Molina Medicare Options Plus HMO SNP

Molina Medicare Options Plus
HMO SNP Plan
Provider Directory
This directory provides a list of Molina Medicare Options Plus’ network providers.
This directory is for the State of Texas in the counties of Collin, Dallas, Harris and Bexar.
This directory is current as of 10/2015. 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 Molina
Medicare Options Plus’ network providers in your area, you can visit
www.MolinaHealthcare.com/Medicare or call our Member Service Department at (866) 4400012, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/TDD users should call 711.
Molina Medicare Options Plus HMO SNP is a Health Plan with a Medicare Contract and a
contract with the state Medicaid program. Enrollment in Molina Medicare Options Plus depends
on contract renewal.
This information is available for free in other languages. Please call our customer service number
at (866) 440-0012, TTY/TDD 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta información
está disponible gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de
teléfono para servicio al cliente al (866) 440-0012, TTY/TDD 711, los 7 días de la semana, de
8:00 a.m. a 8:00 p.m., hora local.
This information is available in other formats such as Braille, large print and audio.
Y0050_16_1080_0001_LRProvPharmDir
Accepted 8/3/2015
Section 1 – Introduction
This directory provides a list of Molina Medicare Options Plus’ network providers. To get
detailed information about your health care coverage, please see your Evidence of Coverage.
While you are a member of our Plan, you must use network providers to get your covered
services except in limited cases such as emergencies, for urgently needed out-of-area care, or for
out-of-area dialysis services.
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 health care services from your PCP. A PCP is medically trained to
take care of your routine or basic health care needs and is primarily responsible for the
coordination of your care. In most cases, you must see your PCP to get a referral before you see
any other health care provider.
The “network providers” listed in this directory have agreed to provide you with your health
care/benefits services. 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. If you have any questions about whether we will pay for
any medical service or care that you are considering, you have the right to ask us whether we
will cover it before you get the service or care.
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 Molina Medicare Options Plus will be responsible for the costs.
What is a Primary Care Provider (PCP)?
A PCP has a contract with Molina Medicare Options Plus to deliver primary care services to
members. Your provider can be a physician, nurse practitioner, or other health care professional
who meets state requirements and is trained to give you basic medical care. Health professionals
are eligible to provide services as PCPs in our Plan when they practice in the areas of family
medicine, general practice, geriatrics, internal medicine, or obstetrics/gynecology.
Choosing your PCP
Selecting a PCP is up to you. Your relationship with your PCP is an important one. We strongly
recommend that you choose a PCP close to home. Having your PCP nearby makes receiving
medical care and developing a trusting and open relationship easier.
If there is a particular specialist or hospital that you want to use, check first to be sure that your
PCP can make referrals to that specialist or uses that hospital.
When making your choice, you might also consider if the PCP’s office is open evenings and/or
weekends and what languages the PCP and staff speak. If you have specific concerns such as
disability access, you may want to call the provider’s office to get the answers you need to help
you pick the right PCP.
Once you have chosen your PCP, we recommend that you have all your medical records
transferred to your provider’s office. This will provide your PCP access to your medical history
and make him/her aware of any existing health care conditions that you may have. Refer to your
Evidence of Coverage for information about how we protect the privacy of your medical records
and personal health information.
Your PCP is responsible for all your routine health care services, so your provider should be the
first one you call with any health concerns. The name of your PCP and the office telephone
number is printed on your membership card.
It is very important to get a referral from your PCP before you see a network specialist or certain
other providers (there are a few exceptions, including routine and preventive women’s health
care).
If you don’t have a referral before you get services from a specialist, you may have to pay
for these services yourself.
Each PCP has certain network specialists they use for referrals. The Molina Medicare Options
Plus specialists you can use may depend on which PCP you choose. If there are specific
specialists you want to use, find out whether your PCP refers patients to these specialists.
You can change your PCP at any time if you want to see a network specialist that your current
PCP does not refer to. If you want to change your PCP, simply call Member Services at (866)
440-0012, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/TDD users should call 711.
