MI Health Link. Medicare Medicaid Plan Provider and Pharmacy Directory Introduction

Transcription

1 MI Health Link Medicare Medicaid Plan 2018 Prvider and Pharmacy Directry Intrductin HAP Midwest Health Plan, Inc. is a health plan that cntracts with bth Medicare and Michigan Medicaid t prvide benefits f bth prgrams t enrllees. H9712_2018 Prv/Rx Dir Intr 1

2 HAP Midwest Health Plan Link 2018 Prvider and Pharmacy Directry HAP Midwest MI Health HAP Midwest Health Plan is a health plan that cntracts with bth Medicare and Michigan 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 Directry lists health care prfessinals (such as dctrs, nurse practitiners, and psychlgists), facilities (such as hspitals r clinics), and supprt prviders (such as Adult Day Health and Hme Health prviders) that yu may see as a HAP Midwest MI Health Link member. We als list the pharmacies that yu may use t get yur prescriptin drugs. We will refer t these grups as netwrk prviders in this Directry. These prviders signed a cntract with us t prvide yu services. This is a list f HAP Midwest Health Plan s netwrk prviders fr Wayne and Macmb cunties. Yu can get this infrmatin fr free in ther languages. Call (888) r TTY 711, seven days a week, 8 a.m. t 8 p.m. The call is free. Yu can als get this infrmatin fr free in ther frmats, such as large print, braille r audi. Call (888) r TTY 711, seven days a week, 8 a.m. t 8 p.m. The call is free. T make a request t get the Prvider and Pharmacy Directry, nw and in the future, in a language ther than English r in anther frmat, call Custmer Service at (888) r TTY 711. The list is up-t-date as f 1/1/2018, but yu need t knw that: Sme HAP Midwest Health Plan MI Health Link netwrk prviders may have been added r remved frm ur netwrk after this Directry was published. Sme HAP Midwest Health Plan MI Health Link 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 Custmer Service at (888) r TTY 711, seven days a week, 8 a.m. t 8 p.m., and we will help yu. 2 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

3 T get the mst up-t-date infrmatin abut HAP Midwest Health Plan s netwrk prviders in yur area, visit r call Custmer Service at (888) r TTY 711, seven days a week, 8 a.m. t 8 p.m. The call is free. Dctrs and ther health care prfessinals in HAP Midwest Health Plan s netwrk are listed n pages Pharmacies in ur netwrk are listed n pages The cunties in ur service area are Wayne and Macmb cunties in sutheastern Michigan. 3 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

4 Prviders Getting started in HAP Midwest MI Health Link This sectin explains key terms yu ll see in ur Prvider and Pharmacy Directry. 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 supprts and services, 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 lngterm supprts and services. 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. A Primary Care Prvider (PCP) is a dctr 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 may need a referral t see a specialist r smene that is nt yur PCP. A referral means that yur netwrk PCP must give yu apprval befre yu can see the ther prvider. If yu dn t get a referral, HAP Midwest MI Health Link may nt cver the service. Referrals frm yur netwrk PCP are nt needed fr: Emergency care; Urgently needed care; 4 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

5 Kidney dialysis services that yu get at a Medicare-certified dialysis facility when yu are utside the plan s service area; r Services frm a wmen s health specialist. Additinally, if yu are eligible t get services frm Indian health prviders, yu may see these prviders withut a referral. We must pay the Indian health prvider fr thse services even if they are ut f ur plan s netwrk. Mre infrmatin n referrals is available in Chapter 3 f the Member Handbk. Yur prvider may need prir authrizatin r an apprval frm HAP Midwest MI Health Link befre yu get certain services. Cvered services that need prir authrizatin are marked in the Benefits Chart in Chapter 4. Sme drugs are cvered nly if yu get prir authrizatin frm us. Cvered drugs that need prir authrizatin are marked in the List f Cvered Drugs. Yu als have access t a Care Crdinatr and an Integrated Care Team (ICT) that yu chse. A Care Crdinatr helps yu manage yur medical prviders and services. Yur Care Team includes yu, yur chsen allies r legal representative, Primary Care Prvider, Care Crdinatr, LTSS Crdinatr r PIHP Supprts Crdinatr (as applicable), and thers as needed. 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. 5 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

6 Chsing a Primary Care Prvider (PCP) Yu can get services frm any prvider wh is in ur netwrk and accepting new members. First, yu shuld chse a Primary Care Prvider. Yu may be able t have a specialist act as yur PCP. Yu may chse a specialist t be yur PCP if yu have a chrnic cnditin and have been underging treatment with that specialist and the specialist agrees t be yur PCP. T request that a specialist serve as yur PCP, call Custmer Service at (888) r TTY 711. T chse a PCP, g t the list f prviders n page 1 and chse a prvider: that yu use nw, r wh has been recmmended by smene yu trust, r whse ffices are easy fr yu t get t. If yu want help in chsing a PCP, please call Custmer Service at (888) r TTY 711, seven days a week, 8 a.m. t 8 p.m. The call is free. Or, visit If yu have questins abut whether we will pay fr any medical service r care that yu want r need, call Custmer Service and ask befre yu get the service r care. Getting lng-term supprts and services As a HAP Midwest MI Health Link member, yu may be able t get lng-term supprts and services (LTSS), such as hme help, persnal care, nursing hme and hme / cmmunity based services. Lng-term supprts and services supprts are help fr peple wh need assistance t d everyday tasks like taking a bath, getting dressed, making fd, and taking medicine. Mst f these services are prvided at yur hme r in yur cmmunity but culd be prvided in a nursing hme r hspital. Yu shuld discuss yur lng-term supprts needs and services with yur Care Crdinatr t determine which services yu qualify fr, and hw t access them. 6 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

