Pharmacy Directory

369 Pages·2017·2.38 MB·English

Health Net Cal MediConnect Plan (Medicare-Medicaid Plan)
2018 Provider and
Pharmacy Directory
Los Angeles County, CA
Region: East LA (East)
H3237_18_PPDR_ACCEPTED_09042017
Introduct
Introduct
H3237_18_PPDR_ACCEPTED_09042017
Health Net Cal MediConnect Plan
(Medicare-Medicaid Plan)
2018 Provider and Pharmacy
Directory
• Health Net Cal MediConnect Plan • We will refer to these groups as “network
(Medicare-Medicaid Plan) is a health plan providers” in this Directory. These providers
that contracts with both Medicare and signed a contract with us to provide you
Medi-Cal to provide benefts of both services. This is a list of Health Net
programs to enrollees. Cal MediConnect’s network providers for East
• Te List of Covered Drugs and/or pharmacy Los Angeles (East).
and provider networks may change throughout
• If you would like a complete listing of all
the year. We will send you a notice before we
providers available, please contact Health Net
make a change that afects you.
Cal MediConnect at 1-855-464-3571 (TTY: 711)
• Benefts and/or copays may change on January 1
from 8 a.m. to 8 p.m., Monday through Friday.
of each year.
After hours, on weekends and on holidays, you
• Tis Directory lists health care professionals may be asked to leave a message. Your call will
(such as doctors, nurse practitioners and be returned within the next business day.
psychologists), facilities (such as hospitals or
clinics), and support providers (such as Adult
Day Health and Home Health providers) that
you may see as a Health Net Cal MediConnect
member. We also list the pharmacies that you
may use to get your prescription drugs.
If you have questions, please call Health Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can
leave a message. Your call will be returned within the next business day. The call is free.For more
information, visit www.healthnet.com/calmediconnect.
www.healthnet.com/calmediconnect / 3
Introduction
If you have questions, please call Health Net Cal MediConnect at 1-855-464- 3571 (TTY: 711)
from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weeken ds and on holidays, you can
leave a message. Your call will be returned within the next business day. The call is free.For more
information, visit www.healthnet.com/calmediconnect.
4 / www.healthnet.com/calmediconnect
Si usted habla español, hay servicios de asistencia de idiomas disponibles para usted sin cargo.
Llame al 1-855-464-3571 en Los Angeles County y al 1-855-464-3572 en San Diego County
(los usuarios de TTY deben llamar al 711), de lunes a viernes, de 8:00 a.m. a
8:00 p.m. Después del horario de atención, los fnes de semana y los días feriados puede dejar
un mensaje. Le devolveremos la llamada el siguiente día hábil. La llamada es gratuita.

If you have questions, please call Health Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can
leave a message. Your call will be returned within the next business day. The call is free.For more
information, visit www.healthnet.com/calmediconnect.
www.healthnet.com/calmediconnect / 5
Introduction
• You can get this document for free in other through Friday. Afer hours, on weekends
formats, such as large print, braille, or audio. and on holidays, you may be asked to leave a
Call 1-855-464-3571 (TTY: 711) from 8 a.m. to message. Your call will be returned within the
8 p.m., Monday through Friday. Afer hours, on next business day. Te call is free.
weekends and on holidays, you may be asked
Doctors and health care professionals in
to leave a message. Your call will be returned
Health Net Cal MediConnect’s network are listed
within the next business day. Te call is free.
on pages 19–347. Pharmacies in our network are
• If you would like Health Net Cal MediConnect
listed on pages 351–367.
to send you member materials on an ongoing
basis in other formats, such as braille or large
print, or in a language other than English, Providers
please contact Member Services. Tell Member Getting started in Health Net Cal MediConnect
Services that you would like to place a standing Tis section explains key terms you’ll see in our
request to get your materials in another format Provider and Pharmacy Directory.
or language.
