Presbyterian MediCare PPO 2007 Practitioner and Provider Directory

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equest may be in writing, by telephone, by sending an email to info@phs.org, or on the Presbyterian website, www.phs.org. The requested change will be made effective the following day of the receipt of the request or at the date requested by you, as long as the date is not retroactive. Member Services will check to be sure the network PCP you want to switch to is accepting new patients. Member Services will change your membership record to show the name of your new plan PCP and will tell you when the change to your new plan PCP will take effect. SPECIALIST CARE Your PCP is available to direct and coordinate any care you may require, and is available to assist you in obtaining a Specialist when needed. Urgent Care Centers If you require medical care and you are unable to reach your PCP, you may go to an Urgent Care Center. You should return to your PCP for followup care. Please refer to your Member Handbook/Evidence of Coverage for urgent care services including cost-sharing information about network and non-network urgent care practitioners and providers. Behavioral Health Behavioral Health Services for Presbyterian MediCare PPO members are provided by calling 923-5470 (Albuquerque area) (Spanish Speaking - Se Habla Español); 1-800-453-4347 (Outside Albuquerque area) or the TTY/TDD Hearing Impaired Access Line at 1-888-625-8818. You may call the number(s) above for help with selecting a behavioral health practitioner or provider. Women’s Healthcare Specialist or OB/GYN You may obtain women’s routine and preventive health services from your PCP, from a Woman’s healthcare specialist, or from an OB/GYN. BENEFIT CERTIFICATION RULES TO MAKE SURE PAYMENT IS MADE FOR CERTAIN SERVICES RECEIVED Some of the network covered services listed in your Summary of Benefits, Member Handbook/ Evidence of Coverage and Formulary (for members of MediCare PPO Plan 2 with Rx and MediCare PPO Plan 3 with Rx only) require Benefit Certification. Benefit Certification for medical services is also sometimes known as Prior Authorization. Benefit Certification for pharmacy benefits is also sometimes known as Prior Authorization or a Request for an Exception. Generally, it is the responsibility of a network practitioner or provider to request benefit certification, but members can also make the request. Generally, we will notify both you and your practitioner or provider of our decision to certify (approve) the benefit requested. For more information, please refer to the Member Handbook/Evidence of Coverage, the Formulary (for MediCare PPO plan members with Part D prescription drug coverage), or you may contact Member Services by e-mail at info@phs.org or by telephone at 923-6060 or 1-800-797-5343. (TTY/TDD Users should call 1-888-625-8818.) HOSPITALS Network Hospitals: All non-emergency network hospital admissions require benefit certification by Presbyterian. Please confirm with your network PCP or other practitioner that Presbyterian has certified your non-emergency hospital stay. iv
Emergency network hospital care does not require benefit certification. Out-of-Network Hospitals: You do not need to get benefit certification from us for non-emergency hospital admission. Please make sure that your doctor or other practitioner has admitting privileges to the hospital of your choice. 25361, Albuquerque, New Mexico 87125-9762. Upon receipt, we will make an initial coverage determination on the claim. Please refer to your Presbyterian MediCare PPO 2007 Evidence of Coverage/Member Handbook or call Member Services for more information on initial coverage determinations. EMERGENCY CARE In an emergency, you should get care immediately. You do NOT have to contact your PCP or get permission in an emergency. You can dial 911 for immediate help by phone or go directly to the nearest emergency room, hospital or urgent care center. If you are a member of Presbyterian MediCare PPO Plan 1, the following information does not apply to you. Presbyterian MediCare PPO Plan 1 does not include Medicare Part D prescription drug coverage. POST-STABILIZATION CARE Post-stabilization care services are covered services related to an emergency medical condition. They are provided to a member in order to maintain a stabilized condition. Post-stabilization care services do not require benefit certification from your PCP or other practitioner or provider or Presbyterian Insurance Company. What should you do if you have bills from outof-network practitioners and providers that you think we should pay Medical and behavioral health benefits: In cases when a non-network provider or practitioner submits a bill directly to you for services, do not pay the bill. Instead, submit it to the following address: Presbyterian MediCare PPO, P. O. Box PHARMACY This booklet provides a list of Presbyterian MediCare PPO’s network pharmacies and includes some basic information about how to fill your prescriptions. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Member Handbook/Evidence of Coverage. We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. A network pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided by Presbyterian MediCare PPO. In most cases, your prescriptions are covered under Presbyterian MediCare PPO only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one, you are not required to continue going to the same pharmacy v
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Family Vision Center 301 E Tucumcar
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Presbyterian MediCare PPO Hospitals
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Hospitals, Facilities and Other Car
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Retail Pharmacies Presbyterian Medi
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Albuquerque (continued) 8301 Golf C
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Santa Fe Del Norte Pharmacy 1691 Ga
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Mail Order Pharmacies Presbyterian
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Long-Term Care Pharmacies Presbyter
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Presbyterian MediCare PPO Long-Term
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Presbyterian MediCare PPO Indian He
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Presbyterian MediCare PPO Index by
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Glasscock, Frances E, CNS Presbyter
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Hiltz, William F, MD Presbyterian M
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Munoz, Gabriela U, PhD Presbyterian
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Schneider, Linda, DC Presbyterian M
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Conkling, Patricia, CNP Presbyteria
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Markwell, Robert E, MD Presbyterian
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Veytia, Laura E, PA Presbyterian Me
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Wetherill, Timothy F, MD Presbyteri
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Khawaja, Mubarak, MD Presbyterian M
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Raley's Pharmacy Presbyterian MediC
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Ingimundson, Tawnya, CNP Presbyteri
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Watts, Amy C, OD Presbyterian MediC
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Kaufman, Paul W, MD Presbyterian Me
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Tularosa Medical Center Presbyteria
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Bass, Harry, MD Presbyterian MediCa
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Presbyterian MediCare PPO 2007 Practitioner and Provider Directory

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