If there are specific hospitals you wish to use, find out whether your PCP uses these hospitals.
In case you receive a bill from a non-contracting provider do not pay this bill, please submit the
bill to Molina Medicare Options Plus for processing and determination of your liability if any.
Getting care from your PCP
Your PCP will provide, arrange, and/or coordinate all your routine medical care. You are
encouraged to develop a close relationship with your PCP. Your PCP will get to know you as an
individual, become acquainted with your medical history, and assist in developing a health care
program to fit your lifestyle and medical needs. Your PCP will provide most of your care and
will help you arrange or coordinate laboratory tests, X-rays, therapies, specialty care, hospital
admissions, and follow-up care. Except for emergency services or as stated elsewhere in the
Evidence of Coverage, services and supplies obtained without an advance referral from your
PCP will not be covered under your Plan.
How to change your PCP?
You may change your PCP for any reason, at any time. To change your PCP, simply call
Member Services at (866) 440-0012, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/TDD users
should call 711.
When you call, be sure to tell Member Services if you are seeing specialists or getting other
covered services that needed your PCP’s approval (such as home health services and durable
medical equipment). Member Services will help make sure that you can continue with the
specialty care and other services you have been getting when you change to a new PCP. They
will also check to be sure that the PCP you want to switch to is accepting new patients.
Member Services will change your membership record to show the name of your new PCP, and
will tell you when the change will take effect. They will also send you a new membership card
that shows the name and phone number of your new PCP.
What if your doctor or provider leaves Molina Medicare Options Plus?
Sometimes a doctor, specialist, clinic, or other network provider that you are using might leave
the Plan. If this happens, you will have to switch to another provider who is part of the Molina
Medicare Options Plus plan.
If your PCP leaves Molina Medicare Options Plus, we will let you know and help you switch to
another PCP so that you can continue to receive covered services.
Getting care from specialists and other network providers
Routine medical care will be provided by your PCP. During the course of treatment, your PCP
may decide that you need specialized treatment and give you a “referral” (approval in advance)
to see a network specialist.
A specialist is a provider who renders health care services for a specific disease or part of the
body. There are many kinds of specialists such as oncologists who treat patients for cancer;
cardiologists who care for patients with heart conditions; and orthopedists who care for patients
with certain bone, joint, or muscle conditions.
Molina Medicare Options Plus maintains a network of specialty providers to care for its
Members. A referral from your PCP is required to receive specialty services; however, no prior
authorization is required when your PCP refers you to a network provider.
At times, your PCP may request a service that is unavailable or not provided within your
network. Your provider may need to get approval ahead of time from Molina Medicare Options
Plus to authorize this type of specialty referral. This process is called “prior authorization.” If
you have questions or concerns about a prior authorization, you may call Member Services at
(866) 440-0012, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/TDD users should call 711.
It is very important to get a referral from your PCP before you see a network specialist or certain
other providers (there are a few exceptions, including routine and preventive women’s health
care).
Getting care if you have a medical emergency or an urgent need for care
A “medical emergency” is when you believe that your health is in serious danger. A medical
emergency includes severe pain, a bad injury, a sudden illness, or a medical condition that is
quickly getting much worse. You may get covered emergency medical care whenever you need,
anywhere in the United States. Get medical help as quickly as possible. Call 911 for help or go
to the nearest emergency room, hospital, or urgent care center. You don’t need to get approval
or a referral first from your doctor or other network provider.
“Urgently needed care” is when you need medical help for an unforeseen illness, injury, or
condition, but your health is not in serious danger. If you have a pressing, non-emergency
medical need while in the service area, you generally must use network providers (refer to the
Evidence of Coverage). If, while temporarily outside the Plan’s service area, you require
urgently needed care, then you may get this care from any provider. In addition, when out of the
service area you can obtain dialysis treatment from any qualified dialysis provider.
