The Provider & Pharmacy Directory Sample Clauses

The Provider & Pharmacy Directory. Your guide to all providers in the plan’s network The Provider & Pharmacy Directory lists our network providers and network pharmacies. What are “network providers”? Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment and any plan cost sharing as payment in full. We have arranged for these providers to deliver covered services to members in our plan. The most recent list of providers is available on our website at xxx.xxxxxxxxx.xxx/xxxxx. Why do you need to know which providers are part of our network? It is important to know which providers are part of our network because, with limited exceptions, while you are a member of our plan you must use network providers to get your medical care and services. In addition, you may be limited to providers within your Primary Care Provider (PCP’s) and/or Medical Group’s network. This means that the PCP and/or Medical Group that you choose may determine the specialists and hospitals you can use. See the chapter “Using the plan’s coverage for your medical services” for more information about choosing a PCP. The only exceptions are emergencies, urgently needed services when the network is not available (generally, when you are out of the area), out-of-area dialysis services, and cases in which our plan authorizes use of out-of-network providers. See Chapter 3 (Using the plan’s coverage for your medical services) for more specific information about emergency, out-of-network, and out- of-area coverage. If you don’t have your copy of the Provider & Pharmacy Directory, you can request a copy from Member Services (phone numbers are printed on the back cover of this booklet). You may ask Member Services for more information about our network providers, including their qualifications. You can also see the Provider & Pharmacy Directory at xxx.xxxxxxxxx.xxx/xxxxx, or download it from this website. Both Member Services and the website can give you the most up-to-date information about changes in our network providers. What are “network pharmacies”? Network pharmacies are all of the pharmacies that have agreed to fill covered prescriptions for our plan members. Why do you need to know about network pharmacies? You can use the Provider & Pharmacy Directory to find the network pharmacy you want to use. There are changes to our network of pharmacies for next year. An updated Provider & Pharmacy Directory...
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