity Customer Service can assist you
(cid:2) What is Medical Management?
with your benefit questions
(cid:2) What is Complex Case Management?
In addition, Unity understands that medical terminology
can be confusing. That’s why we’ve included a detailed vi Being a Wise Health Care Consumer
glossary to explain some of the medical terminology and (cid:2) Member Rights and Responsibilities
abbreviations used throughout this directory. (cid:2) Confidentiality and Privacy Policies
(cid:2) Customer Service
Through unityhealth.com you have access to – (cid:2) Live Chat
(cid:2) Complaints and Grievance
(cid:2) MyChart, a secure online tool where you can access
Resolution
benefit and claims information, receive electronic
(cid:2) Accessing Emergency and
explanation of benefits (EOBs) and more. Plus, if you
Urgent Care
receive care from UW Health you can access portions of
your UW Health medical information and communicate
1 Primary Care Physicians (PCPs)
with your health care team. Sign up for an account at
unitymychart.com. 27 Facilities
(cid:2) Find a Doctor, Unity’s provider search function, provides
37 Specialists
the most up-to-date listing of practitioners and providers
171 Glossary of Medical Terms
(cid:2) Wellness programs that offer incentives for making
healthy lifestyle choices 175 Index of Providers
(cid:2) Health information such as the Preventive Health
Care Guideline and Unity’s health managementprograms
(cid:2) Links to other helpful web sites
To make the most of your health benefits, we encourage
you to read through this directory along with your Unity
Member Guide and Certificate of Coverage.
Read on to learn more!
unityhealth.com i
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USING THE MEDICARE SELECT PROVIDER DIRECTORY
Primary Care Physicians (PCPs) efficient, cost-effective manner. Your PCP
coordinates your medical care through Unity’s
All Unity members must select or be assigned a
network of specialty practitioners. To effectively
PCP at the time they enroll. There are several
manage your care and help you reach an optimal
types of physicians that can serve as PCPs –
level of health, it’s beneficial for you to have a
• Family Practice Physician (FP)
strong working relationship with your PCP.
• Family Practice with Obstetrics Physician
(FP / OB) To help you receive the best care, your PCP
should –
• General Practice Physician (GP)
(cid:2) Know your medical history and coordinate all
• Geriatric Physician (Ger)
of your health care needs, including working
• Internal Medicine Physician (IM)
with medical / surgical specialists and
• OB / GYN Physician (OB / GYN) behavioral health (mental health / alcohol
Each PCP listed in this directory has an and other drug abuse) practitioners
abbreviation behind his / her name indicating (cid:2) Monitor and coordinate your care if you have
his / her PCP type. These abbreviations will assist a chronic medical condition such as asthma
you in selecting PCPs that best meet your or diabetes
individual needs. Refer to the glossary at the
(cid:2) Recommend that you seek regular preventive
end of this directory for more information on
health services, such as immunizations, age
each PCP type.
appropriatephysical examsand screenings
You’ll also find practitioners throughout this
directory who have other abbreviations behind
Selecting a PCP
their names (NP, PA, PA-C, CPNP, etc.). While
you may not select any of these practitioners as Now you’re ready to select a PCP. If you are
your PCP, they are available for annual exams, currently seeing a PCP, check this directory to
urgent care and follow-up of ongoing health care. determine if your PCP is a Unity participating
When calling your clinic for an appointment, physician. If you have not selected a Unity PCP,
keep in mind that you may be able to see a nurse determine which PCP location works best for
practitioner (NP) or physician assistant (PA) you. If you are not familiar with the PCPs at the
instead of waiting for an appointment with clinic you select, you can simply list the name of
your PCP. the clinic and Unity will assign an available PCP
or you may contact the clinic to discuss which
PCP would best meet your needs.
Why Choose a PCP?
If you are looking for a PCP at a UW Health
A PCP is a physician who works with you to
clinic and need help selecting one, contact the
manage your health care. A PCP helps ensure
UW Health Welcome Center at [phone]
you receive continuous, quality care in an
weekdays from 8 a.m. to 5 p.m. You can also send
an email to [email protected].
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USING THE MEDICARE SELECT PROVIDER DIRECTORY
The Welcome Center will – Tips for Selecting a PCP
(cid:2) Help you select a new primary care physician It is important to choose your PCP with care.
(cid:2) Work with you to transfer your medical PCPs are trained to serve as your main doctor
over the long term. They provide your medical
records from your previous health system
care and help you stay healthy.
(cid:2) Gather your medical history
(cid:2) Discuss any chronic and / or preventive issues Look for a PCP who –
or needs you may have
z Is highly recommended by your friends,
(cid:2) Help you schedule any appointments if there family or coworkers
is an immediate need
z Has the training and background that meet
If you have questions regarding participating your needs
providers or your health benefits, send a message
z Takes steps to help you prevent illness – for
to Unity Customer Service through MyChart
example, helps you identify ways to stop
at unitymychart.com, chat with us online at
smoking
unityhealth.com/members or call [phone]
z Has admitting privileges at the hospital of
weekdays from 7 a.m. to 7 p.m.
your choice
(See page ix for emergency and urgent care
z Encourages you to ask questions
information.)
z Listens to you
z Explains things clearly so you can understand
z Treats you with respect
Changing your PCP
Unity provides convenient ways to change your PCP –
1.Go to unitymychart.com and login to MyChart. Go to My Infoand select Primary Care Physician
in the drop-down. Click the Search for Providersbutton and type in the name of your new PCP, or
2.Contact Unity Customer Service at [phone] and press 2
If you have a UW Health PCP, you can also change your PCP at your clinic. Unity and UW Health
share the same database for member and patient information so you only need to notify one of us of
your change to a new UW Health PCP. The database is automatically updated so both of us are
informed at once.

