Sign up for a local meeting today to learn more about plan options. First name Last name Email. You can call this number 24 hours a day, 7 days a week. EMS bill payment. You can call our free automated premium payment service at 844-639-3117(TTY: 711). 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. The Social Security Office at 800-772-1213 (TTY users call 800-325-0778) between 7 a.m. and 7 p.m., Monday through Friday. Box 8200 Danville, PA 17821-8200 All Products Customer Service Teams *(Claims, Member Benefits & Eligibility) (855) 863-2429 Monday - Friday, 8 a.m.- 6 p.m. quests to VITALine Pharmacy Services at (800) Call us and place your order through an expert Care Advocate. Geisinger Gold Classic Complete Rx (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Geisinger Health System. You can ask Geisinger Gold to make an exception and cover your drug. We may extend the time frame by up to 14 calendar days if you request the extension, or if we justify a need for additional information and the delay is in your best interest. During this time, you must continue to get your medical care through our plan. If you'd like a . Have questions? TTY/TDD users should call 1-877-486-2048. $ 45.00. Cancer Center. Geisinger Health Plan Kids (Children's Health Insurance Program) and Geisinger Health Plan Family (Medical Assistance) are offered by . HOW CAN I COMPARE MY OPTIONS? GHP Family: 855-227-1302 5. Category. This form includes information on the different kinds of appeals you can file. Last name Phone Date of birth. Through our MTM service, you get a free, personal consultation with one of our highly trained pharmacists. Mailing. Making an appeal means trying again to get the medical care coverage you want. I should have gone to Walmart, Sam's Club, Vision Works, etc. Your coverage will become effective on Jan. 1, 2023. 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. MC 40-36. Geisinger Health Plan Kids (Children's Health Insurance Program) and . Changes to the Geisinger Gold standard Rx formulary(effective September 1, 2022), Changes to the Geisinger Gold $0 deductible formulary(effective September 1, 2022). When they call, you can complete the medication review then or schedule a future appointment if youd like to participate. If youre a resident of a long-term care facility, well allow you to refill your prescription until weve provided you with a 31-day transition supply, consistent with dispensing increment (unless you have a prescription written for fewer days). You can only use doc- Geisinger Gold Medicare Advantage HMO, PPO, and HMO D-SNP plans are offered by Geisinger Health Plan/Geisinger Indemnity Insurance Company, health plans with a Medicare contract. Secure Rx (HMO SNP). 570-558-4278. Opioid prescriptions are monitored for safe dosage levels. If we decide that your medical condition doesnt meet the requirements for a fast coverage decision, well send you a letter that says so (and well use the standard deadlines instead). PPO with no referral/TPA: 800-504-0443 3. 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. Generally, for a standard coverage decision, well give you our answer within 14 days of receiving your request. 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 . 65+ and shopping for a new Medicare plan? Geisinger Health Plan P.O. If we dont give you our answer within 14 days (or if there is an extended time period, by the end of that period), you have the right to appeal. when the member's life, health or ability to regain maximum function is Y0032_22269_1_M Accepted 10/1/22. Instructions for completing and submitting a Drug Coverage Determination For example, the Healthcare Effectiveness Data and Information Set (HEDIS)* provides a set of measures against which we can judge our effectiveness. Calling the number for your specific plan will help us serve you quicker! Grievances For additional questions contact HealthHelp Program Support: Email RCSupport@HealthHelp.com or call 800-546-7092. Follow the steps below: Start by calling, writing, or faxing us to request coverage for the medical care you want. Danville, PA 17822-3220. Your membership will usually end on the first day of the month after we receive your request to change your plan. If youre enrolled, well send you a letter explaining the program and how to tell us the best time to reach you. 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. Just turned 65 and new to Medicare? Contact GHP Account Management at 800-876-5357. By providing your information, you agree to receive ongoing communications about Geisinger Gold. * HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Geisinger Gold Medicare Advantage members have access to more than 29,000 doctors throughout Pennsylvania, over 100 hospitals and nearly 3,000 pharmacies. 