Molina Dual Options Medicare-Medicaid Plan | 2021 Provider and Pharmacy Directory Online Directory Information
Introduction
This
Provider and Pharmacy Online Directory includes information about provider and pharmacy types in Molina Dual Options and search results of all plan’s providers and pharmacies as of the date your search. The search results contain provider and pharmacy address and contact information as well as other details such as days and hours of operations, specialties, and skills. Key terms and their definitions appear in alphabetical order in the last chapter of the
Member Handbook.
Disclaimers
- Molina Dual Options Medicare-Medicaid Plan is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees.
- Molina Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, ethnicity, national origin, religion, gender, sex, age, mental or physical disability, health status, receipt of healthcare, claims experience, medical history, genetic information, evidence of insurability, geographic location.
- ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (877) 901-8181, TTY al 711, lunes a viernes, de 8:00 a.m. a 8:00 p.m., hora local. Esta es una llamada gratuita.
- This document is available for free in other languages and formats like large print, braille, or audio. Call (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free.
- You can ask that we always send you information in the language or format you need. This is called a standing request. We will keep track of your standing request, so you do not need to make separate requests each time we send you information. To get this document in a language other than English or in an alternate format, call Member Services at (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. A representative can help you make or change a standing request. You can also contact your Care Manager for help with standing requests. To permanently change your preferred language, contact the State at (800) 843-6154, TTY: 711, Monday – Friday, 8:30 a.m. to 5 p.m., local time to update your record with the preferred language.
- This Online Directory includes health care professionals (such as doctors, nurse practitioners, and psychologists), facilities (such as hospitals or clinics), and support providers (such as Adult Day Health and Home Health providers) that you may see as a Molina Dual Options member. We also display the pharmacies that you may use to get your prescription drugs.
- We will refer to these groups as “network providers” in this Directory. These providers signed a contract with us to provide you services. This searchable online directory contains all Molina Dual Options full network of providers for State of Illinois. For additional information contact Member Services at (877) 901-8181, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., local time.
- This Directory includes providers of both Medicare and Medicaid services.
The list is up-to-date as of the current date shown at the bottom page of the searchable online directory, but you need to know that:
- Some Molina Dual Options network providers may have been added or removed from our network after this Directory was published.
- Some Molina Dual Options providers in our network may no longer be accepting new members. If you are having trouble finding a provider who will accept new members, call Member Services at (877) 901-8181, TTY: 711, Monday - Friday, 8 a.m. to 8 p.m., local time and we will help you.
- To get the most up-to-date information about Molina Dual Options’ network providers in your area, use the Member Services website or contact information at the top of the online directory page.
Doctors and other health care professionals in Molina Dual Options network are listed on pages based on your Provider Search. Pharmacies in our network are listed on pages Pharmacy Search.
To
report any mistakes you find in this Provider and Pharmacy Online Directory Information,
e-mail ILMMPMemberServices@MolinaHealthcare.com or
call Member Services using the information at the top.
Providers
Key terms
This section explains key terms you’ll see in our Provider and Pharmacy Online Directory.
- Providers are health care professionals and support providers such as doctors, nurses, pharmacists, therapists, dental and vision providers, and other people who provide care and services. Services include medical care, long-term services and supports (LTSS), supplies, prescription drugs, equipment and other services.
- The term providers also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and long-term services and supports.
- Providers that are a part of our plan’s network are called network providers.
- Network providers are the providers that have contracted with us to provide services to members in our plan. The providers in our network generally bill us directly for care they give you. When you see a network provider, you usually pay nothing for covered services.
- A Primary Care Provider (PCP) is a physician, nurse practitioner, or other health care professional who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time. Your PCP will also give you a referral if you need to see a specialist or other provider.
- Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:
- Oncologists care for patients with cancer.
- Cardiologists care for patients with heart conditions.
- Orthopedists care for patients with certain bone, joint, or muscle conditions.