7 Identifying Prviders in HAP Midwest Health Plan s Netwrk Yu may need a referral t see smene wh is nt a Primary Care Prvider. There is mre infrmatin abut referrals in the Getting started in HAP Midwest Health Plan sectin f this Directry n page IV. Yu must get all f yur cvered services frm prviders within ur netwrk. If yu g t prviders wh are nt in HAP Midwest Health Plan s netwrk (withut prir authrizatin r apprval frm us), yu will have t pay the bill. The exceptins t this rule are when yu need urgent r emergency care r dialysis and cannt get t a prvider in the plan, such as when yu are away frm hme. Yu can als g utside the plan fr ther nn-emergency services if HAP Midwest MI Health Link gives yu permissin first. 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. Yu may change yur PCP fr any reasn, at any time. Cntact ur Members Services at (888) r TTY 711. The representative yu speak t can assist yu in chsing a new prvider r yu can chse yur wn. HAP Midwest MI Health Link 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, HAP Midwest MI Health Link can help yu. Talk t yur, Care Crdinatr, fr assistance. 7 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

8 Finding HAP Midwest MI Health Link prviders in yur area The List f HAP Midwest MI Health Link Prvider can be fund n the fllwing pages. Cntracted prviders and facilities are listed alphabetically based upn the Prvider Type fllwed by the Prvider's Specialty, then the Cunty the prvider/facility is lcated, the city the prvider/facility is lcated. The prviders are listed alphabetically by last name. List f netwrk prviders This Directry f HAP Midwest Health Plan s netwrk prviders cntains: Health care prfessinals including primary care prviders, wh may be physicians, physician assistants, r nurse practitiners; hearing, dental, r visin specialists; Facilities including hspitals; urgent care centers; nursing facilities; Prepaid Inpatient Health Plan (PIHP) facilities fr needs related t behaviral health, intellectual/develpmental disability, and/r substance use; and Supprt prviders including adult day services; assistive technlgy; chre services; cmmunity transitin; envirnmental mdificatins; hme-delivered meals; LTSS and nn-ltss hme health agencies; medical supplies; nn-medical transprtatin; persnal care; preventive nursing; private duty nursing; respite care. 8 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

9 Pharmacies This part f the Directry prvides a list f pharmacies in HAP Midwest Health Plan 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 Wayne and Macmb cunties in which yu live. Yu may als fill yur prescriptins at these pharmacies. Please cntact HAP Midwest Health Plan's Custmer Service department at (888) r TTY 711, 7 days a week frm 8:00am - 8:00pm, fr additinal infrmatin. HAP Midwest Health Plan 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, yu will have t pay ut f pcket fr the service. Read the HAP Midwest Health Plan 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. 9 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

10 Identifying pharmacies in ur netwrk Alng with retail pharmacies, yur plan s netwrk f pharmacies includes: Hme infusin pharmacies Lng-term care (LTC) pharmacies Indian Health Service / Tribal / Urban Indian Health Prgram (I/T/U) 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. Hme Infusin Pharmacies HAP Midwest MI Health Link ffers several in-netwrk Hme Infusin pharmacies fr yu t chse frm. Hme Infusin pharmacies service all cunties in the service area. If yu wuld like help lcating a Hme Infusin Pharmacy near yu r wuld like mre infrmatin, please cntact Custmer Service. Lng-Term Care Facilities Residents f a lng-term care facility, such as a nursing hme, may access their prescriptin drugs cverage under HAP Midwest MI Health Link thrugh the facility's pharmacy r anther netwrk pharmacy. Usually, lng-term care facilities have their wn pharmacies. If yu are a resident f a lng-term care facility, we must make sure yu can get the drugs yu need at the facility's pharmacy. These lng-term care pharmacies service all cunties in the plan's service area. If yur lng-term care facility pharmacy is nt in ur netwrk r yu have any difficulty accessing yur drug benefits in a lng-term care facility, please cntact Custmer Service. Fr up-t-date infrmatin abut HAP Midwest Health Plan's netwrk pharmacies in yur area, please visit ur website at r call Custmer Service at (888) , 7 days a week, 8 am t 8pm, TTY 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 HAP Midwest Health Plan's List f Cvered Drugs by visiting ur website at r call Custmer Service at (888) , 7 days a week, 8 am t 8pm, TTY 711. The call is free. 10 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit

11 HAP Midwest Health Plan Netwrk Pharmacies T lcate a netwrk pharmacy, please fllw the steps belw: 1. Identify the "Pharmacy Type" yu are lking fr (Retail, Hme Infusin, Lng-Term Care, I/T/U, r Specialty); 2. Search and lcate the "Pharmacy Type" sectin within this Directry; 3. Search and lcate the "Cunty" yu are lking fr (listed in alphabetical rder); 4. Search and lcate the "City" yu are lking fr (listed in alphabetical rder); 5. Search and lcate a pharmacy by "Pharmacy Name" (listed in alphabetical rder). Sample frmatting: Pharmacy Type (Retail, Infusin, LTC, etc.) Cunty Pharmacy Name Street Address City, State Zip Cde NPI Phne Number Hurs Yu can g t any f the pharmacies in ur netwrk. 11 If yu have questins, please call Midwest Health Plan at (888) , 7 days a week, 8am t 8pm, TTY 711. The call is free. Fr mre infrmatin, visit