100 North Academy Avenue Geisinger Gold If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General. Contact us. A copy of the most recent well-child visit. PPO with no referral/TPA: 800-504-0443 3. Have questions? Geisinger Medical Laboratories/Geisinger Proven Diagnostics. TTY/TDD users should call 1-877-486-2048. When can you end your membership in our plan? Our Geisinger Gold Medicare Advisors are standing by and are ready to help you on your Medicare journey. First name Last name Email. If you feel that youre being asked to leave our plan because of a health-related reason, you should call Medicare at 800-MEDICARE (800-633-4227 FREE). Monthly . a.m.to 8 p.m. If you intentionally give us incorrect information when youre enrolling in our plan, and that information affects your eligibility for our plan. Write You can ask Geisinger Gold to make an exception and cover your drug. How you can file a fast complaint about our decision to give you a standard coverage decision instead of the fast coverage decision you requested. See below for information about how to request an exception. As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. Box 829703 You can call this number 24 hours a day, 7 days a week. If our answer is yes to part or all of what you requested,we must authorize or provide the medical care coverage we have agreed to provide within 72 hours after we received your request. No, participation in this program is voluntary. Generally, for a fast coverage decision, well give you our answer within 72 hours. They usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs. You can call this number 24 hours a day, 7 days a week. times. Please do not make the same mistake I did in going to a Geisinger doctor. You can only use doc- No. Danville, PA 17822-3220. A coverage decision is a decision we make about your benefits and coverage, or about the amount we'll pay for your medical services. Geisinger Health Plan P.O. If you let someone else use your membership card to get medical care. $ 38.00. Make a donation. The Geisinger Gold Classic Complete Rx has a monthly premium of $38.00 and has an in-network Maximum Out-of-Pocket limit of $4,900 . Our customer care team members are standing by and are ready to help. 65+ and shopping for a new Medicare plan? Geisinger Gold: 800-498-9731 4. Email. Phone: 1-800-695-6491. Please call Geisinger Gold Preferred (PPO) at the number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. TTY/TDD users should call 1-877-486-2048. when the member's life, health or ability to regain maximum function is Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. If we remove drugs from our formulary; add prior authorization, quantity limits and/or step therapy restrictions on a drug; or move a drug to a different tier, we must notify members who take the drug that it will be removed at least 60 days before the date that the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a 60-day supply of the drug. This can be a extremely nice safety net. This program is included free of charge as part of your Medicare Part D prescription coverage and is not considered a benefit. Box 8200 Danville, PA 17821-8200 All Products Customer Service Teams *(Claims, Member Benefits & Eligibility) (855) 863-2429 Monday - Friday, 8 a.m.- 6 p.m. quests to VITALine Pharmacy Services at (800) We may extend the time frame by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest. Heritage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO) Looking for geisinger bill pay phone number? TTY/TDD users should call 1-877-486-2048. . You may call 24 hours a day, seven days a week. Follow the steps below: Start by calling, writing, or faxing us to request coverage for the medical care you want. The Social Security Office at 800-772-1213 (TTY users call 800-325-0778) between 7 a.m. and 7 p.m., Monday through Friday. If you would like information on Geisinger Golds Quality Improvement (QI) program, call the quality and accreditation department at 866-847-1216. "Five Days in May." Learn more about COVID-19 at: http://geisinger.org/co. Phone. Already 65 and shopping for a new Medicare plan for 2023? This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. TTY/TDD users should call 1-877-486-2048. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. Geisinger Gold (Medicare): Phone: 800-498-9731 or 570-271-8771 Oct. 15 - Dec. 7: Daily . When youre requesting a formulary or utilization restriction exception, you should submit a statement from your physician supporting your request. Get in touch with online support or Paying by phone . Danville, PA 17822-3220, In person However, when the member's life, health, or ability to regain maximum function is jeopardized by utilizing the seven-day appeal process, an expedited appeal may be requested verbally by the member, member representative, or prescribing physician by calling 800-498-9731, seven days a week, from 8 a.m. 8 p.m., ET. Note: if your ID number begins with zeroes or ends with 01, exclude them when entering your ID number. Please call Geisinger Gold Classic (HMO) at the tele-phone number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. If an opioid prescription is above a safe dosage limit, the prescription will be stopped at the pharmacy for review by the provider to make sure its medically necessary and appropriate. Visiting students. Refer your patient to ADMI. EMS bill payment. Geisinger Gold Medicare Advantage HMO, PPO, and HMO SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company, health plans with a Medicare contract. 