-
2015
For more information, please contact Cigna-HealthSpring Customer
Service at 1-800-668-3813 or, for TTY users, 711, 7 days a week, 8
a.m. - 8 p.m., or visit www.cignahealthspring.com. Para ms
informacin, favor de ponerse en contacto con el Departamento de
servicio al cliente de Cigna-HealthSpring al 1-800-668-3813 o, para
usuarios TTY, 711, 7 das de la semana, o bien visite
www.cignahealthspring.com. This Provider and Pharmacy Directory was
updated on 08/24/2014. Este Directorio de proveedores y farmacias
se actualiz el 08/24/2014. 2014 Cigna 15_D_66_ESD_66
Y0036_15_19958aBL_FINAL_23 Approved 08252014
Y0036_15_19958aBL_FINAL_23 Cover Provider Pharmacy TX HMO.indd 2
9/5/14 3:11 PM
PROVIDER AND PHARMACY DIRECTORYDirectorio de farmacias y
proveedores
Cigna-HealthSpring El Paso, DFW and San Antonio HMO Provider and
Pharmacy Directory / Directorio de farmacias y proveedoresBexar,
Collin, Dallas, Denton, El Paso, Hood, Johnson, Parker, Tarrant and
/ y Wise Counties / Condados, TX
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Cigna-HealthSpring
HMO Plan Provider Directory
This directory provides a list of Cigna-HealthSprings network
providers. This directory is for Bexar, Collin, Dallas, Denton, El
Paso, Hood, Johnson, Parker, Tarrant and Wise Counties, TX. This
directory is current as of August 2014. 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
Cigna-HealthSprings network providers in your area, you can visit
www.cignahealthspring.com or call our Customer Service Department
at 1-800-668-3813, 7 days a week, 8 a.m. 8 p.m. TTY users should
call 711. All Cigna products and services are provided exclusively
by or through operating subsidiaries of Cigna Corporation,
including Cigna Health and Life Insurance Company, Cigna HealthCare
of South Carolina, Inc., Cigna HealthCare of North Carolina, Inc.,
Cigna HealthCare of Georgia, Inc., Cigna HealthCare of Arizona,
Inc., HealthSpring Life & Health Insurance Company, Inc.,
HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc.,
HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., and
Bravo Health Pennsylvania, Inc. The Cigna name, logos, and other
Cigna marks are owned by Cigna Intellectual Property, Inc.
Cigna-HealthSpring is contracted with Medicare for PDP plans, HMO
and PPO plans in select states, and with select State Medicaid
programs. Enrollment in Cigna-HealthSpring depends on contract
renewal. This information is available for free in other languages.
Please call our customer services number at 1-800-668-3813 (TTY
711), 7 days a week, 8 a.m. 8 p.m. Esta informacin est disponible
de forma gratuita en otros idiomas. Favor de contactar a nuestro
Departamento de servicio al cliente al 1-800-668-3813 (TTY 711), 7
das de la semana, 8 a.m. 8 p.m. This document may be available in
other formats such as Braille, large print or other alternate
formats. Contact the plan for more information.
Y0036_15_19958aBL_FINAL_23 Approved 08252014 15_D_66_ESD_66
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Section 1 Introduction This directory provides a list of
Cigna-HealthSprings network providers. To get detailed information
about your health care coverage, please see your Evidence of
Coverage. 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 healthcare coverage from your PCP.
Your PCP is a physician who is trained to provide general medical
care. Your PCP can also coordinate the rest of the covered services
you need. The network providers listed in this directory have
agreed to provide you with your healthcare, vision, and dental
coverage. 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 going to that same provider. In some cases, you may get
covered services from non-network providers. Even though your PCP
is trained to handle the majority of common health needs, there may
be a time when you need more specialized treatment. In those
situations, you may see a plan specialist. Specialists are doctors
who are trained to provide health services for a specific disease
or part of the body. For some types of specialists, you will need
to obtain a referral from your PCP before you can schedule an
appointment with the specialist. Below is a list of provider
specialty types that require referrals from your PCP before you can
schedule an appointment with them. Please note: Some provider types
may have been added or removed from the list after this directory
was printed. You should check with your PCP or call Customer
Service at the phone number on the cover to see if a referral is
required to see a specialist or other provider. Note that a
referral is different from prior authorization, which is required
before certain services procedures can be performed. Allergy &
Immunology Medical Genetics Physical Therapy Anesthesiology Medical
Oncology Plastic Surgery Audiology Nephrology Podiatry
Cardiovascular Disease Neurosurgery Proctology Cardiovascular
Surgery Neurology Prosthodontics Chiropractor Occupational Therapy
Pulmonary Disease Colon and Rectal Surgery Ophthalmology Radiology
Dermatology Oral Surgery Respiration Therapy Endocrinology
Orthopedic Surgery Rheumatology Gastroenterology Otolaryngology
Speech Language Pathologist General Surgery Pain Management Speech
Therapy Gynecologic Oncology Pediatric Cardiology Sports Medicine
Hand Surgery Pediatric Endocrinology Thoracic Surgery Hematology
Pediatric Hematology-Oncology Urology Hematology/Oncology Pediatric
Rehabilitation Medicine Vascular and Interventional Infectious
Disease Pediatric Surgery Vascular Surgery Maxillofacial Surgery
Physical Medicine/Rehabilitation In addition, each PCP has certain
plan specialists and hospitals they use for referrals. This means
that the Cigna-HealthSpring specialists or hospitals you can use
may depend on which PCP you select. If there are specialists or
hospitals that you want to use, it is important to find out if your
chosen PCP refers to them. Cigna-HealthSpring has different types
of Primary Care Provider relationships. We have contracts with
Independent Physicians, Independent Physician Associations, and
Physician Organized Delivery system. The following paragraphs
describe the relationship these providers have with
Cigna-HealthSpring.
