Molina Dual Options MyCare Ohio(Medicare-Medicaid Plan) | 2021 Provider and Pharmacy Directory Online Directory Information
Introduction
This
Provider and Pharmacy Online Directory includes information about provider and pharmacy types in Molina Dual Options MyCare Ohio and displays all plan’s providers and pharmacies as of the date of your search. The listings contain provider and pharmacy address and contact information as well as other details such as days and hours of operations, specialties, and skills. Key terms and their definitions appear in alphabetical order in the last chapter of the
Member Handbook.
Disclaimers
- Molina Dual Options MyCare Ohio Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees.
- Molina Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, receipt of healthcare, claims experience, medical history, genetic information, evidence of insurability, geographic location.
- This Online Directory displays health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics), and support providers (such as home health providers) that you may see as a Molina Dual Options MyCare Ohio member based on your search results. We also display pharmacies that you may use to get your prescription drugs.
- We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This searchable online directory contains all Molina Dual Options MyCare Ohio’s full network of providers for the State of Ohio. For additional information contact Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
- This Directory includes providers of both Medicare and Medicaid services.
- ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-855-665-4623 de lunes a viernes, de 8:00 a. m. a 8:00 p. m. Los usuarios de TTY deben llamar al 711. La llamada es gratuita.
- You can ask that we always send you information in the language or format you need. This is called a standing request. We will keep track of your standing request, so you do not need to make separate requests each time we send you information. To get this document in a language other than English or in an alternate format, call Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. A representative can help you make or change a standing request. You can also contact your Care Manager for help with standing requests. To permanently change your preferred language or format with your county caseworker, call the Medicaid Hotline at (800) 324-8680, TTY: 711, Monday – Friday, 7 a.m. to 8 p.m. and Saturday, 8 a.m. to 5 p.m., local time to update your record with the preferred language.
- You can get this document for free in other formats, such as large print, braille, or audio. Call (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free.
- Molina Dual Options MyCare Ohio complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
- The list is up-to-date as of the current date shown at the bottom page of the searchable online directory, but you need to know that:
- Some Molina Dual Options MyCare Ohio network providers may have been added or removed from our network after your online directory search.
- Some Molina Dual Options MyCare Ohio providers in our network may no longer be accepting new members. If you are having trouble finding a provider who will accept new members, call Member Services at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time and we will help you.
- To get the most up-to-date information about Molina Dual Options MyCare Ohio’s network providers in your area, visit MolinaHealthcare.com/Duals or call Member Services at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time. TTY users should call 711. The call is free.
Doctors and other health care professionals in Molina Dual Options MyCare Ohio network are listed on pages based on your Provider Search. Pharmacies in our network are listed on pages based on your Pharmacy Search.
Providers
Key terms
This section explains key terms you’ll see in our
Provider and Pharmacy Online Directory.
- Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long-term services and supports (LTSS), supplies, prescription drugs, equipment and other services.
- The term providers also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term services and supports.
- Providers that are a part of our plan’s network are called network providers.
- Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.
- A Primary Care Provider (PCP) is a doctor, certified nurse practitioner (CNP), physician assistant, or other health care professional who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time.
- Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
- Oncologists care for patients with cancer.
- Cardiologists care for patients with heart conditions.
- Orthopedists care for patients with certain bone, joint, or muscle conditions.
- You usually do not need approval from your PCP (called a referral) to see other network providers. It is important to tell your PCP before you see a specialist provider or after you have an urgent or emergency department visit. This allows your PCP to manage your care for the best outcomes.
- All female members are allowed to self-refer to certified nurse midwives (CNMs), obstetricians and gynecologists on Molina Dual Options MyCare Ohio provider panel. In addition, female members are also allowed to self-refer to women’s health specialists on the Molina Dual Options MyCare Ohio panel for routine and preventative health care services if their PCP is not a women’s health specialist. For a list of women’s health specialists on Molina Dual Options MyCare Ohio panel, please call Member Services at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time. TTY users should call 711. The call is free.
- You may need a referral from your PCP for some services, like Acupuncture or out-of-network care, before they will be covered by our plan. Talk to your PCP to find out if you need a referral.
- You also have access to a care manager and a care team that you choose. Your PCP will work closely with your care manager and care team.
- Your care manager helps you manage all your providers and services. He or she works with your care team to make sure you get the care you need.
- Your care team includes
- You
- Your family members and/or caregiver(s)
- Your Primary Care Provider (PCP)
- Your Care Manager
- Other health care professionals who provide care to you
- Other Molina Dual Options MyCare Ohio Care Management Team members, who know you and your health care needs.
- Everyone on the care team works together to make sure your care is coordinated. This means that they make sure tests and labs are done once and the results are shared with the appropriate providers. It also means that your PCP should know all medicines you take so that he or she can reduce any negative effects. Your PCP will always get your permission before sharing your medical information with other providers.