Getting care when traveling outside the Plan’s service area
If you need care when you are outside the service area, your health care coverage is limited. The
only services covered when you are outside the service area is care for a medical emergency,
including urgently needed care, renal dialysis (kidney), and care that Molina Medicare Options
Plus or a network provider has approved in advance.
If you have questions whether a service is covered when you travel, please call Member Services
at (866) 440-0012, 7 days a week, 8 a.m. to 8 p.m., local time. TTY/TDD users should call 711.
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 Molina Medicare Options Plus will be responsible for the costs.
What is the service area for Molina Medicare Options Plus?
The counties in our service area are listed below.
Our service area includes these counties: Collin, Dallas, Harris and Bexar.
How do you find Molina Medicare Options Plus providers in your area?
When you enroll in Molina Medicare Options Plus plan, you must choose a PCP to provide your
basic medical care and coordinate your care. You may find a PCP close to where you live by
checking the PCP listings in this directory. Locate your county and city and then choose a listed
PCP.
You can also visit www.MolinaHealthcare.com/Medicare if you would like to learn more about:

Current list of Molina Medicare Options Plus providers

Providers accepting new patients
 Languages spoken by the provider or staff
You can get a printed copy of all information posted on the Molina Medicare Options Plus
website upon request.
If you have questions about Molina Medicare Options Plus or require assistance in selecting a
PCP, please call our Member Service Department at (866) 440-0012, 7 days a week, 8 a.m. to 8
p.m., local time. TTY\TDD users should call 711. Or, visit
www.MolinaHealthcare.com/Medicare.
Section 2 – List of Network Providers
Go to Molinahealthcare.com to search for a provider within your network
Click on “Find a Doctor or Pharmacy” and follow the steps below
1. Enter your Location
Click on either “Search by City or Zip”, “Search By County” or “Search Near Street Address”



If you clicked on “Search by City or Zip”, Select your “State”, “City or Zip
code” and “Distance Within”
If you clicked on “Search By County” select a “State and County.”
If you clicked on “Search Near Street Address”, simply enter your address
2. Select a Coverage and Provider Type


Select “Medicare” from Coverage drop down
Select “Provider Type” from drop down.
3. Click SEARCH
You can further refine your search using one or more of the advanced search options. To use a
search option, put a check mark in the box next to the search type. Then, use the drop down
menus and/or fill in the search fields with the details you are looking for. When you have
finished the search form, select the "Search" button in the lower right corner. To re-do a search,
choose the "Clear" button. To close the Find a Provider tool, choose "Cancel." For more
information on the Provider Online Directory, click on the “Help” or “FAQ” button on the top of
the page.
Molina Medicare Options Plus / Healthy Advantage / Molina Medicare Choice HMO SNP are
Health Plans with a Medicare Contract and a contract with the state Medicaid program.
Enrollment in Molina Medicare Options Plus / Healthy Advantage / Molina Medicare Choice
depends on contract renewal. Healthy Advantage Plus HMO is a Health Plan with a Medicare
Contract. Enrollment in Healthy Advantage Plus depends on contract renewal. Molina Medicare
Options HMO is a Health Plan with a Medicare Contract. Enrollment in Molina Medicare
Options depends on contract renewal.
This information is available in other formats, such as Braille, large print, and audio. This
information is available for free in other languages. Please call our customer service number at
(800) 665-3086, TTY 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta información está
disponible gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de teléfono
para servicio al cliente al (800) 665-3086,TTY 711, los 7 días de la semana, de 8:00 a.m. a 8:00
p.m., hora local. Other Providers are Available in Our Network. The pharmacy network, and/or
provider network may change at any time. You will receive notice when necessary.
Molina Medicare Options Plus HMO SNP
2016 Pharmacy Directory
This pharmacy directory was updated on 10/2015. For more recent information or other
questions, please contact us, Molina Medicare Options Plus Member Services, at (866) 440-0012
or, for TTY users, 711, 7 days a week, 8 a.m. to 8 p.m., local time, or visit
www.MolinaHealthcare.com/Medicare.
