The Provider and Pharmacy Directory lists the providers and pharmacies in the Virginia Premier CompleteCare (Medicare-Medicaid Plan) network. While you are a member of our plan, you must use network providers to get covered services. There are some exceptions when you first join our plan.
What are “network providers”?
Network providers are doctors, nurses, and other health care professionals that you can go to as a member of our plan. Network providers also include clinics, hospitals, nursing facilities, adult day care facilities, personal care providers, respite care providers, medically appropriate therapies, mental and behavioral health services and other places that provide health services in our plan. They also include home health agencies, medical equipment suppliers, and others who provide goods and services that you get through Medicare or Medicaid.You must get your care from network providers. Usually, the plan will not cover care from a provider who does not work with the health plan. Here are some cases when this rule does not apply:
- The plan covers emergency or urgently needed care from an out-of-network provider. To learn more and to see what emergency or urgently needed care means, see Chapter 3 of the Member Handbook on our Plan Documents page.
- If you need care that our plan covers and our network providers cannot give it to you, you can get the care from an out-of-network provider. Authorization should be obtained from the plan prior to seeking care from an out-of network provider. In this situation, we will cover the care at no cost to you. To learn about getting approval to see an out-of-network provider, see Chapter 3 of the Member Handbook on our Plan Documents page.
- The plan covers kidney dialysis services when you are outside the plan’s service area for a short time. You can get these services at a Medicare-certified dialysis facility.
- When you first join the plan, you can continue seeing any out-of-network providers you see now for 180 days.
- When you switch to Virginia Premier CompleteCare from another health plan, you can continue seeing any out-of-network providers for 30 days.
- If you are pregnant when you enroll in Virginia Premier CompleteCare, you can continue seeing your current provider of obstetrical and gynecological services until six (6) weeks after delivery of the child, even if the provider is an out-of-network provider.
What are “network pharmacies”?
Network pharmacies are pharmacies (drug stores) that have agreed to fill prescriptions for our plan members. Use the Provider and Pharmacy Directory to find the network pharmacy you want to use.
Except during an emergency, you must fill your prescriptions at one of our network pharmacies if you want our plan to help you pay for them.
Have Questions? Let’s talk.Call us at 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice). The call is free.
Virginia Premier CompleteCare is a health plan that contracts with both Medicare and the Virginia Department of Medical Assistance Services to provide benefits of both programs to enrollees.
Limitations, copays, and restrictions may apply. For more information, call Virginia Premier CompleteCare Member Services or read the Virginia Premier CompleteCare Member Handbook.
Benefits, List of Covered Drugs, and pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this information for free in other languages. Call 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice). The call is free.
You can ask for this information in other formats, such as Braille or large print. Call 1-855-338-6467, 8:00 a.m. to 8:00 p.m., Monday through Friday. For TTY/TDD services, please call 1-800-828-1120 (Text), 1-800-828-1140 (Voice).
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