- You may need a referral to see a specialist or someone that is not your PCP. A referral means that your PCP must give you approval before you can see someone that is not your PCP. If you don’t get a referral, Molina Dual Options may not cover the service.
- Referrals from your network PCP are not needed for:
- Emergency care;
- Urgently needed care;
- Kidney dialysis services that you get at a Medicare-certified dialysis facility when you are outside the plan’s service area; or
- Services from a women’s health specialist.
- Additionally, if you are eligible to get services from Indian health providers, you may see these providers without a referral. We must pay the Indian health provider for those services even if they are out of our plan’s network.
- More information on referrals is available in Chapter 3 of the Member Handbook.
- You also have access to a Care Team and a Care Coordinator that you help choose.
- A Case Manager, working closely with you, will lead your Care Team and develop a Care Plan that helps you manage your medical, behavioral health, long term supports and services, and social and functional needs.
- Your Care Team may include, but is not limited to the following people: Primary Care Provider, Specialty Care Provider, Registered Nurse (RN), Molina Case Manager, Utilization Management Staff, Molina Dual Options Medical Director, and Pharmacists. Everyone on the Care Team, led by the Case Manager, works together to make sure your care is coordinated. This means that they make sure your providers are aware of care you get, medicines you take, and that tests and labs are done once and the results are shared with the appropriate providers. Your Care Team will also assess your needs to determine if you need help in other areas besides health, such as physical or social needs. Your Care Team will be in contact with you as often as needed depending on the Care Plan that you help develop.
- A Care Plan will be developed with your help by the Case Manager and Care Team. The Care Plan will list all of your needs, set goals to address those needs, and determine ways to monitor if those needs are being met or if they need to be changed. It will also include a service plan if you are getting Home and Community Based Services.
Primary Care Provider (PCP)
You can get services from any provider who is in our network and accepting new members.
First, you will need to choose a Primary Care Provider. Members can pick a specialist as their PCP in some situations. If you are pregnant, have a disability, have chronic health conditions or special health care needs, a specialist can be your PCP. If you and your specialist believe that he or she should be your PCP, call Molina Dual Options. Call (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time to speak with Member Services.
Our plan’s PCPs are affiliated with medical groups. When you choose your PCP, you are also choosing the affiliated medical group. This means that your PCP will be referring you to specialists and services that are also affiliated with his or her medical group.
- If there is a particular specialist or hospital that you want to use, it is important to see if they are affiliated with your PCP’s medical group. You can look in this Directory or ask Molina Dual Options Member Services to check to see if the PCP you want makes referrals to that specialist or uses that hospital.
- If you don’t stay within your PCP’s medical group, Molina Dual Options may not cover the service.
To choose a PCP, go to the list of providers on page based on your search results and choose a provider:
- that you use now, or
- who has been recommended by someone you trust, or
- whose offices are easy for you to get to.
- If you want help in choosing a PCP, please call (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time or, visit MolinaHealthcare.com/Duals.
- If you have questions about whether we will pay for any medical service or care that you want or need, call Member Services and ask before you get the service or care.
Long-term services and supports (LTSS)
As a Molina Dual Options member, you may be able to get long-term services and supports (LTSS), such as the following waiver programs: Elderly, Supportive Living Facility, Persons with Disability, Traumatic Brain Injury and Persons with HIV/AIDS as a Molina Dual Options member. LTSS help people who need assistance to do everyday tasks like taking a bath, getting dressed, making food, and taking medicine. Most of these services are provided at your home or in your community but could be provided in a nursing home or hospital.
If you need assistance with daily activities like bathing, dressing or grooming you can speak with a Molina Dual Options Case Manager by contacting our Member Services department at (877) 901-8181, TTY 711, Monday - Friday, 8 a.m. to 8 p.m., local time.
