Medicare y Mucho Más HMO Plan Provider and Pharmacy ... - MMM

You should never pay any non plan provider more than what the plan is allowed by Medicare. The provider has aright to obtain their fees, but they do not have the right to obtain them from you. Ask the non plan provider to billus first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If youreceive a bill for the services, you can send the bill to us for payment. We will pay your non plan provider for ourshare of the bill and will let you know if you need to pay any amount.Getting care when traveling or away from the plan's service areaIf you need care when you are outside the service area, your healthcare coverage is limited. The only services wecover when you are outside our service area are: care for a medical emergency, including maintenance care andhospital care after you are stable (known as post stabilization care), urgently needed care, renal dialysis (kidney),and care that MMM or a plan provider has approved in advance. If you have any question regarding whether aservice is covered when you travel, call our Member Services Department at 787-620-2397 (Metro Area),1-866-333-5470 (toll free) or 1-866-333-5469 TTY (hearing impaired), Monday through Sunday, from 8:00 a.m.to 8:00 p.m.What should you do if you have a medical emergency or urgent need for care?In an emergency, you should get care immediately. You do not have to contact your PCP or get permission in anemergency. You can dial 9-1-1 on your phone for immediate help by phone, or go directly to the nearestemergency room, hospital, or urgent care center. The Evidence of Coverage indicates what steps to follow if youhave a medical emergency or urgent need for care. You must use plan providers except in an emergency or duringurgent care situations. If you obtain routine care from out-of-network providers neither Medicare nor MMM willbe responsible for the costs.What should you do if it is not a medical emergency?If you need to talk with your PCP or receive medical care when the PCP's office is closed, and it is not a medicalemergency, call the PCP's telephone number located on your MMM membership card. You may also call theMMM nurse helpline, Haciendo Contacto, at 1-866-677-7779 or 1-866-690-7771 TTY (hearing impaired), 24hours a day, 7 days a week, 365 days a year. These are toll free numbers. The nurses are available to help youdecide what type of care is needed and provide information about available resources.See your Evidence of Coverage for more information about what to do if you have an urgent need for care. Keepin mind that if you have an urgent need for care while you are in the service area, we expect you to obtainthis care from plan providers. In most cases, we will not pay for urgently needed care that you receive from anon plan provider while you are in the plan's service area. (Our service area is listed above.)Page 10