Getting started in Buckeye Health Plan MyCare Ohio (Buckeye)

Transcription

1 2017 Prvider / Pharmacy Directry Infrmatin Intrductin The Find a Dctr r Pharmacy search tl is updated daily. Sme Buckeye prviders in ur netwrk may n lnger be accepting new members. If yu are having truble finding a prvider wh will accept new members, call Member Services at (TTY: 711) and we will help yu. T get the mst up-t-date infrmatin abut Buckeye s netwrk prviders in yur area, use the Find a Prvider tl, r call Member Services at Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. After hurs, n weekends and n hlidays, yu may be asked t leave a message. Yur call will be returned within the next business day. TTY users shuld call 711 (Ohi State Relay). The call is free. We will refer t these grups as netwrk prviders in this Find a Dctr r Pharmacy search tl. These prviders signed a cntract with us t prvide yu services. This is a list f Buckeye s netwrk prviders fr the Cleveland, West Central, and Tled service areas. Getting started in Buckeye Health Plan MyCare Ohi (Buckeye) This sectin explains key terms yu ll see in ur Find a Dctr r Pharmacy search tl. Prviders are health care prfessinals and supprt prviders such as dctrs, nurses, pharmacists, therapists, and ther peple wh prvide care and services. Services include medical care, lng-term services and supprts, supplies, prescriptin drugs, equipment and ther services. The term prviders als includes facilities such as hspitals, clinics, and ther places that prvide medical services, medical equipment, and lng-term services and supprts. Prviders that are a part f ur plan's netwrk are called netwrk prviders. Netwrk prviders are the prviders that have cntracted with us t prvide services t members in ur plan. The prviders in ur netwrk generally bill us directly fr care they give yu. When yu see a netwrk prvider, yu usually pay nthing fr cvered services.

2 A Primary Care Prvider (PCP) is a family practice physician, a general practitiner, a pediatrician, a primary care clinic, r an internal medicine physician wh gives yu rutine health care. Yur PCP will keep yur medical recrds and get t knw yur health needs ver time. Specialists are dctrs wh prvide health care services fr a specific disease r part f the bdy. There are many kinds f specialists. Here are a few examples: Onclgists care fr patients with cancer. Cardilgists care fr patients with heart cnditins. Orthpedists care fr patients with certain bne, jint, r muscle cnditins. Yu als have access t a care manager and a care team that yu chse. Yur PCP will wrk clsely with yur care manager and care team. Yur care manager helps yu manage all yur prviders and services. He r she wrks with yur care team t make sure yu get the care yu need. Yur care team includes dctrs, nurses, cunselrs, r ther health prfessinals. Everyne n the care team wrks tgether t make sure yur care is crdinated. This means that they make sure tests and labs are dne nce and the results are shared with the apprpriate prviders. It als means that yur PCP shuld knw all medicines yu take s that he r she can reduce any negative effects. Yur PCP will always get yur permissin befre sharing yur medical infrmatin with ther prviders. Chsing a Primary Care Prvider (PCP) Yu can get services frm any prvider wh is in ur netwrk and accepting new members. First, yu will need t chse a Primary Care Prvider, r PCP. If yu d nt chse a PCP, we will assign ne t yu. T chse a PCP, where it says Select Prvider Type chse Primary Care Prvider frm the drp-dwn menu and: chse a prvider that yu use nw, r chse a prvider wh has been recmmended by smene yu trust, r chse a prvider whse ffices are easy fr yu t get t. If yu want help in chsing a PCP, please call Member Services at Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. TTY users shuld call 711. The call is