Primary Care Provider (PCP)
You can get services from any provider who is in our network and accepting new members.
First, you will need to choose a Primary Care Provider, or PCP. If you do not choose a PCP, we will assign one to you. You may be able to have a specialist act as your PCP. You may need this if you have complex medical needs. We have a network of specialist providers to care for our members. If you need a specialist as your PCP, Member Services can help you find one.
To choose a PCP, go to the list of providers on page based on your search results and:
- choose a provider that you use now, or
- choose a provider who has been recommended by someone you trust, or
- choose a provider whose offices are easy for you to get to.
You can also use our Provider/Pharmacy Directory to find a PCP in the Molina Dual Options MyCare Ohio network. The directory is on our website at
MolinaHealthcare.com/Duals. If you need a printed copy of the directory or help picking a PCP, call Member Services. You can also call your Care Manager for help.
- Keep in mind that if you do not choose a PCP, Molina Dual Options MyCare Ohio will choose one for you. If you would like to pick a new PCP, please call Member Services or your Care Manager.
- If you want help in choosing a PCP, please call Member Services at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time. TTY users should call 711. The call is free. Or, visit MolinaHealthcare.com/Duals.
- If you have questions about whether any service or care that you want or need is covered, talk to your care manager or call Member Services to ask before you get the service or care.
- Members may be assigned to a Primary Care Clinic and must see whichever provider is available. A Primary Care Clinic is a clinic which acts as a primary care provider.
Long-term services and supports (LTSS)
You may be able to get long-term services and supports (LTSS) which are also called Medicaid “waiver services”, such as services that help with bathing, dressing, grooming, transfers, feeding, meals, chores, transportation and homemaking as a Molina Dual Options MyCare Ohio member. LTSS gives assistance to help you stay at home instead of going to a nursing home or hospital.
If you need help with daily activities, ask your Molina Dual Options MyCare Ohio Care Manager or Call Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
Federally Qualified Health Centers/Rural Health Centers (FQHCs/RHCs)
You are entitled to access the services of any federally qualified health center (FQHC) or rural health center (RHC) providers. To locate FQHCs providers during your search select
Federally Qualified Health Centers/Rural Health Centers (FQHCs/RHCs) as your provider type.
Qualified Family Planning Providers (QFPPs) and Women’s Health Specialists
You are entitled to self-refer to any of the following family planning providers. In addition, you may self-refer to certain family planning providers in other counties.
You are also entitled to self-refer to women’s health specialists, including certified nurse midwives (CNMs), obstetricians and gynecologists. In addition, female members are allowed to self-refer to women’s health specialists for routine and preventative health care services if their PCP is not a women’s health specialist.
For more information about access to these services, please contact Member Services at (855) 665-4623 Monday – Friday, 8 a.m. to 8 p.m., local time. TTY users should call 711. The call is free.
How to identify providers in Molina Dual Options MyCare Ohio’s Network
You must get all of your covered services from providers within our network. These providers have an agreement to work with us and provide you services. We call these providers “network providers.”
The exceptions to this rule are when you need long-term nursing home care, urgent or emergency care, or dialysis and cannot get to a provider in the plan, such as when you are away from home. Also, for a specific period of time after your enrollment with Molina Dual Options MyCare Ohio, you can see your out-of-network physicians and other service providers, including nursing homes and assisted living providers, home health nurses, aides and LTSS or “waiver services” providers.
You can also go outside the plan if Molina Dual Options MyCare Ohio gives you permission first. Call Member Services to ask for the use of providers outside of our network, so we can make arrangements for you.
- You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider. You can change your PCP once a month. If you ask to change your PCP during your first 30 days with the plan, the change will happen right away. If you ask any time after your first 30 days, the change will happen on the first day of the next month. We recommend you first visit your PCP to get to know him or her before changing. You can call Member Services if you want to learn more about any of our providers.
- Remember, our plan’s PCPs are affiliated with medical groups. If you change your PCP, you may also be changing medical groups. When you ask for the change, be sure to tell Member Services if you are seeing a specialist or getting other covered services that require PCP approval. Member Services will help make sure that you can continue your specialty care and other services when you change your PCP.
- Molina Dual Options MyCare Ohio works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this Directory includes information about the accommodations they provide.
- Based on the Americans with Disabilities Act (ADA), this online directory displays the accommodations that provider’s office’s offer for people with disabilities. When searching for a provider in this online directory, check if the wheel chair icon displays. That symbol tells you how accessible a provider’s office is to people with disabilities. When you see the wheel chair icon symbol for “Basic Accessibility,” that means the provider’s office has:
- Accessible parking.
- Parking spaces that are easy to get to.
- A parking area with ramps and curb cutouts.
- Automatic entry or another entry option.
- Elevator for public use with enough room for a wheelchair or scooter.
- Restroom with large stall and safety bars.
- Waiting area with enough room for a wheelchair or scooter to move and turn.
