If your health requires a quick response, request a fast coverage decision.A fast coverage decision means well answer within 72 hours. No, participation in this program is voluntary. Living and working here, you'll join one of our tight-knit communities, and experience a quality of life you can't get elsewhere. Continued enrollment in Geisinger Gold depends on annual contract renewal. Until your membership ends, you must keep getting your medical services through our plan. Standard (seven-day review) appeals must be submitted in writing. By signing up for BillPay , you can: . 100 N. Academy Ave. Danville, PA 17822 . Looking for geisinger bill pay phone number? Please call Geisinger Gold Secure 1 (HMO SNP) at the number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. Resources for billing, prior authorization, pharmacy and more. Expedited (Fast) Grievances can be initiated or requested when you disagree with the time frames Geisinger Gold establishes for making coverage determinations (coverage decisions) for services you havent yet received. Throughout the year, well automatically enroll patients who meet the above criteria. Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. Visiting students can contact Stacey Fenstermacher, clerkship coordinator, at sefenstermacher@geisinger.edu or 570-271-6697 or Megan Longenberger, medical education coordinator, at mrlongenberger@geisinger.edu or 570-271-8121 for information. If you prefer, you can fax it to: 571-271-7225. Used Geisinger instead of a vision care center. If your doctor asks for the fast coverage decision, well automatically give a fast coverage decision. 800-482-8163(TTY: 711) Heritage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO) If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. As a member of Geisinger Gold Medicare Advantage, you have access to benefits and extras that make managing your health easier. Call us at the number on your member identification card, or at the appropriate number below. Call 800-640 . If you are a current Geisinger Gold member and will remain enrolled for 2022, view your2022 Annual Notice of Change (ANOC)letter below: If you are a current Geisinger Gold member and will remain enrolled for 2022, view your2022 Evidence of Coverage documentsbelow: If you're a current member, you can make a one-time payment or set up recurring payments through the member portal. Making an appeal means trying again to get the medical care coverage you want. Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. If you dont stay continuously enrolled in Medicare Part A and Part B. Our customer care team members are standing by and are ready to help. First name Last name Email. Deadlines for fast coverage decisions About Geisinger Commonwealth. HMO/PPO with referral: 800-447-4000 2. ET on weekdays. Geisinger Gold conducts an aggressive preventive health program, geared toward members most at risk for a variety of preventable illnesses, ailments and diseases. Danville, PA 17822-3218. If were not able to resolve the issue over the phone, we have a formal procedure to review grievances, called the grievance procedure. If youre enrolled, well send you a letter explaining the program and how to tell us the best time to reach you. Generally, for a standard coverage decision, well give you our answer within 14 days of receiving your request. At Geisinger, you can expect the best and latest innovations in cancer prevention, screening, diagnosis and treatment. Please call Geisinger Gold Classic (HMO) at the tele-phone number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. Select a 2022 plan now to make sure you have the coverage you need today. Category. If we do not give you our answer within 72 hours (or if there is an extended time period, by the end of that period), you have the right to appeal. 2023 Summaries of Benefits documents: But if you do, our EMS (which stands for Emergency Medical Services) team knows these streets and sidewalks like the backs of our hands. TTY/TDD users should call 1-877-486-2048. GeisingerFoundation@geisinger.edu . Benefits include medical expenses, but not prescriptions. If we cant resolve your complaint over the phone, we have a formal procedure to review your complaints, called the grievance procedure. Expedited (Fast) Grievances can be initiated or requested when you disagree with the time frames Geisinger Gold establishes for making organization determinations (coverage decisions) or reconsiderations (appeals) for services you have not yet received. Already 65 and shopping for a new Medicare plan for 2023? 100 North Academy Avenue. St. Luke's TP See more . However, were happy to spend more time discussing your medications and health-related concerns, if needed. Adams Family First Health 1275 York Rd Ste 17 Gettysburg PA 17325 (717) 337-9400 Rinu Joseph (General Dentist) Steven Lowe (General Dentist) Diana Molta (General Dentist) 65+ and shopping for a new Medicare plan? Changes to the Geisinger Gold standard Rx formulary(effective September 1, 2022), Changes to the Geisinger Gold $0 deductible formulary(effective September 1, 2022). 