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Independent Physicians The Independent Physicians consists of
Primary Care and Specialist Physicians located in and around the
Dallas/Fort Worth, El Paso and San Antonio, Texas areas. If you
select an Independent Primary Care Physician you should be aware
that your PCP will refer you to specialists and hospitals with whom
he/she is affiliated and with whom they work closely to coordinate
your care. You will receive all of your care, including
gynecological and specialty care from the physicians affiliated
with your PCP. Gynecological care can be accessed through any
Independent Gynecologist. Independent Physicians are participating
providers with Cigna-HealthSpring Preferred (HMO), MAPD, and
Cigna-HealthSpring TotalCare (HMO SNP), Full/Partial Duals MAPD.
For further information, please call Customer Service or speak with
your sales representative. You may contact us at the phone number
listed at the beginning of this book. El Paso Integral Care, LLC El
Paso Integral Care, LLC (EPIC) is an Independent Physicians
Association (IPA). EPIC consists of Primary Care and Specialist
Physicians located in and around El Paso, Texas. If you select a
Primary Care Physician who belongs to an IPA you should be aware
that your PCP will refer you to specialists and hospitals
affiliated with the same IPA and with whom they work closely to
coordinate your care. You will receive all of your care, including
gynecological and specialty care from the physicians within the
same IPA. Gynecological care can be accessed by any El Paso
Integrated Care Gynecologist. El Paso Integral Care, LLC are
participating providers with Cigna-HealthSpring Preferred (HMO),
MAPD, and Cigna-HealthSpring TotalCare (HMO SNP), Full/Partial
Duals MAPD. For Further information, please call Customer Service
or speak with your sales representative. You may contact us at the
phone number listed at the beginning of this book. Prospect
Prospect is a Physician Organized Delivery (POD) System. If you
choose a Prospect PCP, you must see a specialist that is part of
the Prospect Network. Prospect are participating providers with
Cigna-HealthSpring Preferred (HMO), MAPD, and Cigna-HealthSpring
TotalCare (HMO SNP), Full/Partial Duals MAPD. For further
information, please call Customer Service or speak with your sales
representative. You may contact us at the phone number listed at
the beginning of this book. WellMed WellMed is a Physician
Organized Delivery (POD) System. If you choose a WellMed PCP, you
must see a specialist that is a part of the WellMed Network.
WellMed are participating providers with Cigna-HealthSpring
Preferred (HMO), MAPD, and Cigna-HealthSpring TotalCare (HMO SNP),
Full/Partial Duals MAPD. For further information, please call
Customer Service or speak with your sales representative. You may
contact us at the phone number listed at the beginning of this
book. There may also be times when you get a bill from a provider
for the full cost of medical care you have received. In many cases,
you should contact Customer Service or send this bill to us instead
of paying it. We will look at the bill and decide whether the
services should be covered. If we decide they should be covered, we
will pay the provider directly. (Please note that we cannot pay a
provider who has opted out of the Medicare program. Check with your
provider before receiving services to confirm that they have not
opted out of Medicare.) If we determine that the services are not
covered or were not medically necessary, we may deny coverage and
you will be responsible for the entire cost. You may get emergency
medical care whenever you need it, anywhere in the United States or
its territories. Our plan covers ambulance services in situations
where getting to the emergency room in any other way could endanger
your health. Please refer to your Evidence of Coverage for details.
You may get covered emergency medical care whenever you need it,
anywhere in the world. If you have an emergency, we will talk with
the doctors who are giving you emergency care to help manage and
follow up on your care. The doctors who are giving you emergency
care will decide when your condition is stable and the medical
emergency is over. After the emergency is over you are entitled to
follow-up care to be sure your condition continues to be
stable.