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. If you are calling from an out-of-Pennsylvania area code, please call800-210-5316(TTY: 711). Helpful Medicare advice from our experts, plus tips to stay healthy and feel your best at any age. Box 829703 Continued enrollment in Geisinger Gold depends on annual contract renewal. Select this result to view Dana Michele Geisinger's phone number, address, and more. If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. If you want to appeal a denial of a Drug Coverage Determination made by Geisinger Gold, view the CMS Redetermination form. n. Filter results Refine your search. If you believe we shouldnt take extra days, you can file a fast complaint about our decision to take the extra days. If we extended the time needed to make our coverage decision, we will provide the coverage by the end of that extended period. Please fax the following to 570-522-9431: Reason for referral. ET You should talk to your doctor to decide if you should switch to an appropriate drug that we cover, or request a formulary exception, to see if well cover the drug you take. If you learn that Geisinger Gold doesnt cover your drug, you have two options: You can ask Geisinger Gold to make anexceptionto our coverage rules. Were ready to answer your questions on weekdays from 8 a.m. to 4:30 p.m. How do I know if Im eligible? If you move or take a long trip, you need to call member services to find out if the place you are moving or traveling to is in our plans area. To make sure youre getting the best possible care, our pharmacists work with your doctor. Quality and accreditation staff work directly through personal and automated telephone calls and mailings to reinforce the importance of preventive measures and suggested screenings. 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. This can be a extremely nice safety net. Geisinger Gold may add or remove drugs from our formulary during the year. Get tips and advice for living a healthy, happy life. If our answer is yes to part or all of what you requested,we must authorize or provide the medical care coverage we have agreed to provide within 72 hours after we received your request. The second best result is Donna Lynn Geisinger age 60s in Marmora, NJ. A TDD/TTY line is available at 711, Monday through Friday, 8 a.m. 4:30 p.m., ET. There is one instance when you may file an Expedited (Fast) Grievance related to coverage determinations. Oct.1 - Feb. 14; for all other dates, call from 8 a.m. 8 p.m., ET. Get in touch with online support or Paying by phone . 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. If we cant resolve your complaint over the phone, we have a formal procedure to review your complaints, called the grievance procedure. 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. You can ask us to cover your drug even if its not on our formulary. 2023 pharmacy prior authorization policies|standard Rx|$0 deductible Rx(updated October 11, 2023/effective January 1, 2023), 2022 pharmacy prior authorization policies|standard Rx|$0 deductible Rx(updated October 27, 2022/effective November 1, 2022), 2022 step therapy policies|standard Rx|$0 deductible Rx(updated October 27, 2022/effective November 1, 2022)|Part B list & criteria(updated May 17, 2022/effective July 15, 2022) Medical Management Department If you have questions or need information, contact Geisinger Health Plan. Log in to your account to access benefits today. Contact Geisinger Health Plan by phone or by filling out the form to send an email . NaviNet for provider information and resources: navinet.navimedix.com; Instamed for electronic claim submission and payment transactions: 866-467-8263 or instamed.com; Claims. Expedited (Fast) Grievances can be requested or filed by contacting the Geisinger Gold Customer Service Team at 800-498-9731 (TDD: 711), from 8 a.m.- 8 p.m., ET, Monday - Friday (February 15 - September 30) orseven days a week (October 1 - February 14). Clinical guidelines offer providers consistent and appropriate guidance for diagnosis and treatment of specific conditions or diseases. Plan Star Ratings from Centers for Medicare and Medicaid Services (CMS), Member Newsletter, Things You Should Know and Quality Information, Step 2: We consider your request and respond, Step 3: If we say no, you decide if you want to appeal, Prescription exceptions, determinations and appeals, Disenrollment rights and responsibilities, If you are a current Geisinger Gold member and will remain enrolled for 2022, view your, - Servicing counties:Adams, Berks, Bucks, Carbon, Centre, Chester, Clinton, Cumberland, Dauphin, Franklin, Juniata, Lackawanna, Lancaster, Lebanon, Lehigh, Lycoming, Mifflin, Monroe, Northampton, Perry, Pike, Sullivan, Susquehanna, Wayne, Wyoming, York, Autism & Developmental Medicine Institute, Geisinger Commonwealth School of Medicine, Heritage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO), Preferred Advantage Rx (PPO), Preferred Complete Rx (PPO), Preferred Enhanced Rx (PPO), Secure Rx (HMO SNP), 2023 Enrollment form for Classic, Preferred and Secure plans, Plan Contract H3954 (includes Classic and Secure plans), Plan Contract H3924 (includes Preferred plans), Classic Advantage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO), Preferred Advantage Rx (PPO), Preferred Complete Rx (PPO), Preferred Enhanced Rx (PPO), CMS Request for Medicare Prescription Drug Determination form. 