2016 PROVIDER AND PHARMACY DIRECTORY - Cigna

2016

PROVIDER AND PHARMACY DIRECTORY

Directorio de farmacias y proveedores

Cigna-HealthSpring Philadelphia Area

PA Counties/Condados: Bucks, Chester, Delaware, Montgomery, Philadelphia

For more information, please contact Cigna-HealthSpring Customer Service at 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8 a.m. - 8 p.m., or visit

. Para m?s informaci?n, favor de ponerse en contacto con el Departamento de servicio al cliente de Cigna-HealthSpring al 1-800-668

3813 o, para usuarios TTY, 711, 7 d?as de la semana, o bien visite . This Provider and Pharmacy Directory was updated on 08/13/15. Este

Directorio de proveedores y farmacias se actualiz? el 08/13/15.

? 2015 Cigna

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Provider Directory

Cigna-HealthSpring HMO Plan

Provider Directory

This directory provides a list of Cigna-HealthSpring's network providers.

This directory is for PA Counties: Bucks, Chester, Delaware, Montgomery, Philadelphia.

This directory is current as of August 2015. 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 get the most up-to-date information about Cigna-HealthSpring's network providers in your area, you can visit or call our Customer Service Department at 1-800-668-3813, October 1 ? February 14, 8:00 a.m. ? 8:00 p.m. local time, 7 days a week. From February 15 ? September 30, Monday ? Friday 8:00 a.m. ? 8:00 p.m. local time, Saturday 8:00 a.m. ? 6:00 p.m. local time. Messaging service used weekends, after hours, and on federal holidays. TTY users should call 711.

All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Cigna HealthCare of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc., Cigna HealthCare of St. Louis, Inc., HealthSpring Life & Health Insurance Company, Inc., HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc., HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO and PPO plans in select states, and with select State Medicaid programs. Enrollment in Cigna-HealthSpring depends on contract renewal.

The pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

This information is available for free in other languages. Please call our customer services number at 1-800-668-3813 (TTY 711), 7 days a week, 8 a.m. - 8 p.m. Esta informaci?n est? disponible de forma gratuita en otros idiomas. Por favor, llame a nuestro servicio al cliente al 1-800-668-3813 (TTY 711), 7 d?as de la semana, 8 a.m. - 8 p.m.

This document may be available in other formats such as Braille, large print or other alternate formats. Contact the plan for more information.

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Section 1 ? Introduction

This directory provides a list of Cigna-HealthSpring's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your healthcare services from your PCP. Your PCP is a physician who is trained to provide general medical care. Your PCP can also coordinate the rest of the covered services you need.

The "network providers" listed in this directory have agreed to provide you with your healthcare, vision and dental services. Please note: Not all Cigna-HealthSpring plans have vision and dental benefits. Please check your Evidence of Coverage to see if your plan has a vision and/or dental benefit. You may go to any of our network providers listed in this directory; however, some services may require a referral. 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 non-network providers.

For POS Plans: While you are a member of our plan, you may use providers outside of the network. Your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency care, out-of-area urgent care, or out-of-area dialysis services. You don't need to get a referral, but you may need prior authorization for some plans* when you get care from out-of network providers. In non-emergent situations, please tell out-of-network providers that you are a Cigna-HealthSpring member before you see them to ensure that they will see Cigna-HealthSpring members. Our payment for out-of-network services is based on the Medicare Allowable Amount. If the out-of-network provider charges more than the Medicare Allowable Amount, you may be liable for the difference between the Medicare Allowable Amount and the provider's total charge. (*Cigna-HealthSpring Premier (HMO-POS) does require prior authorization for out-of-network providers.)

For POS Plans: Cigna-HealthSpring offers a Point-of-Service (POS) option. The POS option allows you to use out-of-network area providers. You must notify Cigna-HealthSpring prior to using out-of-network area providers. If you use an out-of-network area provider for non-emergent services, your out-of-pocket costs may be higher. If you do not notify the plan prior to using an out-of-network provider, you will be responsible for 100% of the cost(s) billed. Neither Cigna-HealthSpring nor Medicare will pay for these services. Please refer to your Evidence of Coverage for details.

Even though your PCP is trained to handle the majority of common health needs, there may be a time when you need more specialized treatment. In those situations, you may see a plan specialist. Specialists are doctors who are trained to provide health services for a specific disease or part of the body. For some types of specialists, you will need to obtain a "referral" from your PCP before you can schedule an appointment with the specialist. Below is a list of provider specialty types that require referrals from your PCP before you can schedule an appointment with them. Please note: Some provider types may have been added or removed from the list after this directory was printed. You should check with your PCP or call Customer Service at the phone number on the cover to see if a referral is required to see a specialist or other provider. Note that a referral is different from "prior authorization", which is required before certain services procedures can be performed.

