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You will have to choose one of our network providers to be your Primary Care Physician (PCP). Your PCP focuses on all your healthcare needs, integrates care across all specialties and healthcare settings, and focuses on wellness and prevention. With a few exceptions, such as using a direct access services for yearly screening mammograms, you may need to obtain prior approval from your PCP before seeing a specialist. This process is called obtaining a “referral”. Our “network providers” have agreed to provide you with your health care coverage. You may go to any of our network providers; however, some services may require a referral. It’s important that you follow the plan’s rules in obtaining prior approval for services when required. If you have been seeing one network provider, you are not required to continue going to that same provider or if your doctor/ other health care provider leaves the plan, your plan will notify you and you may choose another doctor from within the network.
You are always covered for emergencies. If you have an emergency, call 911 or go to the nearest emergency room. You do not need Easy Choice’s or your PCP’s approval before getting emergency care and you are not required to use network hospitals or doctors when seeking emergency care. If you are out of the area when you have an emergency, go to the nearest emergency room and all emergency care and post-stabilization care at the out-of-network provider will be covered. After your emergency room visit or as soon as is reasonably possible, please call your PCP and Easy Choice. Your PCP can coordinate or provide follow-up care that you may require after your emergency room visit. For urgent care, you must use plan providers when in the service area.
Please keep in mind that you must get your care and services from network providers except in emergency or out of area urgent care situations or out-of-area renal dialysis. If you obtain routine care from out-of-network providers neither Medicare nor Easy Choice will be responsible for the costs.
If you should receive a bill directly from an out-of-network provider, you should not pay the bill. Send the bill to Easy Choice for processing. Easy Choice will determine any copays or coinsurance that you are responsible for, if any. We will pay the bill or send you a notice to let you know why we may have determined the service you received was not covered. The notice will include your appeal rights.
Please send your bill to:
Easy Choice Health Plan of New York
P.O. Box 153164
Tampa, FL 33684
For more information, please refer to your Evidence of Coverage (EOC) or contact our Member Services Department at 1-888-300-9320 TTY/TDD 1-800-662-1220.