Introduction
This booklet provides a list of our plan’s network pharmacies. To get a complete description of
your prescription coverage, including how to fill your prescriptions, please review the Evidence
of Coverage and Molina Medicare Options Plus’ formulary.
When this pharmacy directory refers to “we,” “us”, or “our,” it means Molina Healthcare.
When it refers to “plan” or “our plan,” it means Molina Medicare Options Plus.
We call the pharmacies on this list our “network pharmacies” because we have made
arrangements with them to provide prescription drugs to Plan members. In most cases, your
prescriptions are covered under Molina Medicare Options Plus only if they are filled at a
network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy,
you are not required to continue going to the same pharmacy to fill your prescription but can
switch to any other of our network pharmacies. We will fill prescriptions at non-network
pharmacies under certain circumstances as described in your Evidence of Coverage.
All network pharmacies may not be listed in this directory. Pharmacies may have been added or
removed from the list after this directory was printed. This means the pharmacies listed here may
no longer be in our network, or there may be newer pharmacies in our network that are not listed.
This list is current as of 10/2015. For the most current list, please contact us. Our contact
information appears on the front and back cover pages.
You can get prescription drugs shipped to your home through our network mail order delivery
service which is called “CVS Caremark Mail Service Pharmacy Program” For more
information, please contact us or see the mail order section of this pharmacy directory.
This directory is for Collin, Dallas, Harris and Bexar counties, which includes the area in which
you live. However, we cover a larger service area, and there are more pharmacies where your
prescriptions may be covered by our Plan. For information on more pharmacies in our plan
network not listed in this directory please contact us at (866) 440-0012; TTY users should call
711. We are available 7 days a week, 8 a.m. to 8 p.m., local time.
If you have questions about any of the above, including for instructions on how to submit claims
for prescriptions that you had to fill at a non-network pharmacy, please see the first and last
cover pages of this directory for information on how to contact us.
Go to Molinahealthcare.com to search for a Pharmacy
Click on “Find a Doctor or Pharmacy” and follow the steps below
1. Click on Find a Pharmacy
2. Select a State and your Plan
3. Enter your Zip Code or Address in the fields then select Mile Radius
4. Click SEARCH
You can also search for a specific Pharmacy by entering the Pharmacy name. You can further
refine search by selecting a Pharmacy Type and Additional Services.
Molina Medicare Options Plus / Healthy Advantage / Molina Medicare Choice HMO SNP are
Health Plans with a Medicare Contract and a contract with the state Medicaid program.
Enrollment in Molina Medicare Options Plus / Healthy Advantage / Molina Medicare Choice
depends on contract renewal. Healthy Advantage Plus HMO is a Health Plan with a Medicare
Contract. Enrollment in Healthy Advantage Plus depends on contract renewal. Molina Medicare
Options HMO is a Health Plan with a Medicare Contract. Enrollment in Molina Medicare
Options depends on contract renewal.
This information is available in other formats, such as Braille, large print, and audio. This
information is available for free in other languages. Please call our customer service number at
(800) 665-3086, TTY 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta información está
disponible gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de teléfono
para servicio al cliente al (800) 665-3086,TTY 711, los 7 días de la semana, de 8:00 a.m. a 8:00
p.m., hora local. Other Providers are Available in Our Network. The pharmacy network, and/or
provider network may change at any time. You will receive notice when necessary.
Retail Pharmacies, including Chain Pharmacies
Farmacias de venta al público, incluyendo las farmacias de cadena comercial
Mail Order Pharmacies
CVS Caremark Mail Service Pharmacy Program
Farmacia con servicio por correo
Programa de Servicio de Farmacia por Correo de CVS Caremark
1-800-378-5697
TTY: 1-866-236-1069
Home Infusion Pharmacies
Please refer to the list of Molina Medicare’s Network pharmacies below to find a home infusion
pharmacy provider in your area. For more information, contact Member Services, as listed
above.
