PROVIDER AND PHARMACY DIRECTORY - …

1 January 1st - December 31stprovider andpharmacydirectoryINT_19_66610_C ApprovedThis PROVIDER & PHARMACY DIRECTORY was updated on March 2019. For more information, please contact Leon Medical Centers Health Plans Member services , at or toll-free or, for TTY users 711. Hours are 8:00 am - 8:00 pm, seven days a week, October 1st March 31st and 8:00 am - 8:00 pm, Monday Friday from April 1st September 30th. Messaging service used weekends, after hours, and on federal holidays. You can also visit Changes to our PHARMACY network may occur during the benefit year. An updated PROVIDER & PHARMACY DIRECTORY is located on our website at You may also call Member services for updated caresmedicareLeon Medical Centers Health Plans Leon Cares HMO Plan PROVIDER DIRECTORY This DIRECTORY is current as of March 2019 This DIRECTORY provides a list of Leon Medical Centers Health Plans Leon Cares network providers.

2 This DIRECTORY is for Miami-Dade County, Florida including, but may not be limited to the cities of Miami, Miami Beach, Miami Lakes, North Miami, Hialeah, Hialeah Gardens, Opa Locka, Doral, Coral Gables and Kendall. 33010, 33012, 33013, 33014, 33015, 33016, 33018, 33054, 33055, 33056, 33125, 33126, 33127, 33128, 33129, 33130, 33131, 33132, 33133, 33134, 33135, 33136, 33137, 33138, 33139, 33140, 33141, 33142, 33143, 33144, 33145, 33146, 33147, 33150, 33155, 33156, 33157, 33158, 33161, 33165, 33166, 33167, 33168, 33169, 33170, 33172, 33173, 33174, 33175, 33176, 33177, 33178, 33182, 33183, 33184, 33185, 33186, 33187, 33189, 33190, 33192, 33193, 33194, 33196.

3 To access Leon Medical Centers Health Plans Leon Cares online PROVIDER DIRECTORY , you can visit For any questions about the information contained in this DIRECTORY , please call our Member Service Department at 305-559-5366 or toll free 1-866-393-5366, TTY users should call 711, 8:00 am to 8:00 pm, seven days a week October 1st March 31st and 8:00 am - 8:00 pm, Monday Friday from April 1st September 30th. Messaging service used weekends, after hours, and on federal holidays. This document may be available in other formats such as Braille, large print or other alternate formats.

4 Contact the plan for more information. INT_19_66610_C Approved I Table of Contents Section 1 Introduction .. III What is the service area for Leon Medical Centers Health Plans Leon Cares? .. IV How do you find Leon Medical Centers Health Plans Leon Cares providers in your area? .. IV Section 2 List of Network Providers .. V Primary Care Providers (PCP) ..1 Specialists .. 21 Hospitals .. 59 Skilled Nursing Facilities (SNF) .. 60 Behavioral Health Providers .. 48 Dental Providers .. 49 Vision .. 52 Durable Medical Equipment (DME) PHARMACY DIRECTORY - Last Name II Language 1 Introduction This DIRECTORY provides a list of Leon Medical Centers Health Plans Leon Cares network providers.

5 To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).You will have to choose one of our network providers listed in this DIRECTORY to be your Primary Care PROVIDER (PCP). Generally, you must get your health care services from your PCP. Your PCP is a Physician whose primary specialty is Family Practice, Internal Medicine, Geriatrics or General Practice who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP will also coordinate the rest of the covered services you get as a member of our network providers listed in this DIRECTORY have agreed to provide you with your health care, vision and dental services .

6 You may go to any of our network providers listed in this DIRECTORY ; however, some services may require a though your PCP is trained to handle the majority of common health needs, there may be a time when you need more specialized treatment. In those situations, you may see a plan specialist. Specialists are doctors who are trained to provide health services for a specific disease or part of the body. For some types of specialists, you will need to obtain a referral from your PCP before you can schedule an appointment with the specialist. Below is a list of PROVIDER specialty types that require referrals from your PCP before you can schedule an appointment with them.

7 Please note: Some PROVIDER types may have been added or removed from the list after this DIRECTORY was printed. You should check with your PCP or call Member Service at the phone number on the cover to see if a referral is required to see a specialist or other PROVIDER . Please note: A referral is different from prior authorization , which is required before certain services procedures can be performed. Allergy & Immunology AudiologyCardiology Cardio-Thoracic Surgery Chiropractic Colon and Rectal Surgery Dentistry, EndodonticsDentistry, General Dentistry, Periodontics Dermatology Endocrinology ENT / Otolaryngology Gastroenterology Gerontology General Surgery Gynecology Hand Surgery Infectious Disease Nephrology Neurology Neurosurgery Oncology - Medical.

8 Surgical Ophthalmology Optometry Oral Surgery Orthopedic Surgery Pain Management Physical Medicine / Rehabilitation Plastic Surgery Podiatry Psychiatry Pulmonary Medicine Rheumatology Thoracic Surgery Urology Vascular Surgery III There may also be times when you get a bill from a PROVIDER for the full cost of medical care you have received. In many cases, you should contact Member Service or send this bill along with associated medical records to us instead of paying it.

9 In the event that you made a payment, please also submit proof of payment. We will look at the bill and decide whether the services should be covered. If we decide they should be covered, we will pay the PROVIDER directly. (Please note that we cannot pay a PROVIDER who has opted out of the Medicare program. Check with your PROVIDER before receiving services to confirm that they have not opted out of Medicare.) If we determine that the services are not covered or were not medically necessary, we may deny coverage and you will be responsible for the entire cost. You may get emergency medical care whenever you need it, worldwide.

10 If you feel you have an emergency, call 911 for help or go to the nearest emergency room or hospital. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health. Please refer to your Evidence of Coverage for details. If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable.