HOW CAN I COMPARE MY OPTIONS? Find out more about the South Campus. If you dont tell us your preferred time, one of our pharmacists will call you between 8 a.m. and 4:30 p.m. within a few weeks to months after you get the letter. Have questions? To request a Drug Coverage Determination, such as a coverage exception or prior authorization, view the CMS Request for Medicare Prescription Drug Determination form. You may also contact Medicare directly by filling outthis formon the Medicare website. Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases. ET on weekdays. Danville, PA 17822-3220. If we decide to take extra days to make the decision, well tell you in writing. Standard (seven-day review) appeals must be submitted in writing. Expedited (Fast) Grievances can be requested or filed by contacting the Geisinger Gold Customer Service Team at 800-498-9731 seven days a week, from 8 a.m. 8 p.m., ET, Oct. 1 - Feb. 14; for all other dates, call from 8 a.m. 8 p.m., ET, Monday through Friday (TTY/TDD 711). Click here to log in. Talk to your GHP provider account manager about your contract, pay-for-quality programs and educational opportunities. Y0032_22269_1_M Accepted 10/1/22. ET After your first 30-day supply, we wont pay for these drugs, even if youve been a member of the plan for fewer than 90 days. $ 38.00. First name Last name Email. 100 North Academy Avenue Call us at 866-415-7138 View our FAQ; Sign in to your account . If you learn that Geisinger Gold doesnt cover your drug, you have two options: You can ask Geisinger Gold to make anexceptionto our coverage rules. Danville, PA 17821. You'll need the following information to make your payment : . Geisinger Wilkes Barre - Podiatry. Appeals information Your membership will usually end on the first day of the month after we receive your request to change your plan. Quality and accreditation staff work directly through personal and automated telephone calls and mailings to reinforce the importance of preventive measures and suggested screenings. If we decide to take extra days to make the coverage decision, well tell you in writing. Opioid prescriptions that are taken together with benzodiazepine prescriptions will be stopped at the pharmacy for review by the provider to make sure the prescriptions are medically necessary and appropriate. All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. EMS bill payment. If we decide that your medical condition doesnt meet the requirements for a fast coverage decision, well send you a letter that says so (and well use the standard deadlines instead). Name, date of birth, address, phone number and insurance card information. Contact GHP Account Management at 800-876-5357. Appeal Department Select a 2022 plan now to make sure you have the coverage you need today. Healthcare providers wishing to refer patients can call MedLink, 800-332-8901 . Written grievances should be submitted to: As a Geisinger Gold member, you have the right to file an Expedited (Fast) Grievance for services you havent yet received, by following the process listed below. ET. Geisinger Gold must end your membership in the plan if any of the following happens: If you have questions or would like more information on when we can end your membership: We cant ask you to leave our plan for any reason related to your health, what should you do if this happens? You may also contact your provider with any medication-related questions. You can compare Geisinger Gold Secure 1 (HMO SNP) For additional questions contact HealthHelp Program Support: Email RCSupport@HealthHelp.com or call 800-546-7092. Geisinger Gold Medicare Advantage members have access to more than 29,000 doctors throughout Pennsylvania, over 100 hospitals and nearly 3,000 pharmacies. Follow the steps below: Start by calling, writing, or faxing us to request coverage for the medical care you want. Are in a hospice or long-term care facility. Mailing. About Geisinger Commonwealth. P.O. Preferred Advantage Rx (PPO), Preferred Complete Rx (PPO), Preferred Enhanced Rx (PPO), Secure Rx (HMO SNP) For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY/TDD: 711), 7 days a week, 8 a.m. 8 p.m. Geisinger Gold Medicare Advantage HMO, PPO, and HMO D-SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company, health plans with a Medicare contract. A TDD/TTY line is available at 711, Monday through Friday, 8 a.m. 4:30 p.m., ET. This form includes information on the different kinds of appeals you can file. Philadelphia, PA 19182. During the consultation, the pharmacist will: After the call, youll get a personalized medication list. A TDD/TTY line is available at 711, Monday through Friday, 8 a.m. 4:30 p.m., ET. Members who havent had a recent prescription for opioids will be limited to no more than a 7-day supply for their first opioid prescription for the treatment of acute pain. Our customer care team members are standing by and are ready to help. If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General. To request an expedited coverage determination or exception, call 800-988-4861, Monday through Friday, 8 a.m. 8 p.m., ET. But remember, this program is at no cost to you and it lets us work with your doctor to be sure youre getting the best care possible. A coverage decision is a decision we make about your benefits and coverage, or about the amount we'll pay for your medical services. Generally, we use the standard deadlines for giving you our decision. If we extended the time needed to make our coverage decision, we will provide the coverage by the end of that extended period. If you request a written response to your phone complaint, we will respond in writing to you. 