Te providers in this directory are organized
The list is up-to-date as of 06/05/2018, but you
alphabetically by medical group.
need to know that:
• Some Health Net Cal MediConnect network • Providers are health care professionals and support
providers may have been added or removed providers such as doctors, nurses, pharmacists,
from our network afer this Directory was therapists, and other people who provide care
published. and services. Services include medical care, long-
• Some Health Net Cal MediConnect providers term services and supports, supplies, prescription
in our network may no longer be accepting drugs, equipment and other services.
new members. If you are having trouble fnding – Te term providers also includes facilities
a provider who will accept new members,
such as hospitals, clinics, and other places that
call Member Services at 1-855-464-3571
provide medical services, medical equipment,
(TTY: 711) from 8 a.m. to 8 p.m., Monday
and long-term services and supports.
through Friday, and we will help you.
– Providers that are a part of our plan’s network
¶ To get the most up-to-date information are called network providers.
abouItf H yeaoltuh h aNvet qCueasl tMioendsiC,on pnlecats’se call Health Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
netwfororkm p8ro vai.demr.s in t oyo 8ur apr.eam, .vis,it Monday throug•h NFreitdwaoyrk. p rAfotveird ehorusrs a,re othne w pereokveinddesr sa otnhnda tholidays, you can
wwwle.haevael tah nmeets.csoamge/c.al mYoeudr icaolln nwielclt boer returned withianv et hceo netrxatc tbeuds iwnietshs u sd atoy p.ro vTihed ec aslelr ivsic efsree. For more
information, visit www.healthnet.com/calmediconnect.
call Member Services at 1-855-464-3571 to members in our plan. Te providers in our
(TTY: 711) from 8 a.m. to 8 p.m., Monday network generally bill us directly for care they
6 / www.healthnet.com/calmediconnect
give you. When you see a network provider, » Kidney dialysis services that you get at a
you usually pay nothing for covered services. Medicare-certifed dialysis facility when
you are outside the plan’s service area; or
• A Primary Care Provider (PCP) is a doctor
who gives you routine health care. Your PCP » Services from a women’s health specialist.
will keep your medical records and get to know
– Additionally, if you are eligible to get services
your health needs over time. Your PCP will also
from Indian health providers, you may see
give you a referral if you need to see a specialist
these providers without a referral. We must
or other provider.
pay the Indian health provider for those
• Specialists are doctors who provide health care
services, even if they are out of our plan’s
services for a specifc disease or part of the body.
network.
Tere are many kinds of specialists. Here are a
– More information on referrals is available in
few examples:
Chapter 3 of the Member Handbook.
– Oncologists care for patients with cancer.
• You also have access to a Care Coordinator and
– Cardiologists care for patients
care team that you help choose.
with heart conditions.
– A Care Coordinator helps you manage your
– Orthopedists care for patients with certain
medical providers and services.
bone, joint or muscle conditions.
– Your Care Team is a group of people that will
• A Medical Group is a group of PCPs,
get to know your needs and work with you to
specialists, and other health care providers that
write a Personal Care Plan. Your Care Team
work together and are contracted to work with
will talk with you about the services that are
our plan.
right for you. Te goal is to support your
• You may need a referral to see a specialist or
health care wishes and help you regain your
someone that is not your PCP. A referral means
health and improve your abilities.
that your network PCP must give you approval
– Your Care Team starts with your Primary
before you can see the other provider. If you
Care Provider and Care Coordinator. Other
don’t get a referral, Health Net Cal MediConnect
team members, may include a behavioral
may not cover the service.
If you have questions, please call Health Nehte Calathl More sdoicCiaoln snerevcitc ea te x1p-8er5t5, p-4h6y4si-c3ia5n7 1 (TTY: 711)
– Referrals from your network PCP are not
from 8 a.m. to 8 p.m., Monday through Fridays.p Aecftiealri shto, our sd,i eotnic iwane.ekends and on holidays, you can
needleda vfoer a: message. Your call will be returned within the next business day. The call is free.For more
– A Personal Care Plan is the list of health care
information, visit www.healthnet.com/calmediconnect.