2023 pharmacy prior authorization policies|standard Rx|$0 deductible Rx(updated October 11, 2023/effective January 1, 2023), 2022 pharmacy prior authorization policies|standard Rx|$0 deductible Rx(updated October 27, 2022/effective November 1, 2022), 2022 step therapy policies|standard Rx|$0 deductible Rx(updated October 27, 2022/effective November 1, 2022)|Part B list & criteria(updated May 17, 2022/effective July 15, 2022) St. Luke's TP See more . Standard (7-day review) appeals must be submitted in writing. If we cant resolve your complaint over the phone, we have a formal procedure to review your complaints, called the grievance procedure. We can take up to 14 more calendar days (an extended time period) under certain circumstances. But if you do, our EMS (which stands for Emergency Medical Services) team knows these streets and sidewalks like the backs of our hands. Contact medical management to request precertification/prior authorization for inpatient admissions, outpatient rehabilitation, home health & hospice, SNF, DME, etc. Select this result to view Dana Michele Geisinger's phone number, address, and more. Oct. 15 Dec. 7:Daily from 8 a.m. 8 p.m. All other dates:Monday through Friday, 8 a.m. 8 p.m. Current members You can ask us to cover your drug even if its not on our formulary. Academic Administration (1) Academic Support (10) Administrative Support (68) Advanced Practice (61) Business Strategy and Innovations (6) Certified Nurse Midwife (1) Cooks (8) CRNA (11) Customer Services (6) Data Management (7) Diagnostic . Find information on benefit documents, filing grievances, coverage determinations and more. Learn more about Geisinger Gold at an event near you. Used Geisinger instead of a vision care center. There is one instance when you may file an Expedited (Fast) Grievance related to requests for a redetermination (appeal) of a coverage determination. Geisinger Gold Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, Request or verify authorizationsthrough HealthHelp. Geisinger Gold Medicare Advantage members have access to more than 29,000 doctors throughout Pennsylvania, over 100 hospitals and nearly 3,000 pharmacies. Generally, for a standard coverage decision, well give you our answer within 14 days of receiving your request. As a member of Geisinger Gold Medicare Advantage, you have access to benefits and extras that make managing your health easier. In certain situations, you may also be eligible to leave the plan at other times of the year. If you move out of our service area for more than 6 months. Ending your membership in Geisinger Gold may bevoluntary(your own choice) orinvoluntary(not your own choice): If youre leaving our plan, you must continue to get your medical care through our plan until your membership ends. We cannot make you leave our plan for this reason unless we get permission from Medicare first. Are in a hospice or long-term care facility. Walmart, PA Trust, PEBTF, Office of Personnel (FEHB). If your doctor asks for the fast coverage decision, well automatically give a fast coverage decision. E-Mail: Client Services. Preferred Advantage Rx (PPO), Preferred Complete Rx (PPO), Preferred Enhanced Rx (PPO) An Expedited (Fast) Grievance can also be initiated or requested when you disagree with Geisinger Gold's established time frame when you have requested a redetermination (appeal) of a coverage decision. If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. If you dont stay continuously enrolled in Medicare Part A and Part B. Demographics (name, birthdate, address, phone number, and insurance card information) A copy of the most recent well child visit. If you are a current Geisinger Gold member and will remain enrolled for 2022, view your2022 Annual Notice of Change (ANOC)letter below: If you are a current Geisinger Gold member and will remain enrolled for 2022, view your2022 Evidence of Coverage documentsbelow: If you're a current member, you can make a one-time payment or set up recurring payments through the member portal. Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, See what other benefits Geisinger Gold Medicare Advantage plans can offer you >. Throughout the year, well automatically enroll patients who meet the above criteria. If we say no, you have the right to ask us to reconsider this decision by making an appeal. