(HMO) (PPO) - Aetna Medicare

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If you are traveling outside of the Aetna Medicare (HMO) (PPO) plan service area, you are covered for emergency and urgently needed care. Urgent care may be obtained from a private practice physician, a walk-in clinic, an urgent care center or an emergency facility. If, after reviewing information submitted to us by the provider that supplied care, the nature of the urgent or emergency problem does not qualify for coverage, it may be necessary to provide us with additional information. Follow-up care after emergencies All follow-up care should be coordinated by your PCP. Follow-up care with nonparticipating providers is only covered with a referral from your PCP and prior authorization from Aetna. Whether you were treated inside or outside your Aetna Medicare service area, if your plan requires referrals, you must obtain a referral before any follow-up care can be covered. If your plan does not require referrals you should contact Aetna at the number on your ID card before care is received at non–network facilities. Suture removal, cast removal, X-rays and clinic and emergency room revisits are some examples of follow-up care. PPO plans: All in-network and out-of-network followup care will be covered under the terms and conditions of your plan. Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area HMO plan members must use plan providers for urgent care. When out of the service area urgent care may be obtained from the first available provider. In addition, when out of the service area you can obtain dialysis treatment from any qualified dialysis provider. If HMO plan members obtain routine care from out-of-network providers neither Medicare nor Aetna Medicare will be responsible for the costs. What is the service area for the Aetna Medicare (HMO) (PPO) plan? The county in our service area is listed below. Individual and Employer Group Service Area County: See Service Area Maps at the front of this directory for product detail. Richmond How do you find Aetna Medicare (HMO) (PPO) plan providers in your area? To find a plan provider near your home, look under the plan provider section of your choice (for example, “Primary Care Physicians”). The county and city are listed alphabetically in each plan provider section. If you have questions about your Aetna Medicare HMO or PPO plan or require assistance in selecting a PCP, please call our Member Service Department at 1-800-282-5366, 8 am to 8 pm, 7 days a week. TTY/TDD users should call 1-888-760-4748. Or, visit www.aetnamedicare.com. VIII
Índice Información del plan de Aetna Medicare...................................................................XI Mapas del área de servicio........................................................................................XII Introducción .............................................................................................................XV Hospitales y establecimientos de enfermería especializada.........................................2 Médicos de familia....................................................................................................32 Obstetras y ginecólogos / Especialistas de salud para la mujer .................................48 Especialistas ..............................................................................................................54 Proveedores de la salud del comportamiento ...........................................................86 Proveedores del cuidado de la vista ..........................................................................92 Proveedores del cuidado dental................................................................................98 Farmacias................................................................................................................105 Otros proveedores de la red....................................................................................108 Centros de trasplante de los Institutes of Excelence (Institutos de Excelencia) ....119 Institutes of Quality ® (Institutos de Calidad)............................................................125 Índice de proveedores que hablan otros idiomas....................................................138 Índice de proveedores.............................................................................................146 www.aetnamedicare.com Y0001_M_PE_MM_107223 CMS Approved 07/28/2011 IX
Page 1: Aetna Medicare SM Plan (HMO) (PPO)
Page 5 and 6: Aetna Medicare SM Plan (HMO) (PPO)
Page 7: Aetna Medicare SM Employer Group Pl
Page 13 and 14: Directorio de proveedores del Plan
Page 15: Mapa del área de servicio del plan
Page 18 and 19: le pedimos que siga las siguientes
Page 20 and 21: Hospitals and Skilled Nursing Facil
Page 30 and 31: SUBSTANCE ABUSE Intensive Outpatien
Page 49 and 50: Primary Care Physicians Total Numbe
Page 51 and 52: Cohen, Hoffman, Quyyumi, Neil Shahe
Page 53 and 54: ;PCP;98256;Thomas Gravano, Savino,
Page 55 and 56: El-Sayegh, Kleiner, Ripoll, Yazdani
Page 57 and 58: Bergman, Bhutani, Brum, Emmer, Kops
Page 59 and 60: Primary Care Physicians RICHMOND St
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Almakaev, Banerji, Bhutani, Mailian
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;PCP;134838;Richmond Chacon, Hanna,
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RICHMOND Obstetricians and Gynecolo
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RICHMOND Specialists RICHMOND State
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RICHMOND or 355 Bard Avenue Staten
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Bogin, Ghavami, O’Byrne, Pierce,
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RICHMOND Specialists Introna, Mario
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RICHMOND Specialists Das, Seshadri,
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RICHMOND Specialists or 1534 Victor
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RICHMOND Specialists or 200 Castlet
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Alastra, Chang, Shiau, John, Edwin
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Accettola, Markowicz, Reilly, Ruggi
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RICHMOND Specialists or 205 Richmon
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RICHMOND Specialists Weiner, Kevin
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;SPECADDR;0;UPG-Diabetic Kramer, Th
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Ferzli, Shapiro, Vulpe, George Corn
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Brichkov, Hingorani, Jung, Rotella,
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RICHMOND Specialists or 256 Mason A
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Behavioral Health Providers Total N
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Behavioral Health Providers Grace,
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Behavioral Health Providers or 690
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RICHMOND Eye Care Providers RICHMON
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RICHMOND Eye Care Providers Cooper,
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Dental Providers Primary network de
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Dental Providers Rothman, Gary J.,
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How can you get a long-term supply
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Farmacia de entrega a domicilio pre
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Pharmacies QUICK DRUGS.............
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Allergy Extracts - National Other P
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Durable Medical Equipment - Nationa
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Durable Medical Equipment - Nationa
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Independent Lab - National Other Pa
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Optical Facility Drs. Greenwald and
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Centros de trasplante de los Instit
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Institutes of Excellence University
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Institutes of Excellence Hospital o
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Institutos de Calidad Los hospitale
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Colorado Institutes of Quality COLO
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Georgia Institutes of Quality North
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Maryland Institutes of Quality Unio
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North Carolina Institutes of Qualit
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Pennsylvania Institutes of Quality
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Washington Institutes of Quality Ov
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Index of Providers Speaking Additio
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Index of Providers Índice de prove
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Index of Providers Carr, Nancy, RN.
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Index of Providers Hermus, Ingrid,
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Index of Providers New Dorp Medical
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Index of Providers Staten Island Pu
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Notes Apuntes
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Notes Apuntes
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