(cid:1)
Visit unityhealth.com/findadoctor and choose Unityas your network
for the most up-to-date list of practitioners and providers
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U N D E R S T A N D I N G M A N A G E D C A R E
What isManaged Care? What are the Benefits of Managed Care?
Managed care is designed to help keep members Unity’s managed care plans promote the
healthy. Managed care empowers members to following –
seek preventive health care services and to work Coordination of Care–Your relationship with
with their PCP to make the appropriate health your PCP is an important one. He / she should
care choices. help coordinate your health care services.
Managed care consumers have rights and Convenient Access –Unity’s service area spans
responsibilities to assure they receive quality counties throughout southwestern and south
care and services. This includes the right to choose central Wisconsin. Unity provides you with
a PCP, the right to privacy and confidentiality access to local health care.
and the responsibility for providing accurate
Streamlined Administration –There is very
information (see inside back cover for more
little, if any, follow-up paperwork when you seek
details). In addition, Unity expects you, as a
care from a Unity participating provider. Just
member, to be responsible for –
show your member ID card at the time of service
1. Using your Unity PCP to help coordinate and, in most instances, your provider will submit
all your care claims on your behalf.
2. ContactingUnity Customer Service any Care Management –Unity’s doctors, nurses and
time you have questions about your other health professionals work with your PCP
Unity benefits to review your care and help ensure you receive
medically necessary and appropriate services.
Your provider will submit claims and prior
authorizations on your behalf.
Health Education and Wellness –Unity partners
with UW Health and a variety of community
providers to offer health education classes and
services to improve your health and well-being.
Visit unityhealth.com/healthandwellness for
more information.
Preventive Health Care –Unity promotes
preventive health care services such as age
appropriate physical exams, routine Pap tests,
mammograms and many other services to
help keep you healthy.
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U N D E R S T A N D I N G M A N A G E D C A R E
What is MedicalManagement? What is Complex Case Management?
Unity carefully reviews prior authorization If you have a serious or complicated
requests and pre-certification notifications medical problem, you may qualify for complex
which are submitted by participating case management services. Complex case
practitioners. This process of medical management is a process in which experienced
management, sometimes called utilization registered nurses and licensed social workers
management, is conducted by experienced work with both you and your doctor to
staff that includes registered and licensed coordinate, monitor and evaluate the options
practical nurses with the support of board and services available to best meet your health
certified physicians. Medical management care needs.
staff work with your PCP or your treating
Unity’s complex case management staff may
provider to coordinate pre-service review
become involved with you if you experience a
(before care or services are delivered),
critical event or a diagnosis for a complicated
concurrent review (while care or services
problem. Your doctor may refer you to our care
are being provided) and post-service review
team or you may contact us at [phone].
(after care or services have been provided)
In addition, you may be referred for case
related to your care.
management through Unity’s medical
Unity works with participating physicians management processes, a treating practitioner
and medical management staff to help ensure or by a referral from one of Unity’s health
decisions regarding treatment are based only management programs.
on appropriateness of care and service.
Unity does not reward practitioners or
other individuals involved in the medical
management process for issuing denials of
coverage or care. Unity does not offer financial
incentives or rewards for medical management
decision makers to encourage decisions that
result in under utilization.
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B E I N G A W I S E H E A L T H C A R E C O N S U M E R
Member Rights and Responsibilities Authorization for Release of Information
Unity is committed to maintaining a mutually Unity does not need authorization to obtain
respectful relationship with our members and or disclose member information for treatment,
practitioners. We have a written policy that payment or health care operations. For other
states our commitment regarding your rights purposes, Unity will ask the member to sign
and our expectations regarding your an authorization form that gives permission to
responsibilities, including your right to privacy release the information. Authorization must be
and confidentiality, your right to be treated with obtained before the –
respect and dignity and your responsibility to (cid:2) Release of information to a family member,
show consideration and respect to health plan
power of attorney, employer or lawyer
staff and health care providers.
(cid:2) Release of information that could result in
another company contacting you for marketing
Confidentiality and Privacy Policies purposes
The following is a brief summary about (cid:2) Release of information for research (if the
how Unity uses and protects member disclosure includes personally identifiable
information. For additional information member information)
see Unity’s Notice of Privacy Practices at
In instances where a member is unable to provide
unityhealth.com/privacy.
necessary authorization, Unity may require a
Unity has policies and procedures designed valid court order or other written proof of legal
to safeguard the confidentiality of personally authority prior to releasing information.
identifiable member information. These policies
and procedures establish guidelines for the Member Access to Medical Records
proper handling of records and information
Unity does not maintain original medical
used to administer health plan benefits. When
records. Members may access their medical
responding to a request for information, Unity’s
records by contacting their practitioner’s office
policy is to release only the information
or the provider of care (such as a hospital).
necessary to respond to the request.
