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2022

Ally Rx (HMO SNP)

This directory is current as of Aug. 19, 2021.

ŗAlly Rx HMO SNP current network

providers. This directory ŗAlly Rx service area, which includes 12 counties in central Wisconsin as described in detail on page iii. It also includes providers in some adjacent areas in Wisconsin, Michigan and other states. To access ŗAlly Rx HMO SNP online provider directory, you can visit www.securityhealth.org/directory. For any questions about the information contained in this directory, please call our Customer Service Department at 1-877-998-0998 or 715-221-9897. We are open 7 days a week, 8 a.m. to 8 p.m., Oct. 1-March 31; and Monday through Friday,

8 a.m. to 8 p.m., April 1-Sept. 30. TTY users should call 711.

Security Health Plan of Wisconsin, Inc., is an HMO-POS, MSA and D-SNP plan with a Medicare contract and a contract with the ForwardHealth Wisconsin Medicaid program. Enrollment in

Security Health Plan depends on contract renewal.

This document may be available in alternate formats; call Customer Service at the numbers above.

Y0117_MC-778-2798-C-09-21_C

i

Table of Contents

Section 1 Ŕ Introduction....................................................................................... ii

What is the service area for Ally Rx D-SNP? ............................................... iii How do you find Ally Rx D-SNP providers that serve your area? .......... iv

Discrimination is against the law .................................................................. iv

Language assistance services .......................................................................... v

Section 2 Ŕ List of Network Providers .............................................................. vi

Primary care providers ...................................................................................... 1

Specialty care providers ................................................................................. 29

Behavioral health providers ....................................................................... 140

Family planning clinics ................................................................................ 155

Ambulatory surgery centers ....................................................................... 156

Hospitals .......................................................................................................... 157

Urgent care centers ....................................................................................... 160

Other plan providers .................................................................................... 163

- Durable medical equipment ............................................................... 163

- Home health agencies .......................................................................... 174

- Orthotics/prosthetics ............................................................................ 176

- Skilled nursing facilities (SNFs) .......................................................... 179

Pharmacies ...................................................................................................... 184

Providers listed alphabetically .................................................................. 241

ii

SECTION I - INTRODUCTION

This directory provides a list of Security

Health Planŗ Ally Rx D-SNP network

providers. 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 who are listed in this directory to be your Primary Care Provider (PCP).

Generally, you will get most of your health

care services from your PCP.

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. However, some services may require a referral. If you have been going to one network provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-network providers.

When your PCP thinks that you need a

specialized treatment, he or she will give may decide to see a network specialist on your own. If you need medical care that

Medicare requires our plan to cover and the

providers in our network cannot provide this care, you can get this care from an out- of-network provider. If your doctor refers you to an out-of-network provider for specialized treatment, you must call us. The

Security Health Plan medical director must

authorize the service before you receive care. In this situation, we will cover the service as if you got the care from a network provider.

There may be times when you get a bill

from a provider for the full cost of medical care you have received. In many cases, you should send this bill to us so that we can pay our share of the costs for your covered medical services.

If you have a medical emergency:

Get help as quickly as possible.

Call 911 for help or go to the nearest

emergency room, hospital or urgent care center. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.

As soon as possible, make sure that

our plan has been told about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Call Customer Service at

1-877-998-0998 (TTY 711), 7 days a

week from 8 a.m. to 8 p.m.

You may get covered urgent and emergent

medical care whenever you need it, anywhere in the world. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health. For more information, see your Evidence of Coverage booklet.

If you have an emergency, we will talk with

the doctors who are giving you emergency care to help manage and follow up on your care. They will decide when your condition is stable and the medical emergency is over.

Your follow-up post-stabilization care will

be covered according to Medicare guidelines. In general, if your emergency care is provided out-of-network we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

Emergency care can always be obtained in

or out of the service area from the nearest available provider. Whenever possible, you must use our network providers when you an urgent need for care. iii

When out of the service area or when

network providers are unavailable, urgent care may be obtained from any qualified provider. In addition, when out of the service area, you can obtain dialysis treatment from any qualified dialysis provider. However, if you receive routine care from out-of-network providers, neither

Medicare nor Security Health Plan will be

responsible for the costs. What is the service area for Security Health PlanśV Ally Rx

D-SNP plan?