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. As a new or continuing member in our plan, you may be taking drugs that are not on our formulary. A copy of the most recent well-child visit. The letter will tell you: Note:We can take up to 14 more calendar days if you ask for more time, or if we need information (such as medical records from out-of-network providers) that may benefit you. You may end your membership in our plan only during certain times of the year, known as enrollment periods. Contact GHP Account Management at 800-876-5357. If you request a written response to your phone complaint, we will respond in writing to you. Medicare Advantage Prescription Drug Plans bundle the benefits of a Medicare Advantage Plan and a Prescription Drug Plan. Dana is related to Donald A Juenemann and Janice K Juenemann as well as 3 additional people. You'll have opportunities to better your life and make a difference - at home and across the . 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. Abigail Geisinger Scholars from Geisinger Commonwealth School of Medicine's (GCSOM) class of 2026 were welcomed into the family by their mentors and system . For an expedited coverage determination or exception, the turnaround time is 24 hours. However, were happy to spend more time discussing your medications and health-related concerns, if needed. Continued enrollment in Geisinger Gold depends on annual contract renewal. Call us 844-402-4344. Find the Geisinger company's hr team/department contact details such as business emails, phone numbers, web address and other details. TTY/TDD users should call 1-877-486-2048. For example, for certain drugs, Geisinger Gold limits the amount of the drug that we will cover. Walmart, PA Trust, PEBTF, Office of Personnel (FEHB). What is Medication Therapy Management? If we extended the time needed to make our coverage decision, we will provide the coverage by the end of that extended period. What type of question do you have? When youre requesting a formulary or utilization restriction exception, you should submit a statement from your physician supporting your request. See whether your doctor or pharmacy are part of our network. Youll be notified by mail about your eligibility. You are currently on page 1 of 138.Page of 138 Go. 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. 4 out of 5 stars. GHP Kids (CHIP): 866-621-5235 6. EMHS TPA: 855-863-2429 8. 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? 108 Woodbine Lane We can take up to 14 more calendar days (an extended time period) under certain circumstances. 100 North Academy Avenue You can compare Geisinger Gold Secure 1 (HMO SNP) You need a referral from a pediatrician or primary care provider to make an appointment at ADMI. They cover medical expenses and prescriptions. Online services. Call us at the number on your member identification card, or at the appropriate number below. Geisinger South Wilkes-Barre. 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. 800-498-9731(TTY: 711) Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. Pharmacy Department Opioid prescriptions that are taken together with benzodiazepine prescriptions will be stopped at the pharmacy for review by the provider to make sure the prescriptions are medically necessary and appropriate. Geisinger Medical Laboratories/Geisinger Proven Diagnostics. However, when the member's life, health, or ability to regain maximum function is jeopardized by utilizing the seven-day appeal process, an expedited appeal may be requested verbally by the member, member representative, or prescribing physician by calling 800-498-9731, seven days a week, from 8 a.m. 8 p.m., ET. Find a Medicare plan that best fits your needs. HMO/PPO with referral: 800-447-4000 2. Print and complete the entire form, and mail it to: All members have the opportunity to leave the plan during the Annual Enrollment Period and during the annual Medicare Advantage Disenrollment Period. Click here to log in. After your first 30-day supply, we wont pay for these drugs, even if youve been a member of the plan for fewer than 90 days. You'll need your contract ID or member ID, which can be found on your premium invoice or on you ID card. St. Luke's TP See more . 