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Your follow-up care will be covered by our plan. If your
emergency care is provided by out-of-network providers, we will try
to arrange for network providers to take over your care as soon as
your medical condition and the circumstances allow. 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
Cigna-HealthSpring will be responsible for the costs. Behavioral
Healthcare Services Behavioral Health services, including mental
health and substance abuse services, for beneficiaries covered by
Cigna-HealthSpring are provided through Cigna-HealthSpring
Behavioral Healthcare Services. Members and providers may access
Cigna-HealthSpring Behavioral Healthcare Services by calling
1-866-780-8546 (TTY 711) to arrange for a referral or inpatient
admission authorization. Cigna-HealthSpring Behavioral Healthcare
Services is available 24 hours per day, 7 days a week. What is the
service area for Cigna-HealthSpring? The counties in our service
area are listed below. Bexar, Collin, Dallas, Denton, El Paso,
Hood, Johnson, Parker, Tarrant and Wise Counties, TX How do you
find Cigna-HealthSpring providers in your area? To choose a PCP
from the Provider Directory, turn to the Primary Care Provider
section for a listing of primary care providers in your area. You
can also call Customer Service at the number listed below for
assistance. When you select a PCP, you will find a space on your
Enrollment Application to enter the PCPs name. If you choose a PCP
after your Enrollment Application has been submitted, call Customer
Service and inform them of your PCP selection. Please keep in mind
that if you do not select a PCP at the time of enrollment,
Cigna-HealthSpring will select one for you based on where you live.
If you want to change to another PCP, you may do so at any time by
calling Customer Service at the number listed below. The name and
office telephone number of your PCP are printed on your membership
card. To choose a specialist, hospital, pharmacy or other provider,
please turn to the applicable section in the Provider Directory for
a listing of providers in your area. For example, to find hospitals
in your area, turn to the Hospitals section of the directory. If
you have questions about Cigna-HealthSpring or require assistance
in selecting a PCP, please call our Customer Service Department at
1-800-668-3813, 7 days a week, 8 a.m. - 8 p.m. TTY users should
call 711. Or, visit www.cignahealthspring.com. Again, if you want
to use a particular Cigna-HealthSpring specialist or hospital, you
should check with your PCP to make sure they can make referrals to
that specialist or hospital. Please note: Not all
Cigna-HealthSpring plans have vision and dental benefits. Please
check your Evidence of Coverage to see if your plan has a vision
and / or dental benefit.
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Section 2 List of Network Providers This directory is organized
to help you find the type of provider you need. Providers are
listed in the following sections:
- Independent Physician Association (IPA) o Primary Care
Providers (PCP) o Specialists o Hospitals o Skilled Nursing
Facilities o Behavioral Health Providers o Ambulatory Surgical
Centers/Urgent Care Facilities o Ancillary Providers o Dental
Providers o Vision Providers
- Physician Organized Delivery System (POD) o Primary Care
Provider (PCP) o Specialist o Hospitals o Skilled Nursing
Facilities o Behavioral Health Providers o Ambulatory Surgical
Centers/Urgent Care Facilities o Ancillary Providers o Dental
Providers o Vision Providers
- Independent Providers o Primary Care Provider (PCP) o
Specialists o Hospitals o Psychiatric Hospitals o Skilled Nursing
Facilities o Behavioral Health Providers o Ambulatory Surgical
Centers/Urgent Care Facilities o Ancillary Providers o Dental
Providers o Vision Providers
How to use this directory to choose a Primary Care Provider
There are two ways to select a primary care provider:
- You can choose a particular Primary Care Provider by name; or
- You can choose your Primary Care Provider by location.
If you are looking for a particular Primary Care Provider by
name: 1. Go to the Alphabetical Index, which is the last section of
the directory. 2. Find the doctor by last name and the page
number(s) on which he or she is listed. 3. Go to that page number
for information on the Primary Care Provider.
If you are looking for a Primary Care Provider by location: 1.
Go to the Primary Care Provider section. 2. Find the City and/or
zip code.