The counties in our service area are shown on this map. The counties in our service area are listed below:

Barron

Chippewa

Clark

Eau Claire

Lincoln

Marathon

Oneida

Portage

Price Rusk

Taylor

Wood iv How do you find Security Health Plan Ally Rx D-SNP providers that serve your area? Please review the Primary Care and Specialty Care sections of this directory to find a provider in your area. The state, county and city names divide each section so that it is easy for you to locate plan providers near your home or place of work. If you have questions about ŗAlly Rx D-SNP plan or require assistance in selecting a primary care provider, please call our Customer Service Department at 1-877-998-

0998 or 715-221-9897. We are open 7 days a week, 8 a.m. to 8 p.m., Oct. 1-March 31; and

Monday through Friday, 8 a.m. to 8 p.m., April 1-Sept. 30. TTY users should call 711. You can also visit www.securityhealth.org/medicareadvantage.

Discrimination is against the law

Security Health Plan of Wisconsin, Inc., complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, religion, disability, age, sex, gender identity, sexual orientation or health status in the administration of the plan, including enrollment and benefit determinations. Security Health Plan of Wisconsin, Inc., does not exclude people or treat them differently because of race, color, national origin, religion, disability, age, sex, gender identity, sexual orientation or health status.

Security Health Plan of Wisconsin, Inc.:

Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print, audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact Customer Service at 1-877-998-0998 (TTY: 711). If you believe that Security Health Plan of Wisconsin, Inc. has failed to provide these services or discriminated in another way on the basis of race, color, national origin, religion, disability, age, sex, gender identity, sexual orientation or health status, you can file a grievance with:

Security Health Plan

Attn: Grievances

1515 North Saint Joseph Avenue

Marshfield, WI 54449-8000

Phone: 715-221-9596 (TTY 711)

Fax: 715-221-9424

Email: shp.appeals.grievance@securityhealth.org

v You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, Security Health Plan can help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services

200 Independence Avenue SW.

Room 509F, HHH Building

Washington, DC 20201

Phone: 1Ŕ800Ŕ368Ŕ1019 or 800Ŕ537Ŕ7697 (TDD) Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Language assistance services

ATTENTION: If you speak a language other than English, language assistance services, free of charge, are available to you. Call 1-877-998-0998 (TTY 711).

Español (Spanish)

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.

Llame al 1-877-998-0998 (TTY 711).

Hmoob (Hmong)

LUS CEEV: Yog tias koj hais lus Hmoob, cov kev pab txog lus, muaj kev pab dawb rau koj. Hu rau 1-877-998-0998 (TTY 711). Large print Ŕ If you require materials in large print, please call

1-877-998-0998 (TTY 711).

vi

Section 2 Ř List of network providers

This directory is sectioned by: Page #

Primary care providers (PCPs) Ŕ 1,101 total providers 1 Specialty care providers Ŕ 4,366 total providers 29 Behavioral health providers Ŕ 342 total providers 140

Family planning clinics Ŕ 4 total clinics 155

Ambulatory surgery centers Ŕ 12 total centers 156

Hospitals Ŕ 34 total hospitals 157

Urgent care centers Ŕ 30 total centers 160

Other plan providers Ŕ 280 total providers 163

o Durable medical equipment Ŕ 151 providers 163 o Home health agencies Ŕ 27 providers 174 o Orthotics/prosthetics Ŕ 41 providers 176 o Skilled nursing facilities (SNFs) Ŕ 61 providers 179

Pharmacies Ŕ 1,043 total pharmacies 184

Providers listed alphabetically (index) 241

Providers identified with a plus sign (+) are board certified. Providers identified with an asterisk (*) were not accepting new patients at the time this directory was printed. All providers in this provider directory accept both Medicare and Medicaid. The Pharmacy section lists pharmacies that provide Part B drugs. Because you have a Medicare Advantage plan including Part D coverage, please refer to your Pharmacy Directory for more detailed information.

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