2017 Provider and Pharmacy Directory
This section explains key terms you’ll see in our Provider and Pharmacy Directory.
- Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long-term services and supports, supplies, prescription drugs, equipment and other services.
- The term providers also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term services and supports.
- Providers that are a part of our plan’s network are called network providers.
- Network providers are the providers that have contracted with us to provide services to participants in our plan. The providers in our network may only bill us for care they give you. When you see a network provider, you usually pay nothing for covered services.
- If you are eligible to receive services from Indian health providers, you may see these providers even if they are out of our plan’s network.
- A Primary Care Provider (PCP) is a healthcare professional who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. If you request it and he/she is willing, your PCP may participate on your Interdisciplinary Team and help in planning your care and ensuring that you get necessary services.
- Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
- Oncologists care for patients with cancer.
- Cardiologists care for patients with heart conditions.
- Orthopedists care for patients with certain bone, joint, or muscle conditions.
- You also have access to a Care Manager and Interdisciplinary Team (IDT) that you help choose.
- A Care Manager works closely with you and your Interdisciplinary Team to develop a Person-Centered Service Plan that helps you manage your medical, behavioral health, long-term services and supports, and social and functional needs.
- Your Interdisciplinary Team (IDT) helps to coordinate your care. This means that they make sure your providers know about care you get, medicines you take, tests and labs are done once and the results are shared with the appropriate providers. You and your IDT will develop your Person-Centered Service Plan, which will list all of your needs and services, set goals to address those needs, and determine ways to monitor those needs. Your IDT will be in contact with you as often as needed. Your IDT includes:
- You and your designee(s)
- Your Care Manager
You may also choose to have any of the following people participate in any or all of your IDT meetings:
- Your Primary Care Provider (PCP), including a physician, nurse practitioner, physician assistant, or specialist who has agreed to serve as your PCP, or a designee from your PCP’s practice who has clinical experience (such as a registered nurse, nurse practitioner, or physician assistant) and knowledge of your needs;
- Your Behavioral Health (BH) Professional, if you have one, or a designee from your BH Professional’s office (or practice) who has clinical experience and who has knowledge of your needs;
- Your home care aide(s), or a designee with clinical experience from the home care agency who has knowledge of your needs, if you are receiving home care;
- A clinical representative from your nursing facility, if receiving nursing facility care;
- Additional individuals, including:
- Other providers either as requested by you or your designee, or as recommended by the IDT members as necessary for care planning and approved by you or your designee; or
- The registered nurse (RN) who completed your assessment.
You can get services from any provider who is in our network and accepting new participants.
First, you will need to choose a Primary Care Provider.
Choose a PCP:
- That you use now, or
- Who has been recommended by someone you trust, or
- Whose offices are easy for you to get to.
- If you want help in choosing a PCP, please call Participant Services at 1-855-462-3167 between 8:00 A.M. and 8:00 P.M., 7 days a week. The call is free. TTY/TDD users should dial 711. Or, visit www.elderplanfida.org.
- If you have questions about whether any service or care that you want or need is covered, talk to your Care Manager and Interdisciplinary Team or call Participant Services and ask before you get the service or care.
As an Elderplan FIDA Total Care Participant, you may be able to get long-term services and supports (LTSS), such as Adult Day Care Services, Home Health Care Services, etc. Long-term services and supports are help for people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing facility or hospital. A full list of covered LTSS is available in Chapter 4 of your Participant Handbook.
Care Manager and members of the Interdisciplinary Team will work together to identify your unique needs and help you access the appropriate long-term services and supports in order to address your needs and facilitate your optimal level of functioning.
You must get all of your covered services from providers within our network. If you go to providers who are not in Elderplan’s FIDA Total Care network (without prior authorization or approval from us), you will have to pay the bill.
The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if Elderplan FIDA Total Care gives you permission first.
- You may change providers within the network at any time. If you have been going to one network provider, you do not have to keep going to that same provider. If you decide to change your PCP, please call the Participant Services at 1-855-462-3167 between 8:00 A.M. and 8:00 P.M., 7 days a week to request the change. TTY users should call 711. The call is free.
- Elderplan FIDA Total Care works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this Directory includes information about the accommodations they provide. If you need to see a provider and are not sure if they offer the accommodations you need, Elderplan FIDA Total Care can help you. Talk to your Interdisciplinary Team and Care Manager for assistance.