Farmacias de infusiones en el hogar
Por favor consulte la siguiente lista de farmacias de la Red de Molina Medicare para encontrar
un proveedor de farmacia de infusión en el hogar cercano a su área. Para más información,
comuníquese con el Departamento de Servicios para Miembros, conforme se indica más arriba.
Long-Term Care Pharmacies
Residents of a long-term care facility may access their prescription drugs covered under Molina
Medicare Options Plus through the facility’s long-term care pharmacy or another network longterm care pharmacy.
Farmacias de atención médica a largo plazo
Los residentes de un centro de atención médica a largo plazo pueden obtener acceso a su
cobertura de medicamentos recetados bajo Molina Medicare Options Plus a través de la farmacia
del centro de atención médica a largo plazo o la farmacia de otro centro de atención médica a
largo plazo.
Para más información, comuníquese con el Departamento de Servicios para Miembros, conforme
se indica más arriba.
Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies
Only Native Americans and Alaska Natives have access to Indian Health Service / Tribal / Urban
Indian Health Program (I/T/U) Pharmacies through Molina Medicare Options Plus’ pharmacy
network. Those other than Native Americans and Alaskan Natives may be able to access these
pharmacies under limited circumstances (e.g., emergencies).
Please refer to the list of Molina Medicare’s Network Pharmacies below to find an I/T/U
pharmacy in your area. For more information, contact Member Services as listed above.
Farmacias para el Programa Servicio de Salud Indígena / Tribal / Salud de Indígena
Urbano (I/T/U)
Solamente los indígenas de los Estados Unidos o Alaska tienen acceso a las Farmacias para el
Programa de Servicio de Salud Indígena / Tribal / Salud de Indígena Urbano (I/T/U) a través de
la red de farmacias de Molina Medicare Options Plus. Otras personas que no son indígenas de
los Estados Unidos o Alaska podrían tener acceso a estas farmacias en circunstancias limitadas
(p. ej., emergencias).
Por favor, consulte la lista de Farmacias de la red de Molina Medicare más adelante para
encontrar una farmacia I/T/U en su área. Para más información, comuníquese con el
Departamento de Servicios para Miembros, conforme se indica más arriba.
Molina Medicare Options Plus HMO SNP is a Health Plan with a Medicare Contract and a
contract with the state Medicaid program. Enrollment in Molina Medicare Options Plus
depends on contract renewal.
This information is available for free in other languages. Please call our customer service number
at (866) 440-0012, TTY/TDD 711, 7 days a week, 8 a.m. - 8 p.m., local time. Esta información
está disponible gratuitamente en otros idiomas. Por favor, comuníquese a nuestro número de
teléfono para servicio al cliente al (866) 440-0012, TTY/TDD 711, los 7 días de la semana, de
8:00 a.m. a 8:00 p.m., hora local.
This information is available in other formats such as Braille, large print and audio.
The pharmacy network may change at any time. You will receive notice when necessary.
Molina Medicare Options Plus HMO SNP es un plan de salud con un contrato con Medicare y
un contrato con el programa estatal de Medicaid. La inscripción en Molina Medicare Options
Plus depende de la renovación del contrato.
Esta información está disponible en otros formatos, que incluyen braille, letra grande y audio.
La red de farmacias puede cambiar en cualquier momento. Usted recibirá notificación cuando
sea necesario.
This pharmacy directory was updated on 10/2015. For more recent information or other
questions, please contact us, Molina Medicare Options Plus Member Services, at (866) 440-0012
or, for TTY users, 711, 7 days a week, 8 a.m. to 8 p.m., local time, or visit
www.MolinaHealthcare.com/Medicare.
Este directorio de farmacias se actualizó en 10/2015. Para obtener información más reciente o si
tiene otras preguntas, comuníquese con el Departamento de Servicios para Miembros de Molina
Medicare Options Plus al (866) 440-0012, los usuarios del servicio TTY al 711, los 7 días de la
semana de 8:00 a. m. a 8:00 p. m., hora local. O bien, visite
www.MolinaHealthcare.com/Medicare.