Medicare y Mucho Más HMO, SNP & POS Plan Provider and ... - MMM

What should I do if I receive a bill from a non plan provider that I think should be paid byMMM?We cover certain healthcare services that you receive from non plan providers. These include care for a medicalemergency, urgently needed care, renal dialysis (kidney) that you receive when you are outside the plan's service area,healthcare services preauthorized by MMM, and any services which were ordered or covered through an appealsprocess. If a non plan provider requires you to pay for any covered service, please contact our Member ServicesDepartment 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. You may also write to us at the following address:Medicare y Mucho MásPO BOX 71114San Juan, PR 00936-8014You should never pay any non plan provider more than what the plan is allowed by Medicare. The provider has a rightto obtain their fees, but they do not have the right to obtain them from you. Ask the non plan provider to bill us first. Ifyou have already paid for the covered services, we will reimburse you for our share of the cost. If you receive a bill forthe services, you can send the bill to us for payment. We will pay your non plan provider for our share of the bill and willlet 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 we coverwhen you are outside our service area are: care for a medical emergency, including maintenance care and hospital careafter you are stable (known as post stabilization care), urgently needed care, renal dialysis (kidney), and care that MMMor a plan provider has approved in advance. If you have any question regarding whether a service is covered when youtravel, call our Member Services Department at 787-620-2397 (Metro Area), 1-866-333-5470 (toll free) or1-866-333-5469 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 nearest emergencyroom, hospital, or urgent care center. The Evidence of Coverage indicates what steps to follow if you have a medicalemergency or urgent need for care. You must use plan providers except in an emergency or during urgent caresituations. If you obtain routine care from out-of-network providers neither Medicare nor MMM will be responsible forthe costs.Page 10