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. TTY/TDD users should call 1-877-486-2048. . Resources for billing, prior authorization, pharmacy and more. Contact medical management to request precertification/prior authorization for inpatient admissions, outpatient rehabilitation, home health & hospice, SNF, DME, etc. Find information on benefit documents, filing grievances, coverage determinations and more. But if you do, our EMS (which stands for Emergency Medical Services) team knows these streets and sidewalks like the backs of our hands. Box 8200 Danville, PA 17821-8200 All Products Claim Reconsideration Address Geisinger Health Plan P.O. EMHS TPA: 855-863-2429 8. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug thats covered by Geisinger Gold. Our Geisinger Gold Medicare Advisors are standing by and are ready to help you on your Medicare journey. When youre requesting a formulary or utilization restriction exception, you should submit a statement from your physician supporting your request. If youd like more information about the MTM program, call us toll-free at 800-988-4861(TTY: 711). Call us at the number on your member identification card, or at the appropriate number below. You can find a Geisinger Gold plan that offers low out-of-pocket costs, $0 deductibles or other cost-saving perks. You have the right to make a complaint if we end your membership in our plan. By providing your information, you agree to receive ongoing communications about Geisinger Gold. If you have questions or need information, contact Geisinger Health Plan. If we dont give you our answer within 14 days (or if there is an extended time period, by the end of that period), you have the right to appeal. Medical bills can be confusing or difficult to understand. Refer your patient to ADMI. If we do not give you our answer within 72 hours (or if there is an extended time period, by the end of that period), you have the right to appeal. Enter number to jump to a different page. We're here to help. jeopardized by using the seven-day appeal process, an expedited appeal may be For an expedited coverage determination or exception, the turnaround time is 24 hours. 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) PPO with no referral/TPA: 800-504-0443 3. Phone. We will try to resolve any complaint you might have over the phone. No. If our answer is yes to part or all of what you requested,we must authorize or provide the coverage we have agreed to provide within 14 days after we received your request. Standard (7-day review) appeals must be submitted in writing. Print and complete the entire form, and mail it to: Visiting students. Call the GHP pharmacy department for formulary exceptions, drug authorization and prescription drug information. GHP Kids (CHIP): 866-621-5235 6. Our mobile phlebotomists visit nursing homes and homebound patients to collection specimens and transport them to Geisinger Medical Laboratories for testing. Box 8200 Danville, PA 17821-8200 All Products Provider Relations (GHP training and education, orientation sessions, PQS & Pay-for-Quality . An Appointment of Representative form is required to process an appeal from someone other than our member, except when the prescribing physician requests an expedited appeal. Phone: 1-800-695-6491. times. 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 . Referrals should be made to ADMI. 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. 2023 Summaries of Benefits documents: Geisinger Gold Classic (HMO) has formed a network of doctors, specialists, and hospitals. However, You can call this number 24 hours a day, 7 days a week. As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. How do I know if Im eligible? If youd like to withdraw, call 800-988-4861(TTY: 711) between 8 a.m. and 4:30 p.m. Continued enrollment in Geisinger Gold depends on annual contract renewal. Geisinger Gold (Medicare): Phone: 800-498-9731 or 570-271-8771 Oct. 15 - Dec. 7: Daily . You can only use doc- physician by calling 800-498-9731 (TTY: 711) from 8 a.m.to 8 p.m. Monthly . Category. When can you end your membership in our plan? 3. 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. Irene J. Ganahl, a member of Geisinger Commonwealth School of Medicine's MD Class of 2024, received a 2022 Excellence in Public Health Award from the U.S. Public Health Service (USPHS). Instructions for completing and submitting a Drug Coverage Determination Plan ID: H3954-158. Or you may be taking a drug thats on our formulary, but your ability to get it is limited. We must notify you of our decision about your grievance as quickly as your case requires based on your health status, but no later than 30 calendar days after receiving your complaint. Box 829703 Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine.
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