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

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 the MMMnurse helpline, Haciendo Contacto, at 1-866-677-7779 or 1-866-690-7771 TTY (hearing impaired), 24 hours a day,7 days a week, 365 days a year. These are toll free numbers. Healthcare professionals are available to help you decidewhat 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. Keep inmind that if you have an urgent need for care while you are in the service area, we expect you to obtain this care fromplan providers. In most cases, we will not pay for urgently needed care that you receive from a non plan provider whileyou are in the plan's service area. (Our service area is listed below.)You can obtain most services on your own, without the need for prior authorizationAs explained above, you will receive most of your routine or basic care from your PCP, and your PCP will coordinatethe rest of the covered services you receive as a plan member. If you obtain services from any non plan physician,hospital, or other healthcare provider without prior authorization (approval in advance), you may be required to pay forthese services yourself.You can obtain most services on your own, without approval in advance from your PCP or MMM. These include:- Routine women's healthcare, which includes breast exams, mammograms (breast X rays), Pap tests, and pelvicexams- Flu shots and pneumonia vaccinations (as long as you obtain them from a plan provider)- Emergency services, whether you receive these services from plan providers or non plan providers- Urgently needed care that you receive from non plan providers when you are temporarily outside the plan'sservice area. Also, urgently needed care that you receive from non plan providers when you are in the servicearea but, because of unusual or extraordinary circumstances, the plan providers are temporarily unavailable orinaccessible. (Below we explain the plan's service area.)- Renal dialysis services that you receive when you are temporarily outside the plan's service area. If possible,please let us know where you are going to be before you leave the service area so we can help arrange for youto have maintenance dialysis while outside the service area.Page 11