» Emergency care;
goals you agree to work on with your Care
» Urgently needed care; Team. Tese goals include:
www.healthnet.com/calmediconnect / 7
Introduction
• Your physical health care; Our plan’s PCPs are afliated with medical
groups. When you choose your PCP, you are also
• Your mental health care;
choosing the afliated medical group. Tis means
• Long-term services and supports. (Tese
that your PCP will be referring you to specialists
are for people who need help to do everyday
and services that are also afliated with his or her
tasks like taking a bath, getting dressed,
medical group.
making food, and taking medicine.)
• If there is a particular specialist or hospital
– Everyone on the Care Team works together
that you want to use, it is important to see whether
to make sure your care is coordinated. Tis
they are afliated with your PCP’s medical
means that they make sure tests and labs are
group. You can look in this directory, or ask
done once and the results are shared with the
Health Net Cal MediConnect Member Services
appropriate providers. It also means that your
to check to see if the PCP you want makes
PCP should know all medicines you take so
referrals to that specialist or uses that hospital.
that he or she can reduce any negative efects.
Your PCP will always get your permission
To choose a PCP, go to the list of providers
before sharing your medical information with
on page 19 and choose a provider:
other providers.
• that you use now, or
Choosing a Primary Care Provider (PCP) • who has been recommended by someone you
trust, or
You can get services from any provider who is in
our network and accepting new members. • whose ofces are easy for you to get to.
If you want help in choosing a PCP, please
First, you will need to choose a Primary Care
call Member Services at 1-855-464-3571
Provider. You may be able to have a specialist act
(TTY: 711) from 8 a.m. to 8 p.m., Monday
as your PCP. Te specialist must be willing and
through Friday. Afer hours, on weekends and
able to provide the care you need. If you need
on holidays, you may be asked to leave a message.
to request a specialist to be your PCP, call our
Your call will be returned within the next
Member Services at 1-855-464-3571 (TTY: 711)
business day. Te call is free. Or, visit
from 8 a.m. to 8 p.m., Monday through Friday.
www.healthnet.com/calmediconnect.
Afer hoIuf ryso, oun h waeveek eqnudes santido nons ,h poleidaasyes ,c aylol uH ealth Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
may be afsrokmed 8 to ale.avme. a mtoe s8sag pe. Ymo.ur, c aMlol nwdially through Friday. After hours, on weekends aonnd holidays, you can
If you have questions about whether we will pay
leave a message. Your call will be returned within the next business day. The call is free. For more
be returned within the next business day. Te
for any medical service or care that you want or
information, visit www.healthnet.com/calmediconnect.
call is free.
need, call Member Services and ask before you
get the service or care.
8 / www.healthnet.com/calmediconnect
Getting long-term services and supports consistent and any transition is well-planned. To
find providers of these services, go to page 315 in
As a Health Net Cal MediConnect member,
this Directory.
you may be able to get long-term services and
supports (LTSS), such as Community-Based A full list of these services is available in Chapter 4
Adult Services (CBAS), the Multipurpose Senior of your Member Handbook.
Services Program (MSSP), and long-term
custodial care in nursing facilities. Long-term
Identifying Providers in
services and supports are help for people who
Health Net Cal MediConnect’s Network
need assistance to do everyday tasks like taking
You must get all of your covered services from
a bath, getting dressed, making food, and taking
medicine. Most of these services are provided at providers within our network that are afliated
your home or in your community but could be with your PCP’s medical group. If you
provided in a nursing home or hospital. go to providers who are not in Health Net
Cal MediConnect’s network and are not afliated
Tese services include Community-Based Adult
with your PCP’s medical group (without prior
Services (CBAS).
authorization or approval from us), you will have
CBAS is a community-based day health program to pay the bill.
that provides services to older persons and adults
Te exceptions to this rule are when you need
with chronic medical, cognitive, or mental health
urgent or emergency care or dialysis and cannot
conditions and/or disabilities that are at risk of
get to a provider in the plan, such as when you
needing institutional care.
are away from home. You can also go outside the
¶ To apply for CBAS, please contact Health Net plan or your PCP’s medical group if Health Net
Cal MediConnect at 1-855-464-3571 (TTY: 711) Cal MediConnect gives you permission frst.
from 8 a.m. to 8 p.m., Monday through Friday.