1155 East Mountain Boulevard, Wilkes Barre, PA 18702 (Map) 800-275-6401. Pennsylvanias State Pharmaceutical Assistance Programs, called PACE and PACENET, work with both Medicare and Geisinger Gold to ensure eligible Pennsylvanians have quality drug coverage at the lowest possible cost. HOW CAN I COMPARE MY OPTIONS? For additional questions contact HealthHelp Program Support: Email RCSupport@HealthHelp.com or call 800-546-7092. Grievances You: If you have Part D coverage and dont meet the above criteria, youre still eligible to request enrollment in the program. Geisinger Wilkes Barre - Podiatry. GHP Kids (CHIP): 866-621-5235 6. I later got billed for the total amount of the exam, $331. There are several types of exceptions that you can ask us to make: Generally, Geisinger Gold will only approve a request for an exception if the alternative drug is included on the Plan's formulary or additional utilization restrictions would not be as effective in treating your condition and/or would cause you to have adverse medical effects. Our more than 30-year alliance with the National Cancer Institute (NCI) and its community research programs allows us to offer the most advanced care and treatment options to patients close to home. One way we can ensure that we are holding ourselves to the highest standards is to review our performance against accepted care and service measures. As a Geisinger Gold member, you have the right to file an Expedited (Fast) Grievance for services you have not yet received, by following the process below. Our Geisinger Gold Medicare Advisors are standing by and are ready to help you on your Medicare journey. Want to know more? ET, Monday through Friday. Geisinger Gold: 800-498-9731 4. One way of combating this public health emergency is via drug management programs that prevent opioid overuse: For more information, contact the Pharmacy Service Team at 800-988-4861 (TTY: 711), 7 days a week, 8 a.m. 8 p.m. Were ready to answer your questions on weekdays from 8 a.m. to 4:30 p.m. Get tips and advice for living a healthy, happy life. If you prefer, you can fax it to 570-271-5610. If you are an enrollee being admitted to or discharged from a long-term care (LTC) facility, the use of early refill edits will not be used. If youd like more information about the MTM program, call us toll-free at 800-988-4861(TTY: 711). For a standard coverage decision, well answer within 14 days after receiving your request. P.O. You'll have opportunities to better your life and make a difference - at home and across the . First name Last name Birth date Email Phone number What is your question? Irene J. Ganahl, a member of Geisinger Commonwealth School of Medicine's MD Class of 2024, received a 2022 Excellence in Public Health Award from the U.S. Public Health Service (USPHS). Demographics (name, birthdate, address, phone number, and insurance card information) A copy of the most recent well child visit. Additionally, a written response will be provided to you within 72 hours of the medical director's decision. What services are offered? Continued enrollment in Geisinger Gold depends on annual contract renewal. Find out more about the South Campus. What type of question do you have? Preferred Advantage Rx (PPO), Preferred Complete Rx (PPO), Preferred Enhanced Rx (PPO) If our answer is no to part or all of what you requested,well send you a written statement that explains why we said no. If you become incarcerated (go to prison). The webinars will give a system demonstration with user experience insight on how to appropriately enter procedure requests, along with additional program information such as the Geisinger procedure code list, support tools and HealthHelp contact information. Its done right over the phone at a time thats convenient for you. If you want to appeal a denial of a Drug Coverage Determination made by Geisinger Gold, view the CMS Redetermination form. Frequently asked questions Geisinger Gold Phone: 800-498-9731 or 570-271-8771 Oct. 15 - Dec. 7: Daily from 8 a.m. - 8 p.m. All other dates: Monday through . Online services. Call our free automated premium payment service at 844-639-3117. If you would like to appoint a representative to file an appeal on your behalf, view the CMSAppointment of Representative form. 800-498-9731(TTY: 711) Medical Management Department Geisinger South Wilkes-Barre. Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases. While you talk to your doctor to determine the right course of action for you, we may cover your drug in certain cases during the first 90 days you are a member of our plan. TTY/TDD users should call 1-877-486-2048. . Danville, PA 17822. Geisinger Gold Medicare Advantage HMO, PPO, and HMO SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company, health plans with a Medicare contract. If you leave Geisinger Gold, it may take time before your membership ends and your new Medicare coverage goes into effect. Our mobile phlebotomists visit nursing homes and homebound patients to collection specimens and transport them to Geisinger Medical Laboratories for testing. If you prefer, you can fax it to 570-271-7225. Pharmacy Department Please call Geisinger Gold Preferred (PPO) at the number listed at the end of this introduction or 1-800-MEDICARE (1-800-633-4227) for more infor-mation. You can call this number 24 hours a day, 7 days a week. For an expedited coverage determination or exception, the turnaround time is 24 hours. The QI program includes information on clinical guidelines, health management programs and other initiatives intended to improve service to Geisinger Gold members. To get a fast coverage decision, you must meet two requirements: If your doctor tells us that your health requires a fast coverage decision, we will automatically agree to give you a fast coverage decision. If youd like to withdraw, call 800-988-4861(TTY: 711) between 8 a.m. and 4:30 p.m. Geisinger Gold must end your membership in the plan if any of the following happens: If you have questions or would like more information on when we can end your membership: We cant ask you to leave our plan for any reason related to your health, what should you do if this happens? Enter number to jump to a different page. Write: "Five Days in May." Learn more about COVID-19 at: http://geisinger.org/co. 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