directory of healthcare providers 2012 - Universal American Medicare

Contracted Hospitals
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Hospitals listed in this directory are contracted to provide inpatient and outpatient hospital
services. Your Primary Care Physician (PCP) will need to coordinate and arrange any necessary
hospital or specialty care and obtain prior authorization, if required. Please refer to your Evidence
of Coverage for limitations that apply to hospital coverage.
Accessing Services Outside the Plan Service Area
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You can access elective services outside your Plan service area from any participating Today’s
Options PFFS provider in any market and you will only be responsible for in-network out-ofpocket
costs for services rendered by these providers. Please call Member Services who can assist
you in locating a participating Today’s Options PFFS provider.
Emergency Room Services
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You have a lot of options when deciding where to get medical care such as Primary Care Physician
offices, urgent care centers and hospital emergency rooms. We encourage you to contact your
Primary Care Physician if you are not certain where to get the medical care you need. He or she is
familiar with your medical history and can help manage your medical care.
With Today’s Options PFFS, you are always covered for emergencies. Emergency health services
are provided by qualified physicians and healthcare providers and are needed to evaluate or
stabilize an emergency medical condition. An emergency medical condition generally refers to an
injury or illness that happens suddenly and includes acute symptoms of sufficient severity,
including severe pain. Emergency medical conditions appear to a prudent layperson that, without
immediate medical attention, the illness or injury could result in:
serious jeopardy to your health;
serious impairment to a bodily function; or
serious dysfunction of any organ or part.
Examples of emergency medical conditions may include:
loss of consciousness;
intense and uncontrollable pain;
severe shortness of breath that prevents you from talking; or
an accident involving a head injury or possible broken bones.
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