MEDICARE NON METRO2009.sv

Section 1 - Introduction
This directory provides a list of Medica Prime Solution℠’s network providers. To
get detailed information about your health care coverage, please see your
Evidence of Coverage.
As a health care consumer, you have choices to make. Medica offers the
Provider Directory as a tool to help you get the most from your plan. This
Provider Directory offers you a wide range of choices for participating providers
and hospitals available to members. In addition to participating with Medica,
these providers are approved by The Centers for Medicare and Medicaid
Services to treat those with Medicare coverage.
Providers You May See
As a member, you may choose to see any provider or specialist in the Medica
Prime Solution network without a referral. This includes care received from
primary care, specialty care or other providers. Our network serves 1.2 million
Medica members and includes 96 percent of area physicians, hospitals/clinics
and other health care providers.
• You will always receive the highest level of coverage by using Medica’s
contracted providers or network hospitals.
• If you choose to see a provider who is not contracted with Medica, you
may pay higher out-of-pocket costs or may be responsible for the entire
cost of the service provided to you.
• If you leave Medica’s service area for an extended period of more than 90
days and you do not activate your Extended Absence Option, Medica will
not cover your Medicare coinsurance and deductible amounts, except for
emergency care services or urgently needed care.
• You may get care from non-network providers without a referral.
However, if you used non-network providers for care that isn’t emergency
care, urgently needed care or out-of-area dialysis services, you will have
to pay the Original Medicare Plan cost-sharing.
Medica encourages you to establish a long term relationship with providers you
trust. A physician who knows your history and your needs is a valuable resource
in maintaining your ongoing health. You will find the providers in this directory
listed by general category, such as Primary Care, Specialty Care, Mental Health
and Substance Abuse, Eye Care, Rehabilitation, and Chiropractic.
Some of the things you should consider when choosing a physician are:
• Training and Experience. Find out whether the doctor is board-certified
and whether they have any special training. You can check a doctor’s
qualifications by using the resources on the next page.
5