Primavera - MetroPlus Health Plan

4 MetroPlus healthletterBENEFITS AND COVERAGEAttention MetroPlus Members✱& MetroPlus Health Plan wants to besure that you are aware of your rights toreceive the services listed below as partof your MetroPlus health coverage.- CANCER CARE SECOND OPINION. Forthe diagnosis of cancer, recurrence ofcancer, or a recommendation regardingcancer treatment, MetroPlus willpay for a second opinion from a cancerspecialist including one affiliated witha specialty care center for the treatmentof cancer, even if the specialistis not part of the MetroPlus network. Awritten referral from your PCP (primarycare provider) is required.- HOSPITAL CARE WITH BREAST CANCERSURGERY. If you need a lumpectomy,lymph node dissection or mastectomy,MetroPlus will pay for in-hospital carefor as long as your doctor decides it isnecessary, after discussing it with you.- BREAST RECONSTRUCTION FOLLOWINGMASTECTOMY. If you have a mastectomy,MetroPlus will pay for reconstructivesurgery on either or bothbreasts in the manner you or yourdoctor deem appropriate.- MASTECTOMY-RELATED SERVICES. Ifyou have a mastectomy, MetroPlus providesbenefits for mastectomy-relatedservices including reconstruction andsurgery to achieve symmetry betweenthe breasts, prostheses and treatmentof complications resulting from mastectomy(including lymphedema).- DIRECT ACCESS TO OBSTETRICAND GYNECOLOGIC SERVICES.You can self-refer (without areferral from your PCP) for carefrom an in-network obstetricianor gynecologist in the followingsituations: for at least two routineexams annually; for care andservices related to pregnancy;and for care as a result of annualexaminations and/or for care of anacute gynecologic condition.If you have questions about thesebenefits or any other aspect of yourMetroPlus coverage, please callMetroPlus Customer Services at1-800-303-9626.ANNUAL MEMBERSATISFACTION SURVEYYou may have alreadyreceived and returned a surveyabout your satisfactionwith the Plan from The MyersGroup on behalf of MetroPlus.If you were not able to completethe survey, a MyersGroup staffer may call youto finish it over the phone.Please take the time for this.Your answers help us improvethe services we provide.HAVING TROUBLEGETTING SPECIALTYSERVICES?Have you had a problemmaking an appointmentfor specialty care likeophthalmology? Or difficultygetting a test likea mammogram? If youhave any problems gettingtimely specialty care,we want to know. Pleasecall Customer Services at1-800-303-9626.MetroPlus Health Letter ® is published four times a year by MetroPlus Health Plan in cooperation with McMurry. © 2009 MetroPlus Health Plan. All rights reserved. MetroPlus Health Letter is aregistered trademark of the New York City Health and Hospitals Corporation. Reproduction without permission is strictly prohibited. No material in this issue may be reproduced without permissionfrom MetroPlus Health Plan. Health Letter does not promote any form of medical treatment, nor does it encourage the self-management of medical problems. It is meant to supplement, not replace,care from healthcare professionals. Editor: Mari S. Gold; Assistant Editor: Lauren Small