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3. Select a Provider. How to use this directory to choose a
Specialist Specialist physicians and other primary care providers
in this directory are listed by specialty of care, followed by
geographic location, and name. How to use this directory to choose
a Provider that accepts both Medicare and Medicaid Plan providers
that accept both Medicare and Medicaid are located throughout this
Provider Directory and are marked by an asterisk (*). For example,
this provider would be a Medicare and Medicaid provider: Dr. John
Doe* However, this provider would not be a Medicare and Medicaid
provider: Dr. Jane Doe How to use this directory to choose other
Plan Providers Plan providers in this directory, other than primary
care providers and specialists, are listed by geographic location
then the name of the provider. Provider Directory Symbol Key In
this directory, some providers will have a symbol at the end of
their name. Below are the symbols and what they mean:
Symbol Meaning * Accepts Medicare and Medicaid Accepting
Existing Patients Only Not Accepting New Patients
Total Number of Providers within this Directory: Primary Care
Providers: 724Specialists: 4,548Hospitals: 91Skilled Nursing
Facilities: 70 Behavioral Health Providers: 341 Ambulatory Surgical
Centers / Urgent Care Facilities: 105 Ancillary Providers: 680
Dental Providers: 1 Vision Providers: 1 Pharmacies: 1,657
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Directorio de proveedores del Plan HMO de Cigna-HealthSpring
Este directorio incluye una lista de los proveedores de la red
de Cigna-HealthSpring. Este directorio es para los Condados de
Bexar, Collin, Dallas, Denton, El Paso, Hood, Johnson, Parker,
Tarrant y Wise, TX. Este directorio est actualizado a partir de
agosto de 2014. Es posible que se hayan agregado o eliminado de la
lista algunos proveedores de la red, despus de la impresin de este
directorio. No garantizamos que los proveedores estn aceptando
miembros nuevos. Para obtener informacin actualizada sobre los
proveedores de la red de Cigna-HealthSpring en su rea, visite la
pgina www.cignahealthspring.com o bien, llame al Departamento de
servicio al cliente al 1-800-668-3813, los 7 das de la semana, de 8
a.m. a 8 p.m. Los usuarios de TTY deben llamar al 711. Todos los
productos y servicios de Cigna se brindan exclusivamente por o a
travs de subsidiarias operativas de Cigna Corporation, incluyendo
Cigna Health and Life Insurance Company, Cigna HealthCare of South
Carolina, Inc., Cigna HealthCare of North Carolina, Inc., Cigna
HealthCare of Georgia, Inc., Cigna HealthCare of Arizona, Inc.,
HealthSpring Life & Health Insurance Company, Inc.,
HealthSpring of Tennessee, Inc., HealthSpring of Alabama, Inc.,
HealthSpring of Florida, Inc., Bravo Health Mid-Atlantic, Inc., y
Bravo Health Pennsylvania, Inc. El nombre de Cigna, los logotipos,
y otras marcas de Cigna son propiedad de Cigna Intellectual
Property, Inc. Cigna-HealthSpring tiene contrato con Medicare para
planes PDP, y planes HMO y PPO en ciertos estados, y con ciertos
programas estatales de Medicaid. La inscripcin en
Cigna-HealthSpring depende de la renovacin de contrato. This
information is available for free in other languages. Please call
our customer services number at 1-800-668-3813 (TTY 711), 7 days a
week, 8 a.m. 8 p.m. Esta informacin est disponible de forma
gratuita en otros idiomas. Favor de contactar a nuestro
Departamento de servicio al cliente llamando al 1-800-668-3813 (TTY
711), 7 das de la semana, 8 a.m. 8 p.m. Este documento est
disponible en otros formatos como Braille, impresin grande u otros
formatos alternativos. Para ms informacin, pngase en contacto con
el plan. Y0036_15_19958aBL_FINAL_23 Approved 08252014
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Seccin 1 Introduccin
Este directorio incluye una lista de los proveedores de la red
de Cigna-HealthSpring. Para obtener informacin detallada acerca de
su cobertura de atencin mdica, por favor consulte su Evidencia de
Cobertura.
Deber elegir uno de nuestros proveedores de la red que figuran
en este directorio para que sea su Mdico de cabecera (PCP, por sus
siglas en ingls). El trmino PCP se usar en todo este directorio.
Por lo general, debe recibir su cobertura de atencin mdica de su
PCP. Su PCP es un mdico capacitado para brindarle atencin mdica
general. Su PCP tambin puede coordinar el resto de los servicios en
cobertura que usted necesite.
Los proveedores de la red que figuran en este directorio han
aceptado brindarle su cobertura del cuidado de la vista, cuidado
dental y de atencin mdica. Usted puede acudir a cualquiera de los
proveedores de nuestra red que figuran en este directorio; no
obstante, es posible que algunos servicios requieran una
referencia. Si usted ha estado acudiendo a un proveedor de la red,
no es necesario que contine consultando a dicho proveedor. En
algunos casos, puede recibir servicios cubiertos de proveedores que
no pertenecen a la red.
A pesar de que su PCP est capacitado para manejar la mayora de
las necesidades comunes de salud, es posible que, en ocasiones,
usted necesite un tratamiento ms especializado. En esas
situaciones, puede consultar un especialista del plan. Los
especialistas son mdicos que estn capacitados para proporcionar
servicios mdicos para una enfermedad o parte del cuerpo especficos.