- At least one exam room ready to serve persons with disabilities.
- Clear signs that help patients easily find their way.
- Doors to building, office and patient rooms that are at least 32 inches wide.
- If you need to see a provider and are not sure if they offer the accommodations you need, Molina Dual Options MyCare Ohio can help you. Talk to your care manager for assistance Or call Member Services.
How to find Molina Dual Options MyCare Ohio providers in your area
To learn how to search for providers refer to the “
Help” link located on the top portion of searchable online directory page.
If you have questions, please call Member Services at (855) 665-4623, TTY: 7-1-1, Monday – Friday, 8 a.m. to 8 p.m., local time. You can also call your Care Manager if you need help finding a provider.
Network providers
This Online Directory of Molina Dual Options MyCare Ohio network providers contain:
- Health care professionals (for example, primary care physicians, specialists, mental health providers, Qualified Family Planning Providers (QFPPs), dentists, and vision care providers);
- Facilities (for example, hospitals, long-term care facilities and skilled nursing facilities for rehabilitation, mental health facilities, Federally Qualified Health Centers, and Rural Health Centers); and
- Support providers (for example, adult day services, assisted living, home-delivered meals, home health agencies, and home medical equipment providers).
Providers are listed in alphabetical order by last name. In addition to contact information, provider listings also include specialties and skills, for example, such as languages spoken or completion of cultural competence training.
Cultural competence training is additional instruction for our health care providers that helps them better understand your background, values, and beliefs to adapt services to meet your social, cultural, and language needs.
Pharmacies
Molina Dual Options MyCare Ohio network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
You can also search pharmacies that are in our network but are outside our service area: Butler, Clark, Clermont, Clinton, Delaware, Franklin, Greene, Hamilton, Madison, Montgomery, Pickaway, Union, and Warren in which you live. You may also fill your prescriptions at these pharmacies. Please contact Molina Dual Options MyCare Ohio at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time, for additional information.
- Molina Dual Options MyCare Ohio members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency or urgent care situation, including when you are out of the service area, call Molina Dual Options MyCare Ohio toll-free Member Services or 24-hour nurse advice line for assistance in getting your prescription filled.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the Molina Dual Options MyCare Ohio Member Handbook for more information.
- Some network pharmacies may not be listed in this Online Directory.
- Some network pharmacies may have been added or removed from our plan after your search.
For up-to-date information about Molina Dual Options MyCare Ohio network pharmacies in your area, please visit our web site at
MolinaHealthcare.com/Duals or call Member Services at (855) 665-4623, Monday – Friday, 8 a.m. to 8 p.m., local time. TTY users should call 711. The call is free.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the
Member Handbook and Molina Dual Options MyCare Ohio List of Covered Drugs. The List of Covered Drugs can be found at
MolinaHealthcare.com/Duals.
How to identify pharmacies in Molina Duals Options MyCare Ohio’s network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-order pharmacies send covered prescription drugs to members through the mail or shipping companies.
- Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
- Long-term care (LTC) pharmacies serve residents of long-term care facilities, such as nursing homes.
You are not required to continue going to the same pharmacy to fill your prescriptions.
Long-term supplies of prescriptions
- Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
- 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.
Mail order pharmacy
You can get prescription drugs shipped to your home through our network mail order delivery program which is called CVS Caremark Mail Service Pharmacy Program. The pharmacy will contact you, by phone, to get your approval before shipping any prescriptions. If we are unable to reach you for approval, your prescription will not be sent to you.
Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. To learn more about mail order pharmacies, see Chapter 5 of the
Member Handbook.
Home infusion pharmacies
You can get home infusion therapy if Molina Dual Options MyCare Ohio has approved your prescription and if you get your prescription from an authorized prescriber.
Home Infusion Pharmacies services all counties in the Molina Dual Options MyCare Ohio service area. For more information on Long-Term Care services and pharmacies, contact Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
Long-term care pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Molina Dual Options MyCare Ohio through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, see Chapter 5 of the
Member Handbook.
Long-Term Care Pharmacies services all counties in the Molina Dual Options MyCare Ohio service area. For more information on Long-Term Care services and pharmacies, contact Member Services at (855) 665-4623, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
How to find Molina Dual Options MyCare Ohio pharmacy in your area
You can get your drugs covered at any of our network pharmacies. This includes our network pharmacies outside of our service area.
To search for a pharmacy type within our network, go to
MolinaHealthcare.com/ProviderSearch and click on “Find a Pharmacy”. Then, select your state and coverage plan. A notification pop up will appear, letting you know the link will take you away from
MolinaHealthcare.com/Duals. Click “OK” to be directed to the next page that will allow you complete your pharmacy search. Next, enter ZIP code or city and state. You can further refine your search by specifying a pharmacy name and type. All pharmacies shown on the searchable online directory are available in our Network.
If you have questions about any of the above, please contact Member Services or visit
MolinaHealthcare.com/Duals.
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