Tampa RGN HMO DIR AUG 2013.pdf - Simply Healthcare Plans

2Section 1 – IntroductionThis directory provides a list of Simply Healthcare Plans,Inc. network providers. To get detailed information aboutyour health care coverage, please see your Evidence ofCoverage.You will have to choose one of our network providerswho are listed in this directory to be your Primary CarePhysician (PCP). The term “PCP” will be used throughoutthis directory. Generally, you must get your health carecoverage from your PCP.Choosing your Primary Care Physician (PCP)What is a “PCP”?Your PCP is a physician who meets state requirements andis trained to give you basic medical care. You will receiveroutine or basic medical care from your PCP. Your PCP canalso coordinate the rest of the covered services you need.In most cases, you must see your PCP to get a referralbefore you see any other healthcare provider.How do you choose a PCP?You are able to select a PCP at the time of enrollment.Review the Provider/Pharmacy Directory to select the PCPof your choice and indicate the selection on yourenrollment form. If you need help selecting a PCP, you mayvisit www.mysimplymedicare.com or call our MemberServices Department at 1-877-577-0115. From October 1,2012 through February 14, 2013 our hours of operationare 8 a.m. to 8 p.m. 7 days a week. From February 15,2013 until September 30, 2013 our hours of operation areMonday through Friday 8 a.m. to 8 p.m. You may leave usa voice mail message after-hours, Saturdays, Sundays andholidays and we will return your call the next business day.TTY/TDD users should call 711. You are able to changeyour PCP at anytime. If there is a particular Plan specialistor hospital you would like to use, please check with yourPCP first to request a referral to that specialist or ensurePCP uses that Hospital. The name and office telephonenumber of your PCP is printed on your membership card.Your PCP can also help you arrange or coordinate yourcovered services. This includes x-rays, laboratory tests,therapies, specialists, hospital admissions, and follow-upcare. Your PCP also contacts other Plan providers for updatesabout your care and/or treatment. If you need certain typesof covered services or supplies, your PCP must giveapproval ahead of time. Your PCP must give you a referralto see a specialist. In some cases, your PCP will also needto get prior authorization (prior approval). Since your PCPwill provide and coordinate your health care, you shouldhave all your past medical records sent to your new PCP’soffice. The law requires us to protect your privacy ofmedical records and personal health information.How do you change your PCP?You may change your PCP for any reason at any time.Change requests received by the 20th day of the monthwill become effective the first day of the following month.To change your PCP, please call our Member ServicesDepartment at 1-877-577-0115. From October 1, 2012through February 14, 2013 our hours of operation are8 a.m. to 8 p.m. 7 days a week. From February 15, 2013until September 30, 2013 our hours of operation are Mondaythrough Friday 8 a.m. to 8 p.m. You may leave us a voicemail message after-hours, Saturdays, Sundays andholidays and we will return your call the next business day.TTY/TDD users should call 711. When you call, be sure totell the Member Services Representative if you are seeingspecialists or getting other covered services that requiredyour PCP’s approval (such as home health services anddurable medical equipment). Member Services will helpmake sure you can continue with the specialty care andother services you have been getting. They will also checkthat the PCP you wish to switch to is accepting newpatients.Member Services will change your membership record toshow the name of your new PCP, and will tell you when thechange to your new PCP will take effect. They will alsosend you a new membership card that shows the nameand phone number of your new PCP.The “network providers” in this directory have agreed toprovide you with health care coverage. You may go to anyof the network providers listed in this directory; howeversome services may require a referral. If you have beengoing to one network provider, you are not required tocontinue going to that same provider. In some cases, youmay get covered services from out-of-network providers.Simply Healthcare Medicare Provider/Pharmacy DirectoryTampa Region