Para algunos tipos de especialistas, deber obtener una "referencia"
de su PCP antes de que pueda programar una cita con el
especialista. A continuacin est una lista de los tipos de
proveedores especialistas que requieren referencias de su PCP antes
de que pueda programar una cita con ellos. Recuerde: Es posible que
se hayan agregado o eliminado de la lista algunos tipos de
proveedores, despus de la impresin de este directorio. Usted debe
consultar con su PCP o llamar al Departamento de servicio al
cliente al telfono que est en la portada para saber si requiere una
referencia para visitar un especialista u otro proveedor. Tenga en
cuenta una referencia es diferente a un "autorizacin previa", misma
que se requiere antes de que se puedan realizar ciertos servicios o
procedimientos. Alergia e inmunologa Endocrinologa peditrica
Oftalmologa Anestesiologa Enfermedad infecciosa Oncologa
Ginecolgica Audiologa Enfermedad pulmonar Oncologa mdica Cardiologa
peditrica Enfermedades cardiovasculares Otorrinolaringologa Ciruga
cardiovascular Fisioterapia Patlogo del habla y del lenguaje Ciruga
de la mano Gastroenterologa Podologa Ciruga General Gentica mdica
Proctologa Ciruga maxilofacial Hematologa Prostodoncia Ciruga oral
Hematologa-Oncologa peditrica Quiroprctico Ciruga ortopdica
Hematologa/Oncologa Radiologa Ciruga peditrica Manejo del dolor
Radiologa vascular e Ciruga plstica Medicina de rehabilitacin
peditrica intervencionista Ciruga rectal y de colon Medicina del
deporte Reumatologa Ciruga torcica Medicina fsica / rehabilitacin
Terapia del habla Ciruga vascular Nefrologa Terapia ocupacional
Dermatologa Neurociruga Terapia respiratoria Endocrinologa
Neurologa Urologa
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Adems, cada PCP tiene ciertos especialistas y hospitales del
plan que debe usar para las referencias. Esto significa que es
posible que los especialistas u hospitales de Cigna-HealthSpring a
los que puede acudir dependan de los que su PCP haya seleccionado.
En caso de que desee acudir con ciertos especialistas o a ciertos
hospitales, es importante que verifique si su PCP lo enviar con los
mismos. Cigna-HealthSpring tiene diferentes tipos de relaciones con
los mdicos de cabecera. Tenemos contrato con Proveedores
Independientes, Asociaciones de mdicos independientes y el Sistema
organizado de prestaciones mdicas. Los siguientes prrafos describen
la relacin que los proveedores tienen con Cigna-HealthSpring.
Mdicos independientes Los Mdicos independientes son Mdicos de
cabecera y Especialistas que se encuentran en y alrededor de las
reas de Dallas/Fort Worth, El Paso y San Antonio, Texas. Si
selecciona un mdico de cabecera independiente, debe considerar que
su mdico o PCP lo enviar con especialistas y hospitales con los que
l/ella est afiliado y con los que trabajar en conjunto para
coordinar su atencin mdica. Recibir toda su atencin mdica,
incluyendo atencin ginecolgica y de especialidad de mdicos
afiliados con su PCP. Puede tener acceso a la atencin mdica
ginecolgica a travs de cualquier gineclogo independiente. Los
Mdicos independientes son mdicos participantes con
Cigna-HealthSpring Preferred (HMO), MAPD, y Cigna-HealthSpring
TotalCare (HMO SNP), Duales completos/parciales, MAPD. Para ms
informacin, por favor llame al Departamento de servicio al cliente
o hable con su representante de ventas. Puede comunicarse con
nosotros al nmero de telfono que aparece al principio de este
libro. El Paso Integral Care, LLC El Paso Integral Care, LLC (EPIC)
es una Asociacin de mdicos independientes (IPA). EPIC est formada
por Mdicos de cabecera y Especialistas que se encuentran en y
alrededor de El Paso, Texas. Si selecciona un mdico de cabecera que
pertenezca a una IPA, debe considerar que su mdico o PCP lo enviar
con especialistas y hospitales afiliados con la misma IPA y con los
que trabajar en conjunto para coordinar su atencin mdica. Recibir
toda su atencin mdica, incluyendo atencin ginecolgica y de
especialidad de los mdicos dentro de la misma IPA. Puede tener
acceso a la atencin mdica ginecolgica a travs de cualquier
gineclogo de El Paso Integral Care. El Paso Integral Care, LLC son
mdicos participantes con Cigna-HealthSpring Preferred (HMO), MAPD,
y Cigna-HealthSpring TotalCare (HMO SNP), Duales
completos/parciales, MAPD. Para ms informacin, por favor llame al
Departamento de servicio al cliente o hable con su representante de
ventas. Puede comunicarse con nosotros al nmero de telfono que
aparece al principio de este libro. Prospect Prospect es un Sistema
organizado de prestaciones mdicas (POD). Si elige a un Mdico de
cabecera de Prospect, debe acudir con un especialista que sea parte
de la red de Prospect. Prospect son mdicos participantes con
Cigna-HealthSpring Preferred (HMO), MAPD, y Cigna-HealthSpring
TotalCare (HMO SNP), Duales completos/parciales, MAPD. Para ms
informacin, por favor llame al Departamento de servicio al cliente
o hable con su representante de ventas. Puede comunicarse con
nosotros al nmero de telfono que aparece al principio de este
libro. WellMed WellMed es un Sistema organizado de prestaciones
mdicas (POD). Si elige a un Mdico de cabecera de WellMed, debe
acudir con un especialista que sea parte de la red de WellMed.
