Auxiliary events Your coverage will become effective on Jan. 1, 2023. Continued enrollment in Geisinger Gold depends on annual contract renewal. Appeal Department You will be allowed to access an early refill of Part D covered medications upon admission or discharge from LTC facilities. If you dont stay continuously enrolled in Medicare Part A and Part B. Philadelphia, PA 19182. If you are calling from an out-of-Pennsylvania area code, please call800-210-5316(TTY: 711). 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). If you intentionally give us incorrect information when youre enrolling in our plan, and that information affects your eligibility for our plan. Were ready to answer your questions on weekdays from 8 a.m. to 4:30 p.m. If you request a written response to your phone complaint, we will respond in writing to you. You can ask us to waive coverage restrictions or limits on your drug. physician by calling 800-498-9731 (TTY: 711) from 8 a.m.to 8 p.m. If your health requires a quick response, request a fast coverage decision.A fast coverage decision means well answer within 72 hours. This can be a extremely nice safety net. If you or your physician request an expedited 72-hour redetermination and Geisinger Gold decides that your request more closely meets the criteria for a standard seven-day redetermination, you may disagree and file an Expedited (Fast) Grievance. Expedited (Fast) Grievances can be requested or filed by contacting the Geisinger Gold Customer Service Team at 800-498-9731 (TDD: 711), from 8 a.m.- 8 p.m., ET, Monday - Friday (February 15 - September 30) orseven days a week (October 1 - February 14). Have three of these five conditions: diabetes, high blood pressure, COPD, high cholesterol, osteoporosis, Are taking eight or more chronic/maintenance medications covered by Medicare Part D, Have a total medication cost of at least $4,696 annually for 2022 ($4,935 for 2023), Youve been enrolled in our Drug Management Program based on your opioid use. If you move out of our service area for more than 6 months. Continued enrollment in Geisinger Gold depends on annual contract renewal. Phone. A medical director will review your Expedited (Fast) Grievance and you will receive a verbal notification of the decision within 24 hours of receipt of your request for an Expedited (Fast) Grievance. If you want to appeal a denial of a Drug Coverage Determination made by Geisinger Gold, view the CMS Redetermination form. 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? GHP Family: 855-227-1302 5. Benefits include medical expenses, but not prescriptions. Geisinger Wilkes Barre - Podiatry. MC 40-36. Step 3 below explains how to make an appeal. Helpful Medicare advice from our experts, plus tips to stay healthy and feel your best at any age. If we say no, you have the right to ask us to reconsider this decision by making an appeal. Please call Geisinger Gold Secure 1 (HMO SNP) at the number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. There is one instance when you may file an Expedited (Fast) Grievance related to requests for a redetermination (appeal) of a coverage determination. Its done right over the phone at a time thats convenient for you. Appointments - Autism & Developmental Medicine Institute | Geisinger NaviNet for provider information and resources: navinet.navimedix.com; Instamed for electronic claim submission and payment transactions: 866-467-8263 or instamed.com; Claims. E-Mail: Client Services. For additional questions contact HealthHelp Program Support: Email RCSupport@HealthHelp.com or call 800-546-7092. If we cant resolve your complaint over the phone, we have a formal procedure to review your complaints, called the grievance procedure. If our answer is yes to part or all of what you requested,we must authorize or provide the medical care coverage we have agreed to provide within 72 hours after we received your request. You, your doctor or your representative can do this. We will try to resolve your grievance over the phone. Write Or you may be taking a drug thats on our formulary, but your ability to get it is limited. PDF Geisinger Gold Classic 300 (HMO) Summary of Benefits Danville, PA 17822-3220. Quality indicators, such as HEDIS and other initiatives, are set forth by the National Committee for Quality Assurance (NCQA) to ensure that Gold members receive high quality care. Get the latest updates about Geisinger Health Plan. CCHS TPA: 844-568-5229 7. Deadlines for standard coverage decisions Continued enrollment in Geisinger Gold depends on annual contract renewal. Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. Get tips and advice for living a healthy, happy life. The following information should be faxed to 570-522-9431: Reason for referral. There are several types of exceptions that you can ask us to make: Generally, Geisinger Gold will only approve a request for an exception if the alternative drug is included on the Plan's formulary or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. Sign up for a local meeting today to learn more about plan options. Healthcare providers wishing to refer patients can call MedLink, 800-332-8901 . If youre a resident of a long-term care facility, well allow you to refill your prescription until weve provided you with a 31-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). If you would like to appeal a denial for coverage or payment of services, you may appeal this denial by contacting Geisinger Gold at the following address: Write 100 N. Academy Avenue Get news and updates. You can call our free automated premium payment service at 844-639-3117(TTY: 711). Heritage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO) 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. $ 38.00. Geisinger Health Plan Kids (Children's Health Insurance Program) and . podiatry - Geisinger You need a referral from a pediatrician or primary care provider to make an appointment at ADMI. You'll need your contract ID or member ID, which can be found on your premium