2019 Provider/Pharmacy Directory

2019 Provider/Pharmacy Directory

Classic Plan (HMO-POS) Rewards Plan (HMO)

Value Plan (HMO) Secure Plan (HMO)

Employer Group Plans (HMO-POS and HMO)

This directory provides a list of Health First Health Plans' current network providers.

This directory is for members living in Brevard and Indian River Counties in Florida.

All network providers in this directory are available to you for covered services. These providers practice in the following counties: Brevard, Flagler, Hardee, Highlands, Indian River, Orange, Osceola, Seminole and Volusia Counties.

For information about additional providers who participate in our network, please contact us or visit our website.

This directory is current as of December 3, 2019.

Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To access Health First Health Plans' online provider directory, and to get the most up-to-date information about Health First Health Plans' network providers in your area, you can visit .

Changes to our pharmacy network may occur during the benefit year. An updated directory is located on our website at . You may also call Customer Service for an updated directory.

For any questions about the information contained in this directory (hardcopy or online), please call our Customer Service Department at 1.800.716.7737 weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 to March 31, we're available seven days a week from 8 a.m. to 8 p.m. TTY/TDD users should call 1.800.955.8771.

Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract

renewal.

For information about alternative provider directory formats, please contact our Customer Service Department.

Y0089_EL6503_NM

HF-SLS-PDIR-K16-E-19

Table of Contents

Section 1 ? Introduction Bills from out-of-network providers ................................................................................................... 2

Coverage when traveling or in an emergency ..................................................................................... 2

What is the service area for Health First Health Plans? ...................................................................... 3

How do you find Health First Health Plans' providers in your area? ................................................. 3

Section 2 ? List of Network Providers.......................................................................................................... 4

Primary Care Physicians ...................................................................................................................... 5

Specialists .......................................................................................................................................... 92

Outpatient Mental Health Providers ................................................................................................ 334

Hospitals & Emergency Departments.............................................................................................. 363

Skilled Nursing Facilities (SNF)...................................................................................................... 379

Pharmacies ....................................................................................................................................... 385

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Section 1 ? Introduction

This directory provides a list of Health First Health Plans' network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

Regardless of which type of plan you have, Health First Health Plans does not require you to select a Primary Care Physician (PCP), but it's still important to establish a relationship with a doctor for your preventive and primary care and to coordinate any specialty care you may need. The term "PCP" will be used throughout this directory.

Many services today are offered by physician assistants, nurse practitioners or others who are not licensed as physicians. These services are rendered in accordance with Florida regulations, and require the same cost share as you would pay for seeing a physician.

The "network providers" listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from nonnetwork providers. This directory includes providers with offices in the area near where you live. For a list of other providers in our network, please contact us or visit our web site.

If your plan includes point-of-service (POS) benefits, you may see providers out of the network. If a bill is sent directly to you after seeing an out-ofnetwork provider, submit the bill to Health First Health Plans for processing and determination of enrollee liability, if any.

Health First Health Plans does not require members or their providers to obtain a referral for covering medically necessary services, but some specialists may require referrals from primary care physicians. Also, some services may require prior authorization.

If you receive bills from out-of-network

providers that you believe should be

paid by Health First Health Plans

Health First Health Plans covers certain health care services that may be obtained from out-of-network providers. These include:

Care for a medical emergency Urgently needed care Kidney dialysis services that you get at a

Medicare-certified dialysis facility when you are temporarily outside the plan's service area. (If possible, please call Customer Service before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away.) Care that has been approved in advance by Health First Health Plans Any services which were ordered to be covered through an appeals process

Sometimes an out-of-network provider may ask or require you to pay for any of these covered services. The out-of-network provider has a right to get his/her fees, but does not have a right to get them from you. You should ask them to bill us first. In cases where you have already paid for the covered services, we will reimburse you for our share of the cost. You should never pay any out-of-network provider more than what is allowed by Medicare. If you get a bill asking for payment, you can send the bill to us for payment. We will pay your out-ofnetwork provider for our share of the bill and will let you know what, if anything, you must pay.

For questions regarding any of these situations, contact Customer Service toll-free at 1.800.716.7737 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 to March 31, we're available seven days a week from 8 a.m. to 8 p.m.

You will also find detailed information in your Evidence of Coverage.

Coverage when traveling out of the

plan's service area or in an emergency

If you need care when you are outside the service area, your health care coverage is limited. Unless your plan includes POS benefits, the only services we cover when you are outside our service area are:

Care for a medical emergency, including maintenance care and hospital care after you are stable (known as post-stabilization care)

Urgently needed care Renal dialysis (kidney)

 Care that has been approved in advance by Health First Health Plans

For more information about medical emergency and urgently needed care, review the Evidence of Coverage. If you question whether a service is covered when you travel, call Customer Service toll-free at 1.800.716.7737 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 to March 31, we're available seven days a week from 8 a.m. to 8 p.m.

Unless your plan includes POS benefits, you must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Health First Health Plans will be responsible for the costs.

When out of the service area, you can obtain renal dialysis services from any Medicare-certified dialysis facility. (If possible, please call Customer Service before you leave the service area so we can help arrange for you to have maintenance dialysis while you are away.)

If your plan includes POS benefits, with the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.

What is the service area for Health First

Health Plans?

Members who live in the following counties may utilize the Providers listed in this directory, regardless of what county the Provider operates within: Brevard County Indian River County

All network providers in this directory are available to you for covered services. These providers practice in the following counties:

Brevard County Flagler County Hardee County Highlands County Indian River County Orange County Osceola County Seminole County

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Volusia County

How do you find Health First Health Plans providers in your area?

The directory is organized by physician type (PCPs, specialists, etc.), then by county and then by provider specialty. The address of each provider is included to help you find providers with locations most convenient for you.

If you have questions about Health First Health Plans, call our Customer Service Department tollfree at 1.800.716.7737 (TTY/TDD relay: 1.800.955.8771) weekdays from 8 a.m. to 8 p.m. and Saturdays from 8 a.m. to noon. From October 1 to March 31, we're available seven days a week from 8 a.m. to 8 p.m. You can also visit .

Behavioral and mental health

We contract with Magellan Behavioral Health (Magellan) to manage mental health and substance abuse services for our members. Magellan is a leader in behavioral health care management with services that help individuals and families to recover, improve their overall health, and achieve wellness. Magellan connects members with the right care when it is needed most. Magellan manages care for both inpatient and outpatient services and also provides crisis intervention at any time day or night.

Local providers are listed in this directory. You can find a complete nationwide listing of providers at . You can also find online tools, resources and general educational information addressing health and well-being issues.

For more information or to access behavioral health services, including services outside of Brevard and Indian River Counties, call Magellan directly at 1.800.424.4347 (TDD/TTY: 1.800.424.1694).

You don't need a referral to access your behavioral health benefits. However, we recommend you call the help line for assistance in selecting a provider and understanding your benefits.

Magellan Behavioral Health, Inc. is a subsidiary of

Magellan Health Services, Inc.

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Section 2 ? List of Network Providers

This Provider Directory consists of 1,144 Primary Care Physicians, 2,730 Specialists, 715 Outpatient Mental Health Providers, 23 Hospitals, 42 Skilled Nursing Facilities, 51 Urgent Care Centers, and 268 Pharmacies.

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