WellMed son mdicos participantes con Cigna-HealthSpring Preferred
(HMO), MAPD, y Cigna-HealthSpring TotalCare (HMO SNP), Duales
completos/parciales, MAPD. Para ms informacin, por favor llame al
Departamento de servicio al cliente o hable con su representante de
ventas. Puede comunicarse con nosotros al nmero de telfono que
aparece al principio de este libro.
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Adems, es posible que algunas veces reciba una factura de un
proveedor por el costo total de la atencin mdica que haya recibido.
En muchos casos, debe comunicarse con el Departamento de servicio
al cliente o enviarnos esta factura en lugar de pagarla.
Revisaremos la factura y decidiremos si los servicios deberan
cubrirse. Si decidimos que deberan estar cubiertos, le pagaremos
directamente al proveedor. (Tenga en cuenta que no podemos pagarle
a un proveedor que ha decidido retirarse del programa de Medicare.
Consulte a su proveedor antes de recibir los servicios para
confirmar que no se retir del programa de Medicare). Si
determinamos que los servicios no son cubiertos o no fueron
mdicamente necesarios, podemos rechazar la cobertura y usted deber
pagar el costo total. Puede recibir atencin mdica de emergencia
cuando lo necesite, en cualquier lugar de los Estados Unidos o sus
territorios. Nuestro plan cubre servicios de ambulancia en
situaciones en las que llegar a una sala de urgencias por otro
medio podra poner en peligro su salud. Para ms detalles, por favor
consulte su Evidencia de cobertura. Puede recibir atencin mdica de
emergencia siempre que la necesite, en cualquier parte del mundo.
Si tiene una emergencia, nos comunicaremos con los mdicos que le
proporcionen la atencin de emergencia para ayudar a manejar su
atencin y darle el seguimiento a la misma. Los mdicos que le
proporcionen la atencin mdica decidirn cundo su estado es estable y
ya no representa una emergencia mdica. Cuando termine la
emergencia, usted tendr derecho a recibir atencin de seguimiento
para asegurarse de que su estado contina estable. Su atencin de
seguimiento estar cubierta por nuestro plan. Si su atencin de
emergencia es proporcionada por proveedores fuera de la red,
intentaremos organizar para que proveedores de la red se hagan
cargo de su atencin inmediatamente cuando su afeccin mdica y las
circunstancias lo permitan. Debe acudir con los proveedores del
plan excepto en situaciones de emergencia o atencin mdica urgente o
para dilisis renal fuera del rea u otros servicios. Si recibe
atencin de rutina de proveedores fuera de la red, ni Medicare ni
Cigna-HealthSpring sern responsables de los costos. Servicios de
atencin de salud del comportamiento Los servicios de atencin de
salud del comportamiento, incluyendo los servicios de salud mental
y de abuso de sustancias, para los beneficiarios en cobertura de
Cigna-HealthSpring se reciben a travs de los Servicios de atencin
de salud del comportamiento de Cigna-HealthSpring. Los miembros y
los proveedores pueden acceder a los Servicios de atencin de salud
del comportamiento de Cigna-HealthSpring llamando al 1-866-780-8546
(TTY 711) para solicitar una referencia o una autorizacin de
internamiento. Los Servicios de atencin de salud del comportamiento
de Cigna-HealthSpring estn disponibles las 24 horas del da, los 7
das de la semana. Cul es el rea de servicio de Cigna-HealthSpring?
A continuacin encontrar los condados que son parte de nuestra rea
de servicio. Condados de Bexar, Collin, Dallas, Denton, El Paso,
Hood, Johnson, Parker, Tarrant y Wise, TX. Cmo encontrar
proveedores de Cigna-HealthSpring en su rea? Para elegir un PCP del
Directorio de proveedores, dirjase a la seccin Mdicos de cabecera
para consultar la lista de mdicos de cabecera dentro de su rea.
