HMO - Aetna Medicare

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Aetna Medicare SM Plan Provider Directory Basic SM Plan (HMO) Value SM Plan (HMO) Standard SM Plan (HMO) Select SM Plan (HMO) Premier SM Plan (HMO) Value SM Plan (PPO) Standard SM Plan (PPO) Select SM Plan (PPO) Premier SM Plan (PPO) This directory provides a list of Aetna Medicare SM Plan (HMO) (PPO) network providers. Please refer to the Service Area Map at the back of this book for the service area counties included in this directory. This directory is current as of January 1, 2011. Some network providers may have been added or removed from the list after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most up-to-date information about Aetna Medicare (HMO) (PPO) network providers in your area, you can visit www.aetnamedicare.com or call our Customer 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. A Medicare Advantage organization with a Medicare contract Translation of this material into another language may be available. For assistance, please call Member Services at: 1-888-982-3862, (TTY/TDD: 1-888-760-4748). Puede estar disponible la traducción de este material en otro idioma. Para ayuda, por favor llame a Servicios al Miembro al: 1-888-982-3862, (TTY/TDD: 1-888-760-4748).
Section 1 – Introduction This directory provides a list of Aetna Medicare HMO and PPO network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. If you are enrolled in a standard Aetna Medicare Health Maintenance Organization (HMO) plan, you will have to choose one of our network providers that are listed in this directory to be your Primary Care {Physician/Provider} (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care coverage from your PCP. Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna. You must use network providers except for urgent care or out-of-area urgent care/renal dialysis. Except for those benefits described in your plan documents as direct-access benefits, or in an emergency, you will need to obtain a referral from your PCP before seeking covered non-emergency specialty or hospital care. Check your Evidence of Coverage for details. If you are enrolled in an Aetna Medicare (HMO) Open Access plan, you are not required to choose a primary care physician (PCP) and are free to visit network providers without a referral to receive covered services. You must use network providers except for urgent care or out-of-area urgent care/renal dialysis. If you are enrolled in an Aetna Medicare Preferred Provider Organization (PPO) plan, you have the flexibility to choose either network providers at lower out-of-pocket costs, or out-of-network providers at a higher cost sharing level. With the exception of emergencies or urgent care, it may cost PPO members more to get care from out-of-network providers. You can use any Aetna Medicare PPO network PCP and pay the plan's lower primary doctor visit copay. Although you are not required to select a PCP, you are encouraged to do so. 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. In cases where non-contracting providers submit a bill directly to you, you should not pay the bill, but submit it to Aetna Medicare for processing and determination of your financial liability, if any. Certain healthcare services, such as hospitalization or outpatient surgery, require precertification with Aetna. This means the service must be approved by Aetna before it will be covered under the plan. Check your Evidence of Coverage for a complete list of services that require this approval. When you are to obtain services requiring precertification from a participating provider, the provider is responsible to precertify those services prior to treatment. If your plan covers out-ofnetwork benefits and you may self-refer for covered services, it is your responsibility to contact Aetna to precertify those services which require precertification. If you need emergency care, you are covered 24 hours a day, 7 days a week, anywhere in the world. Whether you are in or out of an Aetna Medicare service area, we simply ask that you follow the guidelines below when you believe you need emergency care. ■ Call the local emergency hotline (ex. 911) or go to the nearest emergency facility. If a delay would not be detrimental to your health, call your PCP. Notify your PCP as soon as possible after receiving treatment. ■ If you are admitted to an inpatient facility, you or a family member or friend on your behalf should notify your PCP or Aetna as soon as possible. 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. www.aetnamedicare.com I
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;PCP;102542;Cao Cao, Chen, Kent Yup
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Alerte, Andrews, Kim, Shnaydman, Sh
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Alwani, Chauhan, Delman, Losco, Nah
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Carmel, Harris, Kastor, Phillips, R
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QUEENS Primary Care Physicians Midd
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;PCP;98883;Singal Singal, Sanjiv, S
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QUEENS Primary Care Physicians ;PCP
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Basello, Dovnarsky, Hughes, Kalkste
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QUEENS Primary Care Physicians Yu,
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QUEENS Primary Care Physicians Inte
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;PCP;8439;Woodhaven Jacobs, Marcian
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Obstetricians and Gynecologists / W
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Abayev, Abel-Bey, Bourara, Chiang,
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Albright, Dolen, Kramer, Pili, Solo
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Gupta, Rait, Zhuo, Robin Ying, Anuj
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Specialists Total Number = 2597 www
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Abraham, Kay, Keller, Kosmas, Mello
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Specialists QUEENS Gastroenterology
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Alcaraz, Alexander, Beckhardt, Danz
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;SPECADDR;0;Premier Grossfeld, Cath
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Abraham, Bhatia, Gustafson, Kay, Ke
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Specialists QUEENS Hematology Nephr
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Specialists QUEENS Surgery Nnaemeka
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Bhat, Denneke, Mattoo, Jodumutt Nir
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Cohen, Rentrop, Rubenstein, Joel, K
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Specialists QUEENS Chiropractic Sla
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Specialists QUEENS Infectious Disea
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Specialists QUEENS Su, James Yu-Jen
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;SPECADDR;0;Queens-Long Moazen, Odi
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Hadpawat, Kirtane, Mendoza, Tarkoff
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Specialists QUEENS Maran, Andrew Ho
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Ankobiah, Blum, Thai, Divya, Alan W
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Specialists QUEENS David, Marian M.
