Molina Medicare Complete Care HMO SNP Plan
2021 Online Provider/Pharmacy Directory Information
The Provider searchable online directory displays Molina Medicare Complete Care’s current network providers.
Molina Medicare Complete Care service the State of Wisconsin in the
counties of Brown, Calumet, Dodge, Door, Fond Du Lac, Green Lake, Jefferson,
Kenosha, Kewaunee, Manitowoc, Marinette, Milwaukee, Oconto, Outagamie,
Ozaukee, Racine, Shawano, Sheboygan, Walworth, Washington, Waukesha Waupaca,
Waushara, Winnebago, Florence, Forest, Langlade, Marquette, and Portage.
Additionally, you can search for providers outside of our service
area that form part of our complete network.
To download a copy of Molina Medicare Complete Care’s
provider directory, you can visit
MolinaHealthcare.com/WIMaterials.
For any questions about the information contained in this document, please call our Member Services Department at (855) 315-5663, 7 days a week, 8 a.m. to 8 p.m., local time. TTY users should call 711.
This information is available in other formats, such as Braille, large print, and audio.
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.
Section 1 – Provider Introduction
The searchable online directory displays Molina Medicare Complete Care network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).
Network providers are healthcare professionals such as doctors, medical groups, specialists, and healthcare facilities (i.e hospitals, durable medical equipment suppliers) that are contracted with Molina Medicare Complete Care to provide you with covered services. You may use this searchable online directory to help you select a Primary Care Provider, Specialist, Long-Term Services and Support Provider, Hospital, Skilled Nursing Facility, Outpatient Mental Health Provider and/or Pharmacy.
Choosing your Primary Care Provider (PCP)
You will have to choose one of our network providers shown in our
searchable online directory to be your
Primary
Care
Provider (PCP).
Generally, you must get your health care services from your PCP. Your PCP can be a physician, physician assistant, nurse practitioner, or other health care professional that meet state requirements and is trained to provide you basic medical care. Healthcare professionals are eligible to provide you services as a PCP in our Plan, when they are licensed to practice in areas such as: family medicine, general practice, geriatrics, or internal medicine. Once you have chosen a PCP, please make sure to transfer all of your medical history to their office, in order for your PCP to be informed of any medical conditions you may have. Your PCP can help coordinate your routine medical care, laboratory tests, x-rays, therapies, specialty care, hospital admissions, and appointments.
The network providers shown in this searchable online directory have agreed to provide you with your health care and supplemental services. You may go to any of our network providers shown in the online searchable directory. However, some services may require a referral.
In most situations, if you need specialized treatment your PCP must give you a “referral” to see a network specialist. 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 that hospital. A referral is a written order from your PCP to see a specialist or receive other medical services. It is very important you get a referral from your PCP before you see a network specialist or other providers. If you do not get a referral you may have to pay for these services yourself. However, there are a few exceptions such as: women’s preventive healthcare, flu shots, Hepatitis B vaccinations, pneumonia vaccinations and urgently needed services.
If you have questions about whether we will pay for a 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.
At times, your PCP may request a service that is unavailable or not provided within our network. Your PCP may need to get an approval ahead of time from Molina Medicare Complete Care to authorize this service referral. This process is called “prior authorization.” If you have questions or concerns about a prior authorization, you may call Member Services.
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 (855) 315-5663, 7 days a week, 8 a.m. to 8 p.m., local time. TTY users should call 711. Member Services will verify if your choice of PCP is accepting new patients. Once your new PCP has been assigned, you will receive a new member ID card by mail with your new PCP’s contact information. If your PCP leaves Molina Medicare Complete Care, we will let you know and help you switch to another PCP so that you can continue to receive covered services.
Getting care outside the Plan’s service area
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 Molina Medicare Complete Care will be responsible for the costs. However, you may receive care from out-of-network provider if you are temporarily outside the Plan’s service area and cannot get care from a network provider, or require urgently needed services. If you have questions whether a service is covered when you are outside the service area, please call Member Services.
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. 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.
“Urgent 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, call your PCP first. If they are not available, look in this Provider Directory for an urgent care center. You generally must use network providers (refer to the Evidence of Coverage).
Out-Of-Network Provider Bills
If you receive services from out-of-network providers, you may get billed directly. Do not pay this bill. Please make a copy for your records and mail the original statement for processing and determination of your liability, if any. For more information, please refer to the EOC in Chapter 7.
What is the service area Molina Medicare Complete Care?
The counties in our service area are listed below.
Our service area includes these counties: Brown, Calumet, Dodge, Door,
Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Manitowoc,
Marinette, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Shawano,
Sheboygan, Walworth, Washington, Waukesha Waupaca, Waushara, Winnebago,
Florence, Forest, Langlade, Marquette, and Portage.
How do you find Molina Medicare Complete Care providers that serve in
your area?
To search by location, you have the options of “City or Zip”, “County”, or “Search Near Street Address”. Once you have selected your search option, proceed in the next section by selecting "Medicare" as your coverage option and then the provider type you need. You may narrow your search options using the "More Search Options" section. Next, click on the “Search” button located at the bottom of the page to see the provider listings meeting the criteria’s entered.
If you have questions about Molina Medicare Complete Care or
require assistance in selecting a PCP, please call our Member Services
Department at (855) 315-5663, 7 days a week, 8 a.m. to 8 p.m., local time.
TTY users should call 711. You can also visit
MolinaHealthcare.com/Medicare.
If you need help in scheduling appointments, or finding a provider that is accepting new patients, please call Member Services at (855) 315-5663, 7 days a week, 8 a.m. to 8 p.m., local time. TTY users should call 711.
To report any errors throughout this directory, email
CentralizedOps.Medicare@MolinaHealthcare.com
or call Member Services.
Section 2- Pharmacy Introduction
This information was updated on 10/2020.
For more recent information or other questions, please contact us,
Molina Medicare Complete Care Member Services, at (855) 315-5663 or, for
TTY users, 711, 7 days a week, 8 a.m. to 8 p.m., local time , or
visit
MolinaHealthcare.com/Medicare.
Changes to our pharmacy network may occur during the benefit year.
An updated print Pharmacy Directory is located on our website at
MolinaHealthcare.com/WIMaterials.
You may also call Member Services for updated providers.
The searchable online directory displays Molina Medicare Complete Care 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 Complete Care’s formulary.
When this pharmacy document refers to “we,” “us”, or “our,”
it means
Molina Healthcare. When it refers to “plan” or “our plan,”
it means Molina Medicare Complete Care.
We call the pharmacies shown in this searchable online directory 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 Complete Care 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.
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.” For more information, please contact Member Services
or visit
MolinaHealthcare.com/WIMaterials.
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.
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.
“We also display pharmacies that are in our network but are outside Brown,
Calumet, Dodge, Door, Fond Du Lac, Green Lake, Jefferson, Kenosha, Kewaunee,
Manitowoc, Marinette, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Shawano,
Sheboygan, Walworth, Washington, Waukesha Waupaca, Waushara, Winnebago,
Florence, Forest, Langlade, Marquette, and Portage, the area in which you
live. You may also fill your prescriptions at these pharmacies.
For more information, please contact us at (855) 315-5663; 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, please contact Member
Services or visit
MolinaHealthcare.com/Medicare.
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