How to identify providers in Molina Dual Options’ network
You may need a referral to see someone who is not a Primary Care Provider. There is more information about referrals under the Key Terms section of this Provider and Pharmacy Directory Information.
You must get all of your covered services from providers within our network. If you go to providers who are not in Molina Dual Options network (without prior authorization or approval from us), you will have to pay the bill.
“A
prior authorization is an approval from Molina Dual Options before you can get a specific service, drug, or see an out-of-network provider. Molina Dual Options may not cover the service or drug if you don’t get approval.”
The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. You can also go outside the plan for other non-emergency services if Molina Dual Options gives you permission first.
- You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider. You may change your PCP for any reason, at any time. You can call Member Services if you want more information about our Molina Dual Options providers or if you need help changing your PCP. Member Services will make the PCP change effective on the first day of the following month. For some providers, you may need a referral from your PCP (except for emergency and out of area urgent care services).
- Remember, our plan’s PCPs are affiliated with medical groups. If you change your PCP, you may also be changing medical groups. When you ask for the change, be sure to tell Member Services if you are seeing a specialist or getting other covered services that require PCP approval. Member Services will help make sure that you can continue your specialty care and other services when you change your PCP.
- Molina Dual Options works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, search results of network providers in this Directory include information about the accommodations they provide.
- If you need to see a provider and are not sure if they offer the accommodations you need, Molina Dual Options can help you. Talk to your Case Manager for assistance.
How to find Molina Dual Options providers in your area
To learn how to search for providers refer to the “
Help” link located on the top portion of searchable online directory page.
If you have questions about Molina Dual Options please call Member Services at (877) 901-8181, TTY 711, Monday - Friday, 8 a.m. to 8 p.m., local time. You may receive services from any of the providers shown on your online directory search.
Network providers
This Online Directory of Molina Dual Options’ network providers contains:
- Health care professionals including, for example, primary care physicians, specialists, mental health providers, and dental and vision providers
- Facilities including, for example, hospitals, nursing facilities, mental health facilities, and supportive living; and
- Support providers including, for example, adult day services, consumer-directed services, home-delivered meals, and home health agencies.
Providers are listed in alphabetical order by last name. In addition to contact information, provider listings also include specialties and skills, for example, such as languages spoken or completion of cultural competence training.
“
Cultural competence training is additional instruction for our health care providers that helps them better understand your background, values, and beliefs to adapt services to meet your social, cultural, and language needs.”
Network pharmacies
Molina Dual Options network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.
You can also search pharmacies that are in our network but are outside our service area of: Adams, Alexander, Bond, Boone, Brown, Bureau, Calhoun, Carroll, Cass, Champaign, Christian, Clark, Clay, Clinton, Coles, Cook, Crawford, Cumberland, DeKalb, De Witt, Douglas, DuPage, Edgar, Edwards, Effingham, Fayette, Ford, Franklin, Fulton, Gallatin, Greene, Grundy, Hamilton, Hancock, Hardin, Henderson, Henry, Iroquois, Jackson, Jasper, Jefferson, Jersey, Jo Daviess, Johnson, Kane, Kankakee, Kendall, Knox, Lake, La Salle, Lawrence, Lee, Livingston, Logan, Macon, Macoupin, Madison, Marion, Marshall, Mason, Massac, McDonough, McHenry, McLean, Menard, Mercer, Monroe, Montgomery, Morgan, Moultrie, Ogle, Peoria, Perry, Piatt, Pike, Pope, Pulaski, Putnam, Randolph, Richland, Rock Island, St. Clair, Saline, Sangamon, Schuyler, Scott, Shelby, Stark, Stephenson, Tazewell, Union, Vermilion, Wabash, Warren, Washington, Wayne, White, Whiteside, Will, Williamson, Winnebago, and Woodford. You may also fill your prescriptions at these pharmacies. Please contact Molina Dual Options at (855) 735-5604, TTY: 711, Monday – Friday, 8a.m. to 8 p.m. EST, for additional information.