invoice or on you ID card. 25 Church St. Wilkes-Barre, PA 18765. How much time will this take? Geisinger Gold 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. To request an expedited coverage determination or exception, call 800-988-4861, Monday through Friday, 8 a.m. 8 p.m., ET. ET. You may also contact your provider with any medication-related questions. When youre requesting a formulary or utilization restriction exception, you should submit a statement from your physician supporting your request. Contact case management for assistance with care coordination. Contact us. We cannot make you leave our plan for this reason unless we get permission from Medicare first. Print and complete the entire form, and mail it to: Geisinger Gold Classic (HMO) has formed a network of doctors, specialists, and hospitals. St. Luke's TP See more . For example, the Healthcare Effectiveness Data and Information Set (HEDIS)* provides a set of measures against which we can judge our effectiveness. If you need a drug thats not on our formulary, or if your ability to get your drugs is limited, but you are past the first 90 days of membership in our plan, well cover a 31-day emergency supply of that drug (unless you have a prescription for fewer days) while you pursue a formulary exception. 1155 East Mountain Boulevard, Wilkes Barre, PA 18702 (Map) 800-275-6401. Used Geisinger instead of a vision care center. Find information on benefit documents, filing grievances, coverage determinations and more. Contact medical management to request precertification/prior authorization for inpatient admissions, outpatient rehabilitation, home health & hospice, SNF, DME, etc. Geisinger hr Contacts Business Emails, Phone Numbers | Adapt.io If you continuously behave in a way that is disruptive and makes it difficult for us to provide medical care for you and other members of our plan. Youll be notified by mail about your eligibility. Geisinger Gold Classic Complete Rx (HMO) - HelpAdvisor Danville, PA 17822-3220, In person To speak with a PACE/PACENET representative, call toll-free: You can also contact Geisinger Gold for help at: Geisinger Gold may add or remove drugs from our formulary during the year. You can ask customer service for a list of similar drugs that are covered by Geisinger Gold. You may also contact Medicare directly by filling outthis formon the Medicare website. Secure Rx (HMO SNP). Paid $50 deductible. Mailing. Geisinger Gold Visiting students can contact Stacey Fenstermacher, clerkship coordinator, at sefenstermacher@geisinger.edu or 570-271-6697 or Megan Longenberger, medical education coordinator, at mrlongenberger@geisinger.edu or 570-271-8121 for information. Have questions? You may call 24 hours a day, seven days a week. 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. Until your membership ends, you must keep getting your medical services through our plan. PDF Geisinger Gold Preferred (PPO) Summary of Benefits If you prefer, you can fax it to: 571-271-7225. If we extended the time needed to make our coverage decision, we will provide the coverage by the end of that extended period. Opioid prescriptions are monitored for safe dosage levels. Learn more about Geisinger Gold at an event near you. 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). You have the right to make a complaint if we end your membership in our plan. Select this result to view Dana Michele Geisinger's phone number, address, and more. PDF Geisinger Gold Classic (HMO) Summary of Benefits GHP Kids (CHIP): 866-621-5235 6. What is Medication Therapy Management? 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). For a standard coverage decision, well answer within 14 days after receiving your request. Instructions for completing and submitting a Drug Coverage Determination About Geisinger Commonwealth. Select a 2022 plan now to make sure you have the coverage you need today. A coverage decision is a decision we make about your benefits and coverage, or about the amount we'll pay for your medical services. You can call this number 24 hours a day, 7 days a week. Additionally, a written response will be provided to you within 72 hours of the medical director's decision. 2. If you would like to appoint a representative to file an appeal on your behalf, view the CMSAppointment of Representative form. When they call, you can complete the medication review then or schedule a future appointment if youd like to participate. You can compare Geisinger Gold Classic (HMO) and For school-aged children (6 years of . Shopping for a plan? times. If we decide to take extra days to make the decision, well tell you in writing. To submit a request by phone, or for process or status questions, call 800-988-4861 (FREE), Monday through Friday, 8 a.m. 8 p.m., ET. Dana is related to Donald A Juenemann and Janice K Juenemann as well as 3 additional people. One way of combating this public health emergency is via drug management programs that prevent opioid overuse: For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY: 711), 7 days a week, 8 a.m. 8 p.m. During this time, you must continue to get your medical care through our plan. Generally, for a fast coverage decision, well give you our answer within 72 hours. Danville, PA 17822. 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. If you have questions, contact your Geisinger Health Plan provider relations representative at 800-876-5357. If you request a written response to your phone grievance, we will respond in writing to you. Calling the number for your specific plan will help us serve you quicker! requested verbally by the member, member representative or prescribing Geisinger Gold conducts an aggressive preventive health program, geared toward members most at risk for a variety of preventable illnesses, ailments and diseases. If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. Resources for billing, prior authorization, pharmacy and more. For a free quote or to request a Geisinger Gold Medicare Kit you may call (888) 620-8988 or click the button below. Expedited (Fast) Grievances can be initiated or requested when you disagree with the time frames Geisinger Gold establishes for making coverage determinations (coverage decisions) for services you havent yet received. 