List of network providers
This Directory of Elderplan’s FIDA Total Care network providers contains:
- Health care professionals and support providers including primary care providers, specialists, behavioral health providers, adult day services, social day care, consumer-directed personal assistance services, home-delivered and congregate meals, home health agencies, environmental modifications, home maintenance services, non-emergency transportation, independent living skills and training, moving assistance, personal care services, personal emergency response services, private duty nursing, respite services, home and community support services, and;
- Facilities including hospitals, nursing facilities, and mental health facilities
You may receive services from any of the providers on this list.
The Elderplan FIDA Total Care provider directory contains:
- 70 Hospitals
- 17,738 Specialists
- 4,776 Behavioral Health Providers
- 502 Ancillary Providers
- 594 Long-Term Services and Supports
- 4,540 Primary Care Providers
- 1,819 Dentists
- 195 Skilled Nursing Facilities
- 4,947 Pharmacies
If a provider has this symbol – ADA+ – next to its name, it means that the provider meets the FIDA Program accessibility standards. This means that the provider meets all of the following 25 requirements, except for any that would not apply to that type of provider.
These are the requirements providers have met if they have an “ADA+” symbol next to their names:
- The office has at least one wheelchair-accessible path from an entrance to an exam room.
- Exam tables and all equipment are accessible to people with disabilities.
- Where parking is provided, spaces are reserved for people with disabilities. There are also pedestrian ramps at sidewalks and drop-off zones.
- Where parking is provided, there are an adequate number of accessible parking spaces (8 feet wide for a car and 5-foot access aisle).
- For a provider with a disability-accessible parking space, there is a stable, firm, and slip-resistant path from the disability-accessible parking space to the facility entrance. The path does not require the use of stairs. Except for curb cuts, the path is at least 36 inches wide.
- There is a method for people using wheelchairs or that require other mobility assistance to enter as freely as everyone else. That route of travel is safe and accessible for everyone, including people with disabilities.
- The main exterior entrance door used by people with mobility disabilities to access public spaces meets accessibility standards. This includes a clear opening, low doorstep, and accessible door handle.
- There are ramps for wheelchair access. The slopes of the ramp are accessible for wheelchair access, the railings are sturdy and high enough for wheelchair access, the width between railings is wide enough to accommodate a wheelchair, and the ramps are nonslip and free from any obstruction (cracks).
- Where there are stairs at the main entrance, there is also a ramp or lift, or is there an alternative accessible entrance.
- Any inaccessible entrances have signs indicating the location of the nearest accessible entrance.
- The accessible entrance can be used independently and without assistance.
- Doormats are half inch high or less with beveled or secured edges.
- Waiting rooms and exam rooms are accessible to people with disabilities.
- The interior layout of the building allows people with disabilities to get materials and services without assistance.
- The interior doors comply with the criteria listed above for the exterior door.
- The accessible routes to all public spaces in the facility are 31 inches wide.
- In public areas where services are provided, there is a 5-foot circle or a T-shaped space for a person using a wheelchair to reverse direction.
- All buttons or other controls in the hallway are no higher than 42 inches.
- All elevators in the facility have raised and braille lettering on signs next to the door and on the controls inside the cab. The elevators also have call buttons in the hallway that are not higher than 42 inches.
- Sign language interpreters and other auxiliary aids and services are provided when needed.
- The public lavatory is wheelchair-accessible.
- The public restroom’s exterior door and interior stall doors comply with the standards listed above for exterior doors.
- There is at least one wheelchair accessible stall in the public restroom that has an area of at least 5 feet by 5 feet, clear of the door swing. Or, there is at least one stall that provides greater access than a typical stall (either 36 by 69 inches, or 48 by 69 inches).
- In the accessible stall of the public restroom there are grab bars behind and on the side wall nearest the toilet.
- There is one lavatory in the public restroom that meets accessibility standards, such as an accessible toilet, faucets, and soap dispensers.
This part of the Directory provides a list of pharmacies in Elderplan FIDA Total Care’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a participant of the plan.
- Elderplan FIDA Total Care Participants must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations.
If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out-of-pocket for the service. Read the Elderplan FIDA Total Care Participant Handbook for more information.
- Some network pharmacies may not be listed in this Directory.
- Some network pharmacies may have been added or removed from our plan after this Directory was printed.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the Participant Handbook and Elderplan FIDA Total Care’s List of Covered Drugs. Visit www.elderplanfida.org for a list of drugs covered in our formulary.
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-Order Pharmacies
- Home infusion pharmacies
- Long-term care (LTC) pharmacies
- You are not required to continue going to the same pharmacy to fill your prescriptions.