- Molina Dual Options members must use network pharmacies to get prescription drugs.
- You must use network pharmacies except in emergency or urgent care situations.
- If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out of pocket for the service. Read the Molina Dual Options Member Handbook for more information.
- Some network pharmacies may not be listed in this Directory.
- Some network pharmacies may have been added or removed from our plan after your search.
For up-to-date information about Molina Dual Options network pharmacies in your area, please visit our web site at
MolinaHealthcare.com/Duals or call Member Services at (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time. The call is free.
To report any mistakes you find in this Provider and Pharmacy Online Directory Information, e-mail ILMMPMemberServices@MolinaHealthcare.com or call Member Services using the information at the bottom of the page.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please read the
Member Handbook and Molina Dual Options
List of Covered Drugs. The List of Covered Drugs can be found at
MolinaHealthcare.com/Duals.
How to identify pharmacies in Molina Dual Options network
Along with retail pharmacies, your plan’s network of pharmacies includes:
- Mail-order pharmacies send covered prescription drugs to members through the mail or shipping companies.
- Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
- Long-term care (LTC) pharmacies serve residents of long-term care facilities, such as nursing homes.
You are not required to continue going to the same pharmacy to fill your prescriptions.
Long-term supplies of prescriptions
- Mail-Order Programs. We offer a mail-order program that allows you to get up to a 90-day supply of your prescription drugs sent directly to your home. A 90-day supply has the same copay as a one-month supply.
- 90-Day Retail Pharmacy Programs. Some retail pharmacies may also offer up to a 90-day supply of covered prescription drugs. A 90-day supply has the same copay as a one-month supply.
Mail-order pharmacy
You can get prescription drugs shipped to your home through our network mail order delivery program which is called
CVS Caremark Mail Service Pharmacy Program. The pharmacy will contact you, by phone, to get your approval before shipping any prescriptions. If we are unable to reach you for approval, your prescription will not be sent to you.
Typically, you should expect to get your prescription drugs within 10 days from the time that the mail order pharmacy gets the order. If you do not get your prescription drug(s) within this time, if you would like to cancel an automatic order, or if you need to ask for a refund for prescriptions you got that you did not want or need, please contact us at (855) 432-7015, TTY: 711, 24 hours a day, 7 days a week. To learn more about mail order pharmacies, see Chapter 5 of the
Member Handbook.
Home infusion pharmacies
You can get home infusion therapy if Molina Dual Options has approved your prescription and if you get your prescription from an authorized prescriber.
Home Infusion Pharmacies services all counties in the Molina Dual Options service area. For more information on home infusion services and pharmacies, contact Member Services at (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
Long-term care pharmacies
Residents of a long-term care facility, such as a nursing home, may access their prescription drugs covered under Molina Dual Options through the facility’s pharmacy or another network pharmacy. To learn more about drug coverage in special cases, see Chapter 5 of the
Member Handbook.
Long-Term Care Pharmacies services all counties in the Molina Dual Options service area. For more information on Long Term-Care services and pharmacies, contact Member Services at (877) 901-8181, TTY: 711, Monday – Friday, 8 a.m. to 8 p.m., local time.
How to find Molina Dual Options pharmacy in your area
You can get your drugs covered at any of our network pharmacies. This includes our network pharmacies outside of our service area.
To search for a pharmacy type within our network, go to
MolinaHealthcare.com/ProviderSearch and click on “Find a Pharmacy”. Then, select your state and coverage plan. A notification pop up will appear, letting you know the link will take you away from
MolinaHealthcare.com/Duals. Click “OK” to be directed to the next page that will allow you complete your pharmacy search. Next, enter ZIP code or city and state. You can further refine your search by specifying a pharmacy name and type. All pharmacies shown on the searchable online directory are available in our Network.
If you have questions about any of the above, please contact Member Services or visit
MolinaHealthcare.com/Duals.
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