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Central Health Medicare Plan’s participating provider network includes over 6,000 contracted physicians and other providers of care and is subject to ongoing changes.
When enrolling in Central Health Medicare Plan, you must choose a Primary Care Physician (PCP) from our Provider Directory. Your PCP will provide or coordinate all of your medical care.
In addition, your PCP has referral relationships with Central Health Medicare Plan contracted providers including physician specialists, skilled nursing facilities, durable medical equipment providers and other selected providers.
Central Health Medicare Plan will attempt to ensure the continuing availability of the contracted providers listed in this directory. However, a medical provider, physician, or hospital will occasionally become unavailable due to the lack of capacity or termination of a contract. Central Health Medicare Plan cannot guarantee that a specific medical provider, physician, or hospital will be available to you during the term of your membership.
In most situations, you must obtain services from network providers. You may obtain services from out-of-network providers under very limited circumstances (described below) if the services are covered benefits and are medically necessary and the out-of-network provider participates in Medicare.
Here are examples of services you may obtain from out-of-network providers:
Emergency care or urgently needed care
When providers of specialized services are not available in our network
Kidney dialysis services that you get at a Medicare-certified dialysis facility
If you use an out-of-network provider for emergency care, urgently needed care, or out-of-area dialysis, you will pay the same as you would pay if you got the care from a network provider.
When providers of specialized services are not available in our network, you are responsible for contacting the plan to obtain authorization prior to seeking care outside of our network. In this situation, you will pay the same as you would pay if you got the care from a network provider.
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