You can go to any of the pharmacies in our network.
- Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. Just as there is no copay for a one-month supply, there is no co-pay for a 90-day supply.
- 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. Just as there is no copay for a one-month supply, there is no copay for a 90-day supply.
If a pharmacy has this symbol – ADA+ – next to its name, it means that the pharmacy meets the FIDA Program accessibility standards. This means that the pharmacy meets all 25 requirements that are listed on page <page number>, except for any requirements that would not apply to pharmacies. For example, a pharmacy would not have an exam room, so the requirements about an exam room do not apply to a pharmacy.
You can get prescription drugs shipped to your home through our network mail order delivery program which is called CVS/Caremark Home Delivery Service. Typically, you should expect to receive your prescription drugs within 10 business days from the time that the mail order pharmacy receives your order. If you do not get your prescription drug(s) within this time, please contact CVS/Caremark at 1-866-443-0935, 24 hours a day, 7 days a week. TTY users should dial 711.
Home Infusion Pharmacies specialize in provision of infusion therapies to patients in their homes or other alternate sites. To get more information on Home Infusion Pharmacies please call our Participant Service Department at 1-855-462-3167, between 8:00 A.M. and 8:00 P.M., 7 days a week. TTY users should dial 711.
Residents of a long-term care facility, such as a nursing facility, may access their prescription drugs covered under Elderplan FIDA Total Care through the facility’s pharmacy or another network pharmacy.
- Elderplan, Inc. is a managed care plan that contracts with both Medicare and the New York State Department of Health (Medicaid) to provide benefits of both programs to participants through the Fully Integrated Duals Advantage (FIDA) Demonstration.
- The List of Covered Drugs and/or pharmacy and provider networks may change throughout the year. We will send you a notice before we make a change that affects you.
- Benefits may change on January 1 of each year.
- This Directory lists health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics), and support providers (such as Adult Day Health and Home Health providers) that you may see as an Elderplan FIDA Total Care Participant. We also list the pharmacies that you may use to get your prescription drugs.
- This Directory includes providers of both Medicare and Medicaid services.
- We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This is a list of Elderplan’s FIDA Total Care network providers for Bronx, Queens, Kings, New York, Richmond, and Nassau County.
- You can get this information for free in other languages. Call 1-855-462-3167 and TTY/TDD users should dial 711, between 8:00 A.M. and 8:00 P.M., 7 days a week. The call is free.
- Puede obtener esta información de manera gratuita en otros idiomas. Llame al 1-855-462-3167 y TTY/TDD 711 de lunes a domingos de 8:00 am a 8:00 pm. La llamada es gratuita.
- Ou ka jwenn enfòmasyon sa a gratis nan lòt lang. Rele nan 1-855-462-3167 ak nan TTY/TDD (pou moun ki gen pwoblèm tande oswa moun ki bèbè) 711 de lendi a dimanch 8:00 am -8:00 pm. Apèl la gratis. 이정보는다른언어로도제공됩니다(무료). 월요일-일요일8:00 am – 8:00 pm 중 1-855-462-3167 나 TTY/TDD 711 로전화주십시오. 통화료는무료입니다.
- 您可免費取得以其他語言撰寫的資訊。請於週一至週日上午8 時至下午8時致 電 1-855-462-3167，TTY/TDD 使用者：711。此為免付費電話。
- Данная информация доступна бесплатно на других языках. Звоните по номеру 1-855-462-3167 или 711 (линия TTY/TDD) с понедельника по воскресенье с 8:00 до 20:00. Звонок бесплатный.
- È possibile riceverequeste informazioni in altre lingue gratuitamente. Contatta il
1-855-462-3167 eTTY/TDD 711 dal lunedì alla domenica dalle ore 8:00 alle ore 20:00. Il servizio è gratuito.
- Your preferred language and/or format request is captured at the time of enrollment and we will keep your language/preference on file for future requests. Please note that this process is voluntary, and you have the option to change your preference at any time by calling Participant Services at 1-855-462-3167 TTY 711 between 8:00 A.M. and 8:00 P.M., 7 days a week. You may also email your request to email@example.com.
- The State of New York has created a participant ombudsman program called the Independent Consumer Advocacy Network (ICAN) to provide participants free, confidential assistance on any services offered by Elderplan FIDA Total Care. ICAN may be reached toll-free at 1-844-614-8800 or online at icannys.org. (TTY users call 711, then follow the prompts to dial 844-614-8800.)