You may need a referral to see someone who
Afer hours, on weekends and on holidays,
is not a Primary Care Provider. Tere is more
you may be asked to leave a message. Your call information about referrals in the “Getting
will be returned within the next business day. started in Health Net Cal MediConnect” section
Te call is free. of this Directory on page 6.
Other long-term services and supports provided
If you have questions, please call Health Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
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and longi-ntfeormrm actuisotond,i avl icsairte winww n.uhresainltghn featc.ilitcoiems/. calmedpircoonvnideectr,. you do not have to keep going to that
Te MSSP provides services for people age 65 and same provider. For some providers, you may
older. With long-term custodial care in nursing need a referral fromw ywow.urh ePaCltPh.net.com/calmediconnect / 9
facilities, the health plan makes sure that care is
Introduction
• Remember, our plan’s PCPs are afliated with assigned medical group, and then by city or town.
medical groups. If you change your PCP, you All other provider types are listed by city or town
may also be changing medical groups. When within each section.
you ask for the change, be sure to tell Member
If you need help fnding a provider, call Member
Services whether you are seeing a specialist or
Services at 1-855-464-3571 (TTY: 711) from 8 a.m.
getting other covered services that require PCP
to 8 p.m., Monday through Friday. Afer hours,
approval. Member Services will help make sure
on weekends and on holidays, you may be asked
that you can continue your specialty care and
to leave a message. Your call will be returned
other services when you change your PCP.
within the next business day. Te call is free.
• Health Net Cal MediConnect works with all the
providers in our network to accommodate the
List of network providers
needs of people with disabilities. As applicable,
Tis Directory of Health Net Cal MediConnect’s
the list of network providers in this Directory
network providers contains:
includes information about the accommodations
they provide. If you need to see a provider and
• Health care professionals including primary
are not sure if they ofer the accommodations
care physicians, specialists, nurse practitioners,
you need, Health Net Cal MediConnect can
psychologists and pharmacies.
help you. Talk to your Care Coordinator for
• Facilities including hospitals, nursing facilities,
assistance or call Member Services at
skilled nursing facilities, mental health facilities;
1-855-464-3571 (TTY: 711) from 8 a.m. to
and
8 p.m., Monday through Friday. Afer hours, on
• Support providers including adult day services,
weekends and on holidays, you may be asked
to leave a message. Your call will be returned assisted living, consumer-directed services,
within the next business day. Te call is free. home-delivered meals, home health agencies;
and
Finding Health Net Cal MediConnect
• Vision providers; and
providers in your area
• Acupuncture providers
Tis directory is sorted by type of provider
and location. Provider types include Primary Te providers in this directory are organized
If you have questions, please call Health Net Cal MediConnect at 1-855-464-3571 (TTY: 711)
Care Providers, Specialists, Hospitals, Nursing alphabetically by medical group. You may get
from 8 a.m. to 8 p.m., Monday through Friday. After hours, on weekends and on holidays, you can
services from any of the providers on this list that
Facilities, Skilled Nursing Facilities, Home Health
leave a message. Your call will be returned within the next business day. The call is free.For more
are afliated with your PCP’s medical group.
Agencieisn, fMoermntalt iHoena,l tvhi sPitr owvwidwer.hs,e Laoltnhgn-Teet.rcmo m/calmediconnect.
For some services, you may need a referral from
Services and Supports, Acupuncture Providers,
and 1V0is /i ownw Pwro.hveidaelrths.n Perti.mcoamry/ cCaalrme ePdroicvoidnenres ct your PCP.
and Specialists are listed by