3 free. If yu have questins abut whether any service r care that yu want r need is cvered, talk t yur care manager r call Member Services t ask befre yu get the service r care. Getting lng-term services and supprts Yu may be able t get lng-term services and supprts (LTSS) which are als called Medicaid waiver services, such as hme health aide services and adult day care as a Buckeye member. Lng-term services and supprts give assistance t help yu stay at hme instead f ging t a nursing hme r hspital. T access LTSS, cntact yur care manager at Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. TTY users call 711. Identifying Prviders in Buckeye s Netwrk Yu must get all f yur cvered services frm prviders within ur netwrk. These prviders have an agreement t wrk with us and prvide yu services. We call these prviders netwrk prviders. The exceptins t this rule are when yu need lng-term nursing hme care, urgent r emergency care, r dialysis and cannt get t a prvider in the plan, such as when yu are away frm hme. Als, fr a specific perid f time after yur enrllment with Buckeye, yu can see yur ut-f-netwrk physicians and ther service prviders, including nursing hmes and assisted living prviders, hme health nurses, aides and LTSS r waiver services prviders. Yu can als g utside the plan if Buckeye gives yu permissin first. Call Member Services t ask fr the use f prviders utside f ur netwrk, s we can make arrangements fr yu. Yu may change prviders within the netwrk at any time. If yu have been ging t ne netwrk prvider, yu d nt have t keep ging t that same prvider. T change yur PCP, call Member Services at the number belw. Buckeye wrks with all the prviders in ur netwrk t accmmdate the needs f peple with disabilities. As applicable, the list f netwrk prviders in this Directry includes infrmatin abut the accmmdatins they prvide. If yu need t see a prvider and are nt sure if they ffer the accmmdatins yu need, Buckeye can help yu. Talk t yur care manager fr assistance. Finding Buckeye prviders in yur area This Find a Dctr r Pharmacy search tl is rganized by prvider type, then by the city. Lk fr the type f prvider (fr example, PCP, cardilgist, etc.) then the city in which yu live.

4 List f netwrk prviders Buckeye s netwrk prviders cntains: Health care prfessinals (fr example, primary care physicians, specialists, mental health prviders, Qualified Family Planning Prviders (QFPPs), dentists, and visin care prviders); Facilities (fr example, hspitals, lng-term care facilities and skilled nursing facilities fr rehabilitatin, mental health facilities, Federally Qualified Health Centers, and Rural Health Centers); and Supprt prviders (fr example, adult day services, assisted living, hme-delivered meals, hme health agencies, and hme medical equipment prviders). Federally Qualified Health Centers (FQHC)/Rural Health Centers (RHC) Yu are entitled t access the services f any federally qualified health center (FQHC) r rural health center (RHC) prviders. The fllwing is a list f the FQHC and RHC prviders in yur cunty. Thse prviders listed with an asterisk (*) are cntracted prviders with Buckeye. Yu might als see prviders frm these facilities listed individually in ther parts f this Directry. Qualified Family Planning Prviders (QFPP) Yu are entitled t self-refer t any f the fllwing family planning prviders. In additin, yu may self-refer t certain family planning prviders in ther cunties. Fr mre infrmatin abut access t these services, please cntact Member Services at TTY users shuld call 711. The call is free.

5 Pharmacies This prvides a list f pharmacies in Buckeye s netwrk. These netwrk pharmacies are pharmacies that have agreed t prvide prescriptin drugs t yu as a member f the plan. We als list pharmacies that are in ur netwrk but are utside f the service area in which yu live. Yu may als fill yur prescriptins at these pharmacies. Please cntact Buckeye at fr additinal infrmatin. Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday, TTY users call Buckeye members must use netwrk pharmacies t get prescriptin drugs. Yu must use netwrk pharmacies except in emergency r urgent care situatins. If yu g t an ut-f-netwrk pharmacy fr prescriptins when it is nt an emergency r urgent care situatin, including when yu are ut f the service area, call Buckeye s tllfree Member Services r 24-hur nurse advice line fr assistance in getting yur prescriptin filled. If yu g t an ut-f-netwrk pharmacy fr prescriptins when it is nt an emergency, yu will have t pay ut f pcket fr the service. Read the Buckeye Member Handbk fr mre infrmatin. Sme netwrk pharmacies may nt be listed in this Directry. Sme netwrk pharmacies may have been added r remved frm ur plan after this Directry was published. Fr up-t-date infrmatin abut Buckeye netwrk pharmacies in yur area, please call Member Services at Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. TTY users shuld call 711. The call is free. T get a cmplete descriptin f yur prescriptin cverage, including hw t fill yur prescriptins, please read the Member Handbk and Buckeye s List f Cvered Drugs. The current List f Cvered Drugs can be fund n ur web site at Or yu may cntact Member Services at the number abve t have ne mailed t yu. Identifying pharmacies in ur netwrk Alng with retail pharmacies, yur plan s netwrk f pharmacies includes: Mail-Order Pharmacies Hme infusin pharmacies