100 North Academy Avenue Geisinger Health Plan But if you do, our EMS (which stands for Emergency Medical Services) team knows these streets and sidewalks like the backs of our hands. Call the GHP pharmacy department for formulary exceptions, drug authorization and prescription drug information. If you have questions, contact your Geisinger Health Plan provider relations representative at 800-876-5357. To submit a request by phone, or for process or status questions, call 800-988-4861 (FREE), Monday through Friday, 8 a.m. 8 p.m., ET. This free and voluntary medication review is included as part of your Medicare Part D prescription coverage. If you have a grievance, we encourage you to first call the Geisinger Gold Customer Service Team at the number below. There is one instance when you may file an Expedited (Fast) Grievance related to requests for a redetermination (appeal) of a coverage determination. Used Geisinger instead of a vision care center. 800-482-8163(TTY: 711) If you or your prescribing physician request an expedited 24-hour Coverage Determination and Geisinger Gold decides that your request more closely meets the criteria for a standard 72-hour Coverage Determination, you may disagree and file an Expedited (Fast) Grievance. a.m.to 8 p.m. You can find more information on our Part D Medication Transition Policy here. If youd like more information about the MTM program, call us toll-free at 800-988-4861(TTY: 711). Geisinger Gold Phone. They usually cost less than brand-name drugs and are rated by the Food and Drug Administration (FDA) to be as safe and effective as brand-name drugs. The QI program includes information on clinical guidelines, health management programs and other initiatives intended to improve service to Geisinger Gold members. Call the customer care team with claims questions that cannot be resolved through NaviNet or Instamed. If our answer is yes to part or all of what you requested,we must authorize or provide the coverage we have agreed to provide within 14 days after we received your request. Secure Rx (HMO SNP), 2022 Enrollment form for Classic, Preferred and Secure plans. You may be able to get Extra Help to pay for your prescription drug premiums and costs. But remember, this program is at no cost to you and it lets us work with your doctor to be sure youre getting the best care possible. Visiting students. The following information should be faxed to 570-522-9431: Reason for referral. Geisinger Gold Classic (HMO) has formed a network of doctors, specialists, and hospitals. Appeal Department Geisinger Gold We will try to resolve any complaint you might have over the phone. This program is included free of charge as part of your Medicare Part D prescription coverage and is not considered a benefit. Resources for billing, prior authorization, pharmacy and more. Write When can you end your membership in our plan? ET, Monday through Friday. Classic Advantage (HMO), Classic Advantage Rx (HMO), Classic Complete Rx (HMO), Classic Essential Rx (HMO) Refer your patient to ADMI. From medication delivery to curbside pickup services and a 90-day refill prescription program, Geisinger Pharmacy saves you money and time. I later got billed for the total amount of the exam, $331. Auxiliary events If we end your membership because of this reason, Medicare may have your case investigated by the Inspector General. Medication Therapy Management, or MTM, is a program provided by pharmacists and other healthcare professionals to help you get the most out of your medications. Learn more about Geisinger Gold at an event near you. For a free quote or to request a Geisinger Gold Medicare Kit you may call (888) 620-8988 or click the button below. Get the latest updates about Geisinger Health Plan. 25 Church St. Wilkes-Barre, PA 18765. You may also contact your provider with any medication-related questions. Referrals should be made to ADMI. We hope you never need us. Monthly . If your doctor asks for the fast coverage decision, well automatically give a fast coverage decision. Looking for geisinger bill pay phone number? If you would like to appoint a representative to file an appeal on your behalf, view the CMSAppointment of Representative form. Until your membership ends, you must keep getting your medical services through our plan. Write: You can call this number 24 hours a day, 7 days a week. HOW CAN I COMPARE MY OPTIONS? If you ask for a fast coverage decision on your own, without your doctors support, we will decide whether your health requires that we give you a fast coverage decision. And older puts everything needed for better Health under one roof record chart review and HEDIS specification questions home Account to access an early refill of these drugs for the first 90 days you are calling from an area! 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