Orange County - Care1st Health Plan

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Care1st Health Plan Plan HMO Directorio de Proveedores y Farmacias Este directorio contiene una lista de proveedores de la red y farmacias de la red de Care1st Health Plan. Este directorio es para el condado de Orange, California. Este directorio está en vigencia desde el otoño de 2011. Algunos proveedores de la red y farmacias de la red del plan pueden haberse agregado o eliminado de nuestra red una vez impreso este directorio. No podemos garantizar que cada proveedor esté aceptando nuevos miembros todavía. Para obtener la información más actualizada sobre los proveedores de la red y las farmacias de la red de Care1st Health Plan en su área, puede visitar http://www.care1st.com/ca/medicare o llamar a nuestro Departamento de Servicios para Miembros al 1-800-544-0088, de 8:00 a.m. a 8:00 p.m., los siete días de la semana. Los usuarios de TTY deben llamar al 1-800-735-2929. Care1st Health Plan es un plan HMO aprobado por Medicare. H5928_12_019_PNORX_FINAL_4_SPA CMS Approved 09072011
Section 1 – Introduction This directory provides a list of Care1st Health Plan’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. 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. Your Primary Care Physician (PCP) Your PCP is a physician who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you need. In most cases, you must see your PCP to get a referral before you see any other health care providers or visit a specialist. You may self-refer to an obstetrical and gynecological (OB-GYN) specialist within your contracting medical group/IPA for a routine Pap smear, pelvic exam and breast exam annually. If there are specific specialists you want to use, find out whether your PCP sends patients to these specialists. Each plan PCP has certain plan specialists they use for referrals. This means that the PCP you select determines the specialists you see. If the PCP is associated with a medical group that has a formal referral circle, you will be referred to a specialist within that subnetwork. If you are unhappy with the referral circle used by your current PCP, please follow the steps in the section, “How do you find Care1st Health Plan providers in your area?” in order to choose a new PCP. The “network providers” listed in this directory have agreed to provide you with your health care coverage. You may go to any of our network providers listed in this directory; however, some services may require a referral. If you have been going to one network provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-network providers. What should I do if I have bills from non-plan providers that I think should be paid by Care1st Health Plan? We cover certain health care services that you get from non-plan providers. These include care for a medical emergency, urgently needed care, renal dialysis (kidney) that you get when you are outside the plan’s service area, care that has been approved in advance by Care1st Health Plan, and any services which were ordered covered through an appeals process. If a non-plan provider asks you to pay for covered services you get in these situations, please contact our Member Services Department at 1-800-544-0088 (TTY 1-800-735-2929) from 8:00 a.m. to 8:00 p.m., seven days a week. Or you may write us at Care1st Member Services, P.O. Box 4239, Montebello, CA 90640. You should never pay any non-plan provider more than what the plan is allowed by Medicare. The provider has a right to get his/her fees, but does not have a right to get them from you. Ask the non-plan provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If you get a bill for the services, you can send the bill to us for payment. We will pay your non-plan provider for our share of the bill and will let you know what, if anything, you must pay. 1
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Index Audrey Pharmacy..............
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Index Chai, Edward MD .............
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Index Doan, Hung MD................
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Index Grace Community Pharmacy ....
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Index Kaplan, Daniel MD ...........
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Index Lutsky, Burton MD ...........
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Orange County - Care1st Health Plan

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