Tambin puede llamar al Departamento de servicio al cliente al nmero
que aparece ms abajo, donde con gusto le ayudarn. Una vez que haya
elegido un PCP, deber ingresar el nombre del PCP en el espacio
correspondiente en su Solicitud de inscripcin. Si elige un PCP
despus de haber presentado su Solicitud de inscripcin, llame al
Departamento de servicio al cliente e infrmeles su eleccin de PCP.
Recuerde que si no elige un PCP al momento de la inscripcin,
Cigna-HealthSpring elegir uno por usted segn su lugar de
residencia. Si desea cambiar por otro PCP, puede hacerlo en
cualquier momento llamando al Departamento de servicio al cliente
al nmero que figura aparece ms abajo. El nombre y el nmero de
telfono del consultorio de su PCP estn impresos en su tarjeta de
membresa. Para elegir un especialista, hospital, farmacia u otro
proveedor, dirjase a la seccin correspondiente del Directorio de
proveedores para ver la lista de proveedores de su rea. Por
ejemplo, para encontrar hospitales en su rea, dirjase a la seccin
Hospitales del directorio.
-
Si tiene alguna pregunta sobre Cigna-HealthSpring o necesita
ayuda para seleccionar un PCP, por favor llame al Departamento de
servicio al cliente al 1-800-668-3813, los 7 das de la semana, 8
a.m. - 8 p.m. Los usuarios de TTY deben llamar al 711. O bien,
visite www.cignahealthspring.com. Nuevamente, si desea acudir con
ciertos especialistas o a ciertos hospitales de Cigna-HealthSpring,
es importante que verifique si su PCP lo enviar a ese especialista
u hospital. Por favor recuerde: No todos los planes de
Cigna-HealthSpring cuentan con beneficios dentales y del cuidado de
la vista. Por favor revise su Evidencia de cobertura para ver si su
plan cuenta con los beneficios dentales y/o del cuidado de la
vista.
-
Seccin 2 Lista de proveedores de la red Este directorio est
organizado para ayudarlo a encontrar el tipo de proveedor que
necesita. Los proveedores figuran en las siguientes secciones:
- Asociacin de Mdicos Independientes (IPA) o Mdico de cabecera
(PCP) o Especialistas o Hospitales o Centros de enfermera
especializada o Proveedores de atencin de salud del comportamiento
o Centros de ciruga ambulatoria/Centros de atencin de emergencia o
Proveedores auxiliares o Proveedores de atencin dental o
Proveedores del cuidado de la vista
- Sistemas organizado de prestaciones mdicas (POD) o Mdico de
cabecera (PCP) o Especialista o Hospitales o Centros de enfermera
especializada o Proveedores de atencin de salud del comportamiento
o Centros de ciruga ambulatoria/Centros de atencin de emergencia o
Proveedores auxiliares o Proveedores de atencin dental o
Proveedores del cuidado de la vista
- Proveedores independientes o Mdico de cabecera (PCP) o
Especialistas o Hospitales o Hospitales Psiquitricos o Centros de
enfermera especializada o Proveedores de atencin la salud del
comportamiento o Centros de ciruga ambulatoria/Centros de atencin
de emergencia o Proveedores auxiliares o Proveedores de atencin
dental o Proveedores del cuidado de la vista
Cmo usar este directorio para elegir un Mdico de cabecera? Hay
dos maneras de elegir un Mdico de cabecera:
- Puede elegir un Mdico de cabecera particular por nombre; o -
Puede elegir un Mdico de cabecera por ubicacin.
Si busca un Mdico de cabecera en particular por nombre: 1.
Consulte el ndice alfabtico, que se encuentra en la ltima seccin
del directorio. 2. Encuentre el mdico por apellido y el(los)
nmero(s) de pgina en los que figura.
-
3. Vaya a ese nmero de pgina para obtener informacin acerca del
Mdico de cabecera. Si busca un Mdico de cabecera por ubicacin:
1. Vaya a la seccin Mdico de cabecera. 2. Busque la ciudad y/o
el cdigo postal. 3. Seleccione un proveedor.