6 Lng-term care (LTC) pharmacies Yu are nt required t cntinue ging t the same pharmacy t fill yur prescriptins. Yu can g t any f the pharmacies in ur netwrk. Lng-term supplies f prescriptins Mail-Order Prgrams. We ffer a mail-rder prgram that allws yu t get up t a 90- day supply f yur prescriptin drugs sent directly t yur hme. A 90-day supply has the same cpay as a ne-mnth supply. 90-Day Retail Pharmacy Prgrams. Sme retail pharmacies may als ffer up t a 90-day supply f cvered prescriptin drugs. A 90-day supply has the same cpay as a ne-mnth supply. Mail Order Pharmacy(ies) Yu can get prescriptin drugs shipped t yur hme thrugh ur netwrk mail rder delivery prgram. Typically, yu shuld expect t get yur prescriptin drugs within 16 days frm the time that the mail rder pharmacy gets the rder. If yu d nt get yur prescriptin drug(s) within this time, if yu wuld like t cancel an autmatic rder, r if yu need t ask fr a refund fr prescriptins yu gt that yu did nt want r need, please cntact us at Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. TTY users call 711. Lng-Term Care Pharmacies Residents f a lng-term care facility, such as a nursing hme, may access their prescriptin drugs cvered under Buckeye thrugh the facility s pharmacy r anther netwrk pharmacy. Buckeye Health Plan MyCare Ohi is a health plan that cntracts with bth Medicare and Ohi Medicaid t prvide benefits f bth prgrams t enrllees. The List f Cvered Drugs and/r pharmacy and prvider netwrks may change thrughut the year. We will send yu a ntice befre we make a change that affects yu. Benefits may change n January 1 f each year. This Find a Dctr r Pharmacy search tl lists health care prfessinals (such as dctrs, nurse practitiners, and psychlgists), facilities (such as hspitals r clinics), and supprt

7 prviders (such as Adult Day Health and Hme Health prviders) that yu may see as a Buckeye Health Plan (Buckeye) MyCare Ohi member. We als list the pharmacies that yu may use t get yur prescriptin drugs. This Find a Dctr r Pharmacy search tl includes prviders fr bth Medicare and Ohi Medicaid Services. Yu can get this infrmatin fr free in ther languages. Call Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. After hurs, n weekends and n hlidays, yu may be asked t leave a message. Yur call will be returned within the next business day. TTY users call 711. The call is free. Puede btener esta infrmación en trs idimas gratis. Llame al Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. After hurs, n weekends and n hlidays, yu may be asked t leave a message. Yur call will be returned within the next business day. Ls usuaris de TTY deben llamar al 711. La llamada es gratuita. Yu can get this infrmatin fr free in ther frmats, such as large print, braille, r audi. Call frm 8 a.m. t 8 p.m., Mnday thrugh Friday. TTY users call 711. The call is free. If yu wuld like this infrmatin in a frmat ther than English r in an alternate frmat, please call Hurs are frm 8 a.m. t 8 p.m., Mnday thrugh Friday. After hurs, n weekends and n hlidays, yu may be asked t leave a message. Yur call will be returned within the next business day. TTY users call 711. The call is free. Yu can als OH_MMP_ Requests@centene.cm.

