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Easy Choice of New York uses a network of pharmacies that is equal to or exceeds CMS requirements for pharmacy access in your area. In the State of New York, Easy Choice has 4,697 pharmacies in their network. These pharmacies are contracted through our Pharmacy Benefit Administrator, Spectral Solutions.
To search for a pharmacy, click on the "Pharmacy Network Listing" link below. Select your "County" and "Provider Type" then click on the “Search Now” button.
A formulary is a list of drugs covered by your plan to meet patient needs.
If your drug is not included in this formulary, you should first contact Member Services and confirm that your drug is not covered. If you learn that Easy Choice does not cover your drug, you have two options:
1. You can ask Member Services for a list of similar drugs that are covered by Easy Choice. When you receive the list, show it to your doctor and ask him or her to prescribe a similar drug that is covered by Easy Choice.
To search for a drug, click on the link below. Once the page is opened, select your county and plan then type in your drug name or drug category in the “Search” box. You can even download the Formulary in a PDF version.
For information on obtaining an updated coverage determination or an exception to a coverage determination please call Member Services at 1-888-300-9320. Hours of operation from October 1, 2012 to February 14, 2013, are 7 days a week from 8:00 AM to 8:00 PM. From February 15, 2013 to October 14, 2013, hours of operation are Monday through Friday from 8:00 AM to 8:00 PM. TTY/TDD users should call 1-800-662-1220.
Formulary list may change during the year. Updates, if any, will be posted monthly.
What can you do if your drug is not on the Drug List?
For information about the (BAE) policy please contact member services.
Learn what can you do if you believe you are eligible for Low Income Subsidy but do not have a required piece of evidence. (By clicking this link you will be leaving the EC website.)
Members and providers who have questions about the Grievance and Appeals processes, need the status of a coverage determination or want to receive an aggregate number of grievance, appeals, and exceptions filed with the plan sponsor please contact Member Services.
The Appointment of Representative Form (PDF, 66 KB) is located on the CMS Web site.
Beneficiaries and providers may appoint another individual, including an attorney, as their representative in dealings with Medicare, including appeals you file. Form CMS-1696, Appointment of Representative form, must be submitted with the appeal and is valid for one year from the date. The form must be signed by both you and the appointed representative. A representative may be designated at any point in the appeals process. This representative may assist you during the processing of a claim or claims and/or any subsequent appeal. Refer to the CMS Medicare Claims Processing Manual (PDF, 605 KB) (Pub. 100-04, chapter 29, section 270.1.10) for information on disclosing information to third parties.
The following types of individuals may be appointed to act as representative for a party to an appeal. This list is not exhaustive and is meant for illustrative purposes only:
The party making the appointment and the individual accepting the appointment must either complete an appointment of representative form (CMS-1696) or use a conforming written instrument. Refer to the CMS Medicare Claims Processing Manual (Pub. 100-04, chapter 29, section 270.1) for required elements of written instruments. You may appoint a representative at any time during the course of an appeal. The representative must sign the CMS-1696 or other conforming written instrument within 30 calendar days of the date the beneficiary or you sign an order for the appointment to be valid. By signing the appointment, the representative indicates his/her acceptance of being appointed as representative.
The CMS-1696 is available for the convenience of the beneficiary or you to use when appointing a representative. Instructions for completing the form:
If any one of the elements listed above is missing from the appointment, the adjudicator shall contact the party (individual attempting to act as a beneficiary’s representative) and provide a description of the missing documentation or information. Unless the missing information is provided, the prospective appointed representative lacks the authority to act on behalf of the party and is not entitled to obtain or receive any information related to the appeal, including the appeal decision. The adjudicator will not dismiss the appeal request because the appointment of representative is not valid.
Mail or fax this statement to the Plan at:
Grievance and Appeals Department
PO Box 153098
Tampa, FL 33684 Fax: 1-813-506-6235 or 888-548-0097
You can also call the Member Services Department to learn more about how to name your appointed representative.
To learn more about how to ask for an Exception, a Coverage Determination, Appeal or to make a complaint, click on a link below:
Potential for Contract Termination:
Easy Choice Health Plan of New York (Atlantis Health Plan) has a contract with the Centers for Medicare and Medicaid Services (CMS), the government agency that runs Medicare. This contract renews each year. Easy Choice of New York is required to notify beneficiaries that it is authorized by law to refuse to renew its contract with the Centers for Medicare & Medicaid Services (CMS), that CMS also may refuse to renew the contract, and that termination or non-renewal may result in termination of your enrollment. In addition, the plan may reduce its service area and no longer offer services in the area where you reside. In the event this happens, you will receive advance notice.
Rights and Responsibilities upon Disenrollment
"Disenrollment" from an Easy Choice Health Plan of New York plan means ending your membership with us. Disenrollment can be voluntary (your choice) or, in limited circumstances, involuntary (not your choice).
You might leave one of our plans because you decide that you want to leave. During specified times (October 15 – December 7), you can choose to disenroll from your current Medicare plan.
Some situations require you to leave. For example, if you move out of our geographic service area, are absent from our service area for more than six consecutive months or if we no longer offer the plan in your geographic area.
Usually, to end your membership in our plan, you simply enroll in another health plan during one of the election periods. One exception is when you want to switch from our plan to Original Medicare without a Medicare prescription drug plan. In this situation, you must contact Member Services and ask to be disenrolled from our plan.
If you have questions about ending your membership with us, call 1-888-300-9320 (TTY/TDD 1-800-662-1220), Our hours of operation are October 1, 2012 to February 14, 2013 from 8 a.m. to 8 p.m. 7 days a week, February 15, 2013 to September 30, 2013 from 8 a.m. to 8 p.m. Monday through Friday.
Information on aggregate number of grievances, appeals and exceptions
Members can obtain an aggregate number of grievances, appeals and exceptions filed with the plan by calling our customer service department at 1-888-300-9320.