Members must follow the practitioner’s or
provider’s procedures for accessing medical
information.
Member Access to Unity Records
Members may request access to their Unity
records, such as claim and billing information.
Unity requires members to complete a written
request for access. Members can call Unity
Customer Service at [phone] to request a
copy of the written request form and learn more.
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B E I N G A W I S E H E A L T H C A R E C O N S U M E R
Treatment Setting Unity’s privacy and confidentiality policies
protect member privacy and address the
Practitioners and providers are expected to
following topics –
implement confidentiality policies and
procedures that address the disclosure of (cid:2) Routine use and disclosure of member health
medical information, patient access to medical information
information and the storage and protection of
(cid:2) Use of authorizations for non-routine
medical information. Unity Health Insurance
disclosure of member health information
reviews practitioner confidentiality processes
(cid:2) Procedures to monitor access to information
during pre-contractual site visits for primary
care physicians and certain specialty care (cid:2) Protection of information disclosed to external
practitioners. entities
You may access Unity’s Notice of Privacy
Quality Improvement
Practices online at unityhealth.com/privacy.
Data for quality improvement measures is If you would prefer a printed copy, please call
collected from claims, pharmacy and member Unity’s Privacy Official at [phone], Ext.
medical records. Unity protects confidential 101852 or email [email protected].
information by reviewing records in non-public
areas and excluding member identifiable
Unity Health Insurance Customer Service
information from written reports.
Unity is committed to member satisfaction.
Unity Customer Service can assist you with
Opting Out of Information Sharing
any questions about your Unity health benefits
or Gathering
quickly. Unity Customer Service can be reached
You may have received notices from other by sending a message through MyChart at
organizations that allow you to opt out of certain unitymychart.com, through our online chat
disclosures. The most common type of disclosure feature at unityhealth.com/members or toll-free
that applies to opt outs is the disclosure of at [phone] or [phone]
personal information to a non-affiliated company (TDD / TTY Only).
so that company can market its products or
Customer service representatives are available
services to you. As a health plan, we must follow
weekdays from 7 a.m. to 7 p.m. central time.
many federal and state laws that prohibit us from
Outside of normal business hours, you may
making these types of disclosures. Because we do
leave a voice mail message including your name,
not make disclosures that apply to opt outs, it is
subscriber number, telephone number where you
not necessary for you to complete an opt out
can be reached and the best time (day or night)
form or take any action to restrict such
for a customer service representative to return
disclosures.
your call. Unity monitors email and phone
messages during normal business hours.
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B E I N G A W I S E H E A L T H C A R E C O N S U M E R
Live Chat For certain types of claims, you are entitled to
request an independent, external review of the
Unity now offers the ability to chat with a
Unity Health Insurance decision. For details
customer service representative online. Chat is
please see your Certificate of Coverage. If your
available weekdays from 7 a.m. to 7 p.m. Chat
claim is not eligible for independent external
makes it more convenient to receive real
review but you still disagree with a denial, your
time answers to questions.
state insurance regulator may be able to help to
resolve the dispute. For questions about your
Complaint and Grievance Resolution rights or for assistance, you can contact –
Unity is dedicated to providing quality service to Office of the Commissioner of Insurance
its members. To continuously improve care and PO Box 7873
services, Unity looks to you for comments or Madison WI 53707-7873
suggestions. Fax: [phone]
Phone: [phone] or [phone]
There may be a time when you have a complaint
Email: [email protected]
or concern regarding Unity benefits or service.
As a member, you have the right to voice a For more information about your appeal rights,
complaint or appeal a decision made by Unity visit unityhealth.com/appeals.
and to receive a prompt and fair review.
If you have a complaint you would like
Accessing Urgent and Emergency
addressed, please contact Unity Customer Service
Care Services
at [phone]. Unity’s customer service
Unity Health Insurance will consider payment
representatives are dedicated to resolving your
for out-of-area urgent care services if you
complaint in a timely fashion. If Unity Customer
experience a sudden and unexpected illness or
Service is unable to resolve your complaint, a
injury and all of the following are true –
member advocate will assist you.
(cid:2) You urgently needed the care, AND
Unity’s grievance process includes a
comprehensive review of your grievance by (cid:2) You could not have foreseen the need for care
prior to leaving the service area, AND
a member advocate and review by qualified
medical personnel and the Reconsideration (cid:2) You did not specifically leave the service area to
obtain care, AND
Committee when needed.
(cid:2) You could not have delayed care until you were
The Reconsideration Committee was established
able to return to the service area.
to assure you receive all the benefits your
contract entitles you to as well as a fair and Your plan will not cover care provided by
impartial hearing of your grievance. This out-of-area providers if you can safely return
committee also provides you the opportunity to the service area to obtain the care needed.
to share information concerning your grievance Contact your PCP for all follow-up care.
in person.
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