8 Ntice f Nn-Discriminatin. Buckeye Health Plan MyCare Ohi (Medicare-Medicaid Plan) cmplies with applicable federal civil rights laws and des nt discriminate n the basis f race, clr, natinal rigin, age, disability, r sex. Buckeye Health Plan des nt exclude peple r treat them differently because f race, clr, natinal rigin, age, disability, r sex. Buckeye Health Plan: Prvides free aids and services t peple with disabilities t cmmunicate effectively with us, such as qualified sign language interpreters and written infrmatin in ther frmats (large print, accessible electrnic frmats, ther frmats). Prvides free language services t peple whse primary language is nt English, such as qualified interpreters and infrmatin written in ther languages. If yu need these services, cntact Buckeye Health Plan's Member Services at (TTY: 711). If yu believe that Buckeye Health Plan has failed t prvide these services r discriminated in anther way n the basis f race, clr, natinal rigin, age, disability r sex, yu can file a grievance by calling the number abve and telling them yu need help filing a grievance; Buckeye Health Plan's Member Services is available t help yu. Yu can als file a civil rights cmplaint with the U.S. Department f Health and Human Services, Office fr Civil Rights, electrnically thrugh the Office fr Civil Rights Cmplaint Prtal, available at r by mail r phne at: U.S. Department f Health and Human Services, 200 Independence Avenue SW., Rm 509F, HHH Building, Washingtn, DC 20201, , (TDD: ). Cmplaint frms are available at Language Services ATTENTION: If yu speak English, language assistance services, free f charge, are available t yu. Call (TTY: 711). ATENCIÓN: si habla españl, tiene a su dispsición servicis gratuits de asistencia lingüística. Llame al (TTY: 711). 注意 : 如果您使用繁體中文, 您可以免費獲得語言援助服務 請致電 (TTY: 711) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kstenls sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: (TTY: 711). ملحوظة: إذا كنت تتحدث اللغة العربية فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم )رقم هاتف الصم والبكم: 177(. Wann du Deitsch (Pennsylvania German / Dutch) schwetzscht, kannscht du mitaus Kschte ebber gricke, ass dihr helft mit die englisch Schprch. Ruf selli Nummer uff: Call (TTY: 711). ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните (телетайп: 711). ATTENTION : Si vus parlez français, des services d'aide linguistique vus snt prpsés gratuitement. Appelez le (ATS : 711). CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành ch bạn. Gọi số (TTY: 711). XIYYEEFFANNAA: Afaan dubbattu Ormiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa (TTY: 711).

9 주의 : 한국어를사용하시는경우, 언어지원서비스를무료로이용하실수있습니다 (TTY: 711) 번으로전화해주십시오. ATTENZIONE: In cas la lingua parlata sia l'italian, sn dispnibili servizi di assistenza linguistica gratuiti. Chiamare il numer (TTY: 711). 注意事項 : 日本語を話される場合 無料の言語支援をご利用いただけます (TTY: 711) まで お電話にてご連絡ください AANDACHT: Als u nederlands spreekt, kunt u gratis gebruikmaken van de taalkundige diensten. Bel (TTY: 711). УВАГА! Якщо ви розмовляєте українською мовою, ви можете звернутися до безкоштовної служби мовної підтримки. Телефонуйте за номером (телетайп: 711). ATENȚIE: Dacă vrbiți limba rmână, vă stau la dispziție servicii de asistență lingvistică, gratuit. Sunați la (TTY: 711). LA SOCO: Haddii aad ku hadash Ingiriisi, adeegyada taageerada luqada, bilaash ah, ayaad heli kartaa, Wac (TTY: 711). ध य न द नह स: तप र इल न प ल ब ल नहन छ भन तप र इक दनदतत भ ष सह यत स व हर दन शल क र पम उपलब ध छ फ न गनह स (द द व र इ: 711) H0022_PPDInf17R_Apprved_