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Bhat, Hwu, Leung, Lopez, Subrahmany
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Specialists QUEENS Iglesias, Alejan
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Kim, Palumbo, Rubin, Sang Moshe, Fr
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Specialists QUEENS Hsu, Tony C.S.,
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Specialists QUEENS Neurology Amitin
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Specialists QUEENS Oncology Chung,
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Alexander, Nyquist, Snyder, Gary Gu
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Specialists QUEENS Kaylakov, Robert
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;SPECADDR;0;Epstein Epstein, Tavrof
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Castro, Chen, Chorost, Margaret, Ar
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Specialists QUEENS Tarantini, Frank
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Kim, Landis, Lee, Andy Kak Gregg R.
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Ballas, Cohen, Hasan, Mayer Choudhu
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Specialists QUEENS Jacobs, Marc L.,
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Specialists QUEENS Klotz, Henry Mar
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Specialists QUEENS Neurology Alluri
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Specialists QUEENS Kleinman, Yehuda
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Forde, Kechejian, Mantena, Rousseau
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Specialists QUEENS Chadha, Jang B.,
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Specialists QUEENS Moss, Edward N.,
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Fulman, James, Roca, Javier, Leonar
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Specialists QUEENS Kraft, Robert L.
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Alyskewycz, Bakal, Berkeley-Gsegnet
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Specialists QUEENS Silva, Jose V.,
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Specialists QUEENS Rottenberg, Eric
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Specialists QUEENS Appel, Evan Herb
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Specialists QUEENS Jen, Albert, MD;
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Specialists QUEENS Figueroa, Hochsz
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Specialists QUEENS David, Marian M.
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Specialists QUEENS Mendez, Beatriz,
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Specialists QUEENS Infectious Disea
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Specialists QUEENS Madrid, Ivan Jor
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Specialists QUEENS Timmireddy, Arun
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Aaronson, Bottone, Dybner, Ruben, A
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Specialists QUEENS Neurology Beg, M
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Specialists QUEENS Dermatology Azar
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Specialists QUEENS Fahim, Nabil M.,
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Specialists QUEENS or 78-23 Metropo
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Specialists QUEENS Nicastro, Jeffre
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Specialists QUEENS Rubin, Lorry, MD
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Specialists QUEENS Narasimhan, Mang
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Specialists QUEENS Pulmonology Shiv
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Specialists QUEENS Hurt, Melvin B.,
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Specialists QUEENS Marfatia, Salil
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Specialists QUEENS Suurna, Maria, M
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Specialists QUEENS Cardiology Azer,
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Kukar, Raza, Steinbaum, Van Tosh, J
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Specialists QUEENS or 68-23 Fresh P
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Specialists QUEENS Rosedale Cardiol
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Specialists QUEENS or 128-09 Libert
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Specialists QUEENS Pizarro, Francis
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Specialists QUEENS Urology Chiropra
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Behavioral Health Providers Total N
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Behavioral Health Providers Elmhurs
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Behavioral Health Providers Markowi
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Behavioral Health Providers Hollis
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Behavioral Health Providers Behavio
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QUEENS Eye Care Providers QUEENS As
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Draga, Kapoor, Aspasia Irene Namrat
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QUEENS Eye Care Providers or 7901 B
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QUEENS Eye Care Providers Berman, J
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QUEENS Eye Care Providers Wang, Geo
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QUEENS Eye Care Providers Berman, G
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QUEENS Eye Care Providers Nus, Dean
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QUEENS Eye Care Providers Friedman,
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QUEENS Eye Care Providers Mason, Be
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QUEENS Eye Care Providers Hendler-G
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Appel, Jofe, Ligh, Moskowitz, Smoly
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QUEENS Eye Care Providers Mirkin, D
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QUEENS Eye Care Providers Lope, Nic
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QUEENS Dental Providers QUEENS Asto
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QUEENS Dental Providers Far Rockawa
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QUEENS Dental Providers Howard Beac
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QUEENS Dental Providers Little Neck
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Fensterstock, Mallman, Pavone, Rubi
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Pharmacies NEW YORK MAIL ORDER AETN
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Pharmacies NATIONAL RX CORP........
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Pharmacies HORIZON PHARMACY .......
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Pharmacies WALDBAUM’S PHARMACYe .
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Pharmacies PATHMARK PHARMACYe .....
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Pharmacies KASSEL PHARMACYe .......
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Pharmacies LAVEN PHARMACY .........
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Allergy Extracts - National Other P
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Durable Medical Equipment - Nationa
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Independent Lab - National Other Pa
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Independent Lab - National Other Pa
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Index of Providers Speaking Additio
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Index of Providers www.aetnamedicar
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Index of Providers Amarga, Evelyn R
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Index of Providers Bhat, Jodumutt G
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Chhabra, Inderpal S., MD 103414 ...
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Index of Providers Douris, Peter, P
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Index of Providers Fung, Katie Loky
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Hans, Roger Adam, DPM .....138, 270
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Index of Providers Jones, Johannes
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Kourtesis, Pedro, MD...133, 240, 27
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Ma, Joseph H., MD .................
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Index of Providers Morcos, Marcelle
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Palumbo, Anthony Mario, DC......267
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Index of Providers Queens Long Isla
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Index of Providers Rubin, Sherman,
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Siegelbaum, Gary, OD...............
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Index of Providers Thompson, Rupert
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Index of Providers Wu, Alexander C.
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Notes
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Aetna is the brand name used for pr
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HMO - Aetna Medicare

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