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. However, If your doctor asks for the fast coverage decision, well automatically give a fast coverage decision. If you would like to make a payment with the help of a representative, or if you have questions about your premium invoice, call 844-343-2639(TTY: 711). Geisinger Health Plan Kids (Children's Health Insurance Program) and Geisinger Health Plan Family (Medical Assistance) are offered by . 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) If we end your membership in our plan, we must tell you in writing our reasons for ending your membership. Continued enrollment in Geisinger Gold depends on annual contract renewal. ET, Monday through Friday. Geisinger Gold Classic Complete Rx (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Geisinger Health System. Just turned 65 and new to Medicare? When can you end your membership in our plan? Am I required to participate? If our answer is no to part or all of what you requested,well send you a detailed written explanation as to why we said no. Well cover more than one refill of these drugs for the first 90 days you are a member of our plan. HMO/PPO with referral: 800-447-4000 2. Changes to the Geisinger Gold standard Rx formulary(effective September 1, 2022), Changes to the Geisinger Gold $0 deductible formulary(effective September 1, 2022). For additional questions contact HealthHelp Program Support: Email RCSupport@HealthHelp.com or call 800-546-7092. Click here to log in. HOW CAN I COMPARE MY OPTIONS? Dana Geisinger - Address & Phone Number | Whitepages PDF Who to Call - Geisinger 100 North Academy Avenue Generally, we must make our decision within 72 hours of your request. Make a donation. As a member of Geisinger Gold Medicare Advantage, you have access to benefits and extras that make managing your health easier. TTY/TDD users should call 1-877-486-2048. Search. If you are an enrollee being admitted to or discharged from a long-term care (LTC) facility, the use of early refill edits will not be used. No. Fax: 570-271-5660. Home; Geisinger health provider phone number Geisinger health insurance phone . Plan ID: H3954-158. Geisinger Health Provider Phone Number 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. Call us at 866-415-7138 View our FAQ; Sign in to your account . Geisinger Health Plan & Tomorrow Health Geisinger Health Plan Shop 2023 plans and enroll today for coverage starting Jan. 1, 2023. By signing up for BillPay , you can: . You'll need the following information to make your payment : . If you become incarcerated (go to prison). 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. HOW CAN I COMPARE MY OPTIONS? EMS bill payment. Geisinger Commonwealth School of Medicine | Geisinger Provider claims: 800-447-4000 Provider account management For example, for certain drugs, Geisinger Gold limits the amount of the drug that we will cover. If you ask for a fast coverage decision on your own, without your doctors support, we will decide whether your health requires that we give you a fast coverage decision. Continued enrollment in Geisinger Gold depends on annual contract renewal. If you prefer to mail in your payment, please send your payment to the address below: Geisinger Health Plan Call us and place your order through an expert Care Advocate. 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. Geisinger Gold 100 North Academy Avenue Emergency Ambulance Services - Geisinger EMS | Geisinger You'll have opportunities to better your life and make a difference - at home and across the . Contact Us | Providers | Geisinger Health Plan Walmart, PA Trust, PEBTF, Office of Personnel (FEHB). A TDD/TTY line is available at 711, Monday through Friday, 8 a.m. 4:30 p.m., ET. We hope you never need us. Our more than 30-year alliance with the National Cancer Institute (NCI) and its community research programs allows us to offer the most advanced care and treatment options to patients close to home. We must notify you in writing that you have 2 months to pay the plan premium before we end your membership. Geisinger Gold may add or remove drugs from our formulary during the year. Call 800-640 . If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. Please do not make the same mistake I did in going to a Geisinger doctor. https://www . Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. $ 45.00. Geisinger Health Plan - pahealthbenefits At GHP, we'll work with you to make sure you're satisfied with your health coverage. I later got billed for the total amount of the exam, $331. If youre hospitalized on the day that your membership ends, your hospital stay will usually be covered by our plan until youre discharged(even if youre discharged after your new health coverage begins). 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. 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. Call us at the number on your member identification card, or at the appropriate number below. 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. Note: if your ID number begins with zeroes or ends with 01, exclude them when entering your ID number. That's because we provide emergency and non-emergency care to more than 5 counties, 39 municipalities and thousands of people across Pennsylvania 24/7/365. Box 8200 Danville, PA 17821-8200 All Products Provider Relations (GHP training and education, orientation sessions, PQS & Pay-for-Quality . TTY/TDD users should call 1-877-486-2048. . This form includes information on the different kinds of appeals you can file. Contact us - Geisinger Health System Grievances Write: Generally, for a standard coverage decision, well give you our answer within 14 days of receiving your request. Just an eye exam, no glasses. 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