Allergy & Immunology Anesthesiology Audiology Cardiovascular Disease Cardiovascular Surgery Chiropractor Colon and Rectal Surgery Dermatology Endocrinology Gastroenterology General Surgery Gynecologic Oncology Hand Surgery Hematology Hematology/Oncology Infectious Disease Maxillofacial Surgery

Medical Genetics Medical Oncology Nephrology Neurosurgery Neurology Occupational Therapy Ophthalmology Oral Surgery Orthopedic Surgery Otolaryngology Pain Management Pediatric Cardiology Pediatric Endocrinology Pediatric Hematology-Oncology Pediatric Rehabilitation Medicine Pediatric Surgery Physical Medicine/Rehabilitation

Physical Therapy Plastic Surgery Podiatry Proctology Prosthodontics Pulmonary Disease Radiology Respiration Therapy Rheumatology Speech Language Pathologist Speech Therapy Sports Medicine Thoracic Surgery Urology Vascular and Interventional Vascular Surgery

In addition, each PCP has certain plan specialists and hospitals they use for referrals. This means that the Cigna-HealthSpring specialists or hospitals you can use may depend on which PCP you select. If there are specialists or hospitals that you want to use, it is important to find out if your chosen PCP refers to them.

Cigna-HealthSpring has different types of Primary Care Provider relationships. We have contracts with independent physicians, Independent Physician Associations, Physician Organized Delivery system and clinic based providers. The following paragraphs describe the relationship these providers have with Cigna-HealthSpring.

For all H3949 Plans in the Philadelphia Area: Preferred Providers Our network includes Preferred Providers located in and around your area that offer reduced copayments for Primary Care Physician services, Inpatient Acute Hospital services, and Outpatient Hospital services. Please see your Evidence of Coverage (EOC) for more information on cost sharing. Preferred Providers may be part of the relationships described below and will be marked in the directory listing with an "".

Independent Physician Associations (IPA) Independent Physician Associations (IPAs) consist of Primary Care and Specialist Physicians located in and around your area. If you select a Primary Care Physician who belongs to an IPA, you should be aware that your PCP will refer you to specialists and hospitals affiliated with the same IPA and with whom they work closely to coordinate your care. You will receive all of your care, including gynecological and specialty care from the physicians within the same IPA. Gynecological care can be accessed by any Gynecologist in the network.

Your IPA is designed to provide a team of primary care and specialty physicians who can manage your care needs. However, if your medical condition should ever require you to seek care outside the IPA, your primary care physician will continue to assist you in the coordination of any needed services outside the IPA. The following IPAs are network providers with your plan.

Ben Franklin Physicians IPA LLC

Broad Spectrum IPA

Liberty Independent Physicians Group, LLC

Independent physicians Independent physicians are of Primary Care and Specialist physicians located in and around your area that are not part of an IPA or POD. If you select an independent Primary Care Physician you should be aware that your PCP will refer you to

specialists and hospitals with whom he/she is affiliated and with whom they work closely to coordinate your care. Please confirm whether the referred physician or hospital is a network provider with your plan. You will receive all of your care, including gynecological and specialty care from the physicians affiliated with your PCP. Gynecological care can be accessed through any independent Gynecologist.

There may also be times when you get a bill from a provider for the full cost of medical care you have received. In many cases, you should contact Customer Service or send this bill to us instead of paying it. We will look at the bill and decide whether the services should be covered. If we decide they should be covered, we will pay the provider directly. (Please note that we cannot pay a provider who has opted out of the Medicare program. Check with your provider before receiving services to confirm that they have not opted out of Medicare.) If we determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the entire cost.

You may get emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health. Please refer to your Evidence of Coverage for details. You may get covered emergency medical care whenever you need it, anywhere in the world. If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

You must use plan 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 Cigna-HealthSpring will be responsible for the costs.

For POS Plans: If you obtain routine care from out-of-network providers you will have to pay the out-of-network cost-sharing, except for emergency care, out-of-area urgent care, or out-of-area dialysis services. Please refer to your Evidence of Coverage for more information.

Behavioral Healthcare Services Behavioral Health services, including mental health and substance abuse services, for beneficiaries covered by CignaHealthSpring are provided through Cigna-HealthSpring Behavioral Healthcare Services. Members and providers may access Cigna-HealthSpring Behavioral Healthcare Services by calling 1-866-780-8546 (TTY 711) for assistance in finding a behavioral healthcare professional or to arrange for inpatient admission authorization. Cigna-HealthSpring Behavioral Healthcare Services is available 24 hours per day, 7 days a week.

What is the service area for Cigna-HealthSpring? The counties in our service area are listed below.

PA Counties: Bucks, Chester, Delaware, Montgomery, Philadelphia

How do you find Cigna-HealthSpring providers in your area? To choose a PCP from the Provider Directory, turn to the Primary Care Provider section for a listing of primary care providers in your area. You can also call Customer Service at the number listed below for assistance. When you select a PCP, you will find a space on your Enrollment Application to enter the PCP's name. If you choose a PCP after your Enrollment Application has been submitted, call Customer Service and inform them of your PCP selection. Please keep in mind that if you do not select a PCP at the time of enrollment, Cigna-HealthSpring will select one for you based on where you live. If you want to change to another PCP, you may do so at any time by calling Customer Service at the number listed below. The name and office telephone number of your PCP are printed on your membership card.

To choose a specialist, hospital, pharmacy or other provider, please turn to the applicable section in the Provider Directory for a listing of providers in your area. For example, to find hospitals in your area, turn to the Hospitals section of the directory.

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