Cmo usar este directorio para elegir un especialista? Los mdicos
especialistas y otros mdicos de cabecera de este directorio se
encuentran por especialidad de atencin, seguidos de la ubicacin
geogrfica y el nombre. Cmo usar este directorio para elegir un
proveedor que acepte tanto Medicare como Medicaid? Los proveedores
del plan que aceptan tanto Medicare como Medicaid se encuentran en
todo este Directorio de proveedores y estn marcados con un
asterisco (*). Por ejemplo, este proveedor sera un proveedor de
Medicare y de Medicaid: Dr. John Doe* No obstante, este proveedor
no sera un proveedor de Medicare y de Medicaid: Dr. Jane Doe Cmo
usar este directorio para elegir otros proveedores del plan? Los
proveedores del plan de este directorio, que no sean mdicos de
cabecera y especialistas, figuran por ubicacin geogrfica seguida
por el nombre del proveedor. Clave del smbolo del Directorio de
proveedores En este directorio, algunos proveedores tendrn un
smbolo al final de su nombre. A continuacin estn los smbolos y lo
que significan:
Smbolo Significado * Acepta Medicare y Medicaid Slo acepta
pacientes existentes No acepta pacientes nuevos
Nmero total de proveedores dentro de este directorio: Mdicos de
cabecera (PCP): 724 Especialistas: 4,548Hospitales: 91Centros de
enfermera especializada: 70 Proveedores de atencin de salud del
comportamiento: 341 Centros de ciruga ambulatoria/Centros de
atencin de emergencia: 105 Proveedores auxiliares: 680 Proveedores
de atencin dental: 1 Proveedores del cuidado de la vista: 1
Farmacias: 1,657
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intencionalmente.
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Table of Contents / tabla de contenidos
Provider Directory / Directorio de proveedoresEl Paso Integral
Care
El Paso Integral CarePrimary Care Providers / Mdico de
cabecera..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................1Specialists
/
Especialistas..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................3
WellMed - El PasoWellMed - El Paso
Primary Care Providers / Mdico de
cabecera..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................6Specialists
/
Especialistas..........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................8Hospitals
/
Hospitales...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................23Skilled
Nursing Facilities / Centros de Enfermeria
Especializada....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................24Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros de atencinde
emergencia..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................25Ancillary
Providers / Proveedores
Auxiliarios............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................26
El Paso IndependentEl Paso Independent
Primary Care Providers / Mdico de
cabecera....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................27Specialists
/
Especialistas.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................29Hospitals
/
Hospitales...........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................35Skilled
Nursing Facilities / Centros de Enfermeria
Especializada....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................36Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros de atencinde
emergencia..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................37Behavioral
Health Providers / Proveedores de atencin de la salud
emocional.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................38Ancillary
Providers / Proveedores
Auxiliarios............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................40
North Texas IndependentNorth Texas Independent
Primary Care Providers / Mdico de
cabecera....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................42Specialists
/
Especialistas.....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................55Hospitals
/
Hospitales......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................112Skilled
Nursing Facilities / Centros de Enfermeria
Especializada..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................114Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros deatencin de
emergencia.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................115Behavioral
Health Providers / Proveedores de atencin de la salud
emocional....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................117Ancillary
Providers / Proveedores
Auxiliarios......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................122
WellMed - San AntonioWellMed - San Antonio
Primary Care Providers / Mdico de
cabecera...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................134Specialists
/
Especialistas...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................140Hospitals
/
Hospitales......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................169Skilled
Nursing Facilities / Centros de Enfermeria
Especializada..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................170Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros deatencin de
emergencia.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................171Behavioral
Health Providers / Proveedores de atencin de la salud
emocional....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................172Ancillary
Providers / Proveedores
Auxiliarios......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................173
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Table of Contents / tabla de contenidos
Prospect - San AntonioProspect - San Antonio
Primary Care Providers / Mdico de
cabecera...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................175Specialists
/
Especialistas...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................176Skilled
Nursing Facilities / Centros de Enfermeria
Especializada..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................184Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros deatencin de
emergencia.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................185
San Antonio IndependentSan Antonio Independent
Primary Care Providers / Mdico de
cabecera...............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................186Hospitals
/
Hospitales......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................187Skilled
Nursing Facilities / Centros de Enfermeria
Especializada..............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................188Ambulatory
Surgical Centers / Urgent Care Facilities / Centros de ciruga
ambulatoria/Centros deatencin de
emergencia.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................189Behavioral
Health Providers / Proveedores de atencin de la salud
emocional....................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................190Ancillary
Providers / Proveedores
Auxiliarios......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................193
Dental Providers / Proveedores
odontolgicos.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................196Vision
Providers / Proveedores del cuidado de la
vista.............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................197Cigna-HealthSprings
Network Pharmacies / Farmacias de la red de Cigna-HealthSpring
Retail Pharmacies, including Chain Pharmacies / Farmacias de
venta al menudeo, incluyendo Farmacias de
cadena........................................................................200Mail
Order Pharmacies / Farmacias de orden por
correo......................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................218Home
Infusion Pharmacies / Farmacias de infusin en el
hogar........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................219Long-Term
Care Pharmacies / Farmacias de atencin a largo
plazo...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................221
Last Name Index / ndice de
Apellidos..................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................224IPA/POD
Index / IPA/POD
ndice.................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................