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. If you'd like a . Oct.1 - Feb. 14; for all other dates, call from 8 a.m. 8 p.m., ET. Changes to the Geisinger Gold standard Rx formulary(effective September 1, 2022), Changes to the Geisinger Gold $0 deductible formulary(effective September 1, 2022). Just an eye exam, no glasses. The average MTM session ranges from 15 to 30 minutes. Geisinger Gold Phone: 800-498-9731 or 570-271-8771 Oct. 15 - Dec. 7: Daily from 8 a.m. - 8 p.m. All other dates: Monday through . If our answer is no to part or all of what you requested,well send you a written statement that explains why we said no. MC 40-36. Monday, Tuesday, Thursday and Friday, 7 a.m. 7 p.m.; Walmart, PA Trust, PEBTF, Office of Personnel (FEHB), Bucknell University, Evangelical Community Hospital, Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine. Have three of these five conditions: diabetes, high blood pressure, COPD, high cholesterol, osteoporosis, Are taking eight or more chronic/maintenance medications covered by Medicare Part D, Have a total medication cost of at least $4,696 annually for 2022 ($4,935 for 2023), Youve been enrolled in our Drug Management Program based on your opioid use. Expedited (Fast) Grievances can be initiated or requested when you disagree with the time frames Geisinger Gold establishes for making organization determinations (coverage decisions) or reconsiderations (appeals) for services you have not yet received. Home; Geisinger health provider phone number Geisinger health insurance phone . There is one instance when you may file an Expedited (Fast) Grievance related to coverage determinations. To request an expedited coverage determination or exception, call 800-988-4861, Monday through Friday, 8 a.m. 8 p.m., ET. Geisinger Gold Classic Complete Rx (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Geisinger Health System. Geisinger Gold We will try to resolve your grievance over the phone. If you have questions, contact your Geisinger Health Plan provider relations representative at 800-876-5357. Well also look for drug interactions and possible ways you can save on costs. Medical bills can be confusing or difficult to understand. P.O. If were not able to resolve the issue over the phone, we have a formal procedure to review grievances, called the grievance procedure. Sign up for a local meeting today to learn more about plan options. You can compare Geisinger Gold Classic (HMO) and We must notify you in writing that you have 2 months to pay the plan premium before we end your membership. One way of combating this public health emergency is via drug management programs that prevent opioid overuse: For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY: 711), 7 days a week, 8 a.m. 8 p.m. You, your doctor or your representative can do this. GeisingerFoundation@geisinger.edu . A medical director will review your Expedited (Fast) Grievance and you will receive a verbal notification of the decision within 24 hours of receipt of your request for an Expedited (Fast) Grievance. You need a referral from a pediatrician or primary care provider to make an appointment at ADMI. One way we can ensure that we are holding ourselves to the highest standards is to review our performance against accepted care and service measures. As a Geisinger Gold member, you have the right to file an Expedited (Fast) Grievance for services you have not yet received, by following the process below. By providing your information, you agree to receive ongoing communications about Geisinger Gold. 2. Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases. Find out more about the South Campus. For a free quote or to request a Geisinger Gold Medicare Kit you may call (888) 620-8988 or click the button below. Auxiliary events If you become incarcerated (go to prison). Danville, PA 17822-3218. 100 North Academy Avenue Geisinger Gold Classic Complete Rx (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Geisinger Health System. Instructions for completing and submitting a Drug Coverage Determination This revolutionary approach to primary care for people 65 and older puts everything needed for better health under one roof. Geisinger Gold Preferred Enhanced Rx (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Geisinger Health System. You'll need the following information to make your payment : . Write: $ 45.00. Instructions for completing and submitting a Drug Coverage Redetermination/Appeal. Your coverage will become effective on Jan. 1, 2023. Box 8200 Danville, PA 17821-8200 All Products Claim Reconsideration Address Geisinger Health Plan P.O. Your membership will usually end on the first day of the month after we receive your request to change your plan. You can also contact Geisinger Gold for help at: 800-498-9731, Monday - Friday, 8 a.m. - 8 p.m. TTY users should call 711; What prescriptions are covered by Geisinger Gold?
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