Passport has customer service representatives ready to serve you. You can call us:

Member Services: 1-844-859-6152 | TTY/TDD 711

April 1 - September 30 | Mon - Fri | 8am - 9pm EST (8pm CST) and October 1 - March 31 | 7 days a week | 8am - 9pm EST (8pm CST)

If You Are Interested In This Plan, Call Toll-Free 1-844-643-2780 | TTY/TDD 711

April 1 - September 30 | Mon - Fri | 8am - 9pm EST (8pm CST) and October 1 - March 31 | 7 days a week | 8am - 9pm EST (8pm CST)
Passport has customer service representatives ready to serve you. You can call us:

Member Services: 1-844-859-6152 | TTY/TDD 711

April 1 - September 30 | Mon - Fri | 8am - 9pm EST (8pm CST) and October 1 - March 31 | 7 days a week | 8am - 9pm EST (8pm CST)

If You Are Interested In This Plan, Call Toll-Free 1-844-643-2780 | TTY/TDD 711

April 1 - September 30 | Mon - Fri | 8am - 9pm EST (8pm CST) and October 1 - March 31 | 7 days a week | 8am - 9pm EST (8pm CST)
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Find a Doctor or Pharmacy

 


This Provider and Pharmacy Directory was updated October 1, 2020.  Changes to our provider and pharmacy network may occur during the benefit year. You may also call Member Services for updated provider information. For more recent information or other questions, please contact Member Services, at 1-844-859-6152. (TTY 711), Monday through Friday 8 am to 9 pm Eastern Time (8 pm Central Time) from April 1 to September 30, and 7 days a week from 8 am to 9 pm Eastern Time (8 pm Central Time) from October 1 to March 31.

If you would like the Provider and Pharmacy Directory mailed to you or made available in an alternate format such as braille, large print, or audio, you may call our Member Services number listed above, or request one at the website link provided above.

Our directory provides a list of Passport Advantage’s current network providers and pharmacies.  The provider network and pharmacy network may change at any time.

Our directory is for the following counties in Kentucky: Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble, and Washington county.

All providers in the directory accept both Medicare and Medicaid.

Introduction

Introduction

This directory provides a list of Passport Advantage’s network providers and pharmacies. 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. Passport Advantage is a Health Maintenance Organization (HMO) Special Needs Plan (SNP) for those dually eligible for

Medicare and full Kentucky Medicaid benefits.

The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers listed in this directory.

If you receive a bill from a provider, do not pay the bill. Send the bill to us for review so we may determine what we should pay and what you should pay, if anything.

You must use network providers except in emergency or urgent care situations, or for out-of-area renal dialysis. If you obtain routine care from out-of-network providers, neither Medicare nor Passport Advantage will be responsible for the costs.

Out-of-area dialysis services means dialysis that is provided when you are temporarily away from the plan’s service area, such as on vacation. If you are within the plan’s service area, you must obtain dialysis services from a network provider.

What is the service area for Passport Advantage?

Our service area covers the following counties in Kentucky:

Breckinridge, Bullitt, Carroll, Grayson, Hardin, Henry, Jefferson, Larue, Marion, Meade, Nelson, Oldham, Shelby, Spencer, Trimble, and Washington county.

How do you find Passport Advantage’s providers that serve your area?

We have a searchable Provider and Pharmacy Directory.  To access, click the link at the top of the page. Our searchable directory allows for identifying providers meeting certain criteria, such as a PCP or Specialist within a 10-mile radius of a zip code. Our searchable directory will give you immediate results you can easily print.

 


Out of Network Rules

Why do you need to know which providers are part of our network?

It is important to know which providers and pharmacies are part of our network because as a member of our plan you must use network providers and pharmacies to get your medical care and prescriptions. In Network providers are physicians, facilities and pharmacies that Passport Advantage has contracted with to provide you with your health care services.

Out of Network providers are physicians, facilities and pharmacies that are not contracted with Passport Advantage to provide you with your health care services.

Are there exceptions?

In most cases, care you receive from an out-of network provider (a provider who is not part of our plan’s network) will not be covered.

Below are the limited circumstances:

  • The plan covers emergency care or urgently needed services that you get from an out-of-network provider.  For more information about this, and to see what emergency or urgently needed services mean, see your Evidence of Coverage.
  •  If you need medical care that Medicare requires our plan to cover but the providers in our network cannot provide this care, you may be able to obtain authorization for this care from an out-of-network provider.  Authorization should be obtained from Passport Advantage prior to seeking care from an out-of-network provider.  If approved, we will cover these services as if you got the care from an in network provider. For information about getting approval to see an out-of-network doctor, see your Evidence of Coverage.
  • The plan covers kidney dialysis services that you get at a Medicare-certified dialysis facility when you are temporarily outside the plan’s service area.

WHEN CAN YOU USE A PHARMACY THAT IS NOT IN THE PLAN’S NETWORK?

Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. To help you, we may have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan.

Your prescription may be covered in certain situations if you cannot use a network pharmacy. Below are the circumstances when we would cover prescriptions filled at an out of network pharmacy:

  • If you are unable to get a covered drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provides 24-hour services.
  • If you are trying to fill a covered drug that is not regularly stocked at an eligible network retail pharmacy. (These drugs include orphan drugs or other specialty pharmaceuticals).
  • If you are filling prescriptions at an out-of-network pharmacy related to a medical emergency.

In these situations, please check first with Member Services to see if there is a network pharmacy nearby. You may be required to pay the difference between what you pay for the drug at the out-of-network pharmacy and the cost that we would cover at an in-network pharmacy.

Please note that out of network prescriptions are limited to reimbursement for a single refill of up to a 10-day supply. If you are planning an extended stay in an area without a network pharmacy, please call our Member Services Department for assistance in signing up for mail order services.

 

 

 

Last Modified: October 1, 2020

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Friday March 13th,12:00 am-12:00 am

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