2018 Provider Directory

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1 Clover 2018 Provider Directory List of participating providers for New Jersey CarePoint Green, Classic Aqua, Premier Orange, and Purple PPO Plans Central New Jersey: Hunterdon, Middlesex, Monmouth, Ocean, Somerset Please read: this document contains information about the providers covered in your plan. This directory was updated on 04/27/2018. For more recent information or other questions, please contact Clover at (TTY 711), 8 am 8 pm local time, 7 days a week, or visit cloverhealth.com/doctors. Between February 15th and September 30th, alternate technologies (for example, voic ) will be used on the weekends and holidays.

2 This directory is current as of April 27, Clover Health PPO Plan Provider Directory This directory provides a list of Clover Health s current network providers. This directory is for Hunterdon, Middlesex, Monmouth, Ocean, Somerset counties in New Jersey. To access Clover Healths s online provider directory, you can visit doctors. For any questions about the information contained in this directory (hardcopy or online), please call our Member Service Department at , (TTY users should call 711) from 8 am 8 pm, local time, 7 days a week. From February 15 through September 30, alternate technologies (for example, voic ) will be used on the weekends and holidays. Clover Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Clover Health does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Clover Health: Provides free aids and services to people with disabilities to communicate effectively with us, such as: 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 Information written in other languages If you need these services, contact Member Services at TTY users should call 711. We are open 8 a.m. 8.p.m., EST, 7 days a week. From February 15th through September 30th, alternate technologies (for example, voic ) will be used on the weekends and holidays. April-18 1

3 Clover Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Clover Health does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. Clover Health: Provides free aids and services to people with disabilities to communicate effectively with us, such as: 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 Member Services at TTY users should call th 711. We are open 8 a.m. 8.p.m., EST, 7 days a week. From February 15 through September th 30, alternate technologies (For example, voic ) will be used on the weekends and holidays. If you believe that Clover Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Clover Health Attention: Appeals and Grievances Harborside Financial Center Plaza 10, Suite 803 Jersey City, NJ Phone: Fax: You can file a grievance by mail, or by fax. If you need help filing a grievance, the Clover Health Appeals and Grievance Department is available to 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 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, , (TDD). Complaint forms are available at 2 April-18

4 Clover Health Plan PPO 2018 Directorio de proveedores Este directorio ofrece una lista de los proveedores de la red de Clover Health. Este directorio es para los condados Hunterdon, Middlesex, Monmouth, Ocean, Somerset en New Jersey. Este directorio es válido al 27 de abril de Es posible que algunos proveedores se hayan agregado o quitado de nuestra red después de la impresión de este directorio. No garantizamos que los proveedores sigan aceptando nuevos miembros. Para obtener la información más actualizada acerca de los proveedores de la red de Clover Health en su área, puede visitar cloverhealth.com/doctors o llamar al número de Servicios para los miembros al (los usuarios de TTY deben llamar al 711) de 8 a. m. a 8 p. m., hora local, los 7 días de la semana. Desde el 15 de febrero hasta el 30 de septiembre, se usarán tecnologías alternativas (por ejemplo, correo de voz) los fines de semana y los días feriados. ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY:711). ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (TTY:711). La red de proveedores puede modificarse en cualquier momento. Recibirá un aviso cuando sea necesario. Tenga en cuenta que los proveedores fuera de la red/sin contrato no tienen la obligación de tratar a los miembros de Clover Health, salvo en caso de emergencia. Si desea saber si cubriremos un servicio fuera de la red, le recomendamos que usted o su proveedor solicite una determinación de la organización previa al servicio antes de recibir el servicio. Llame al Servicio al cliente o consulte la Evidencia de cobertura para obtener más información, incluidos los costos compartidos que se aplican a los servicios fuera de la red. Clover Health es un plan de Organización de Proveedores Preferidos (Preferred Provider Organization, PPO) que tiene un contrato con Medicare. La inscripción en Clover Health depende de la renovación del contrato. H5141_2018_Provider_Directory_NJ April-18 3

5 Clover Health cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Clover Health no excluye a las personas ni las trata de manera diferente por su raza, color, nacionalidad, edad, discapacidad o sexo. Clover Health: Ofrece recursos y servicios gratuitos para que las personas con discapacidades se comuniquen con nosotros de manera eficaz, por ejemplo: o Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, entre otros). Brinda servicios lingüísticos gratuitos para las personas cuyo idioma principal no es el inglés, por ejemplo: o Intérpretes calificados. o Información escrita en otros idiomas. Si necesita estos servicios, comuníquese con Servicios para los miembros al Los usuarios de TTY deben llamar al 711. Estamos disponibles los 7 días de la semana, de 8 a. m. a 8 p. m. (hora del este). Desde el 15 de febrero hasta el 30 de septiembre, se usarán tecnologías alternativas (por ejemplo, correo de voz) los fines de semana y los días feriados. Si considera que Clover Health no le brindó estos servicios o lo discriminó de cualquier otra forma por su raza, color, nacionalidad, edad, discapacidad o sexo, puede utilizar la siguiente información para presentar una queja: Clover Health Attention: Appeals and Grievances Harborside Financial Center Plaza 10, Suite 803 Jersey City, NJ Teléfono: Fax: Puede presentar una queja por correo o por fax. Si necesita ayuda para presentar una queja, el Departamento de Apelaciones y Reclamos de Clover Health está disponible para asistirlo. También puede presentar una queja relacionada con sus derechos civiles ante la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos de los EE. UU. en forma electrónica. Para ello, debe acceder al Portal de Reclamos de la Oficina de Derechos Civiles en Utilice la siguiente información si desea presentar un reclamo por correo o por teléfono: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, DC 20201, , (TDD). Los formularios una queja están disponibles en 4 April-18

6 ENGLISH ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call (TTY: 711). SPANISH ATENCIÓN: Si usted habla español, tenemos servicios de asistencia lingüística disponibles para usted sin costo alguno. Llame al (TTY: 711). CHINESE 小贴士 : 如果您说普通话, 欢迎使用免费语言协助服务 请拨 (TTY: 711) VIETNAMESE CHÚ Ý: Nếu quý vị nói tiếng Việt, thì có sẵn các dịch vụ trợ giúp ngôn ngữ miễn phí dành cho quý vị. Hãy gọi số (TTY: 711). KOREAN 알림 : 한국어를하시는경우무료통역서비스가준비되어있습니다 (TTY: 711) 로연락주시기바랍니다. TAGALOG Pansinin: Kung nagsasalita ka ng Tagalog, mga serbisyo ng tulong sa wika, nang walang bayad, ay magagamit sa iyo. Tawagan ang (TTY: 711). RUSSIAN ВНИМАНИЕ: Если вы говорите на русском языке, вам будут бесплатно предоставлены услуги переводчика. Звоните по телефону: (телетайп: 711). FRENCH CREOLE ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele (TTY: 711). April-18 5

7 FRENCH ATTENTION : Si vous parlez français, des services gratuits d interprétation sont à votre disposition. Veuillez appeler le (TTY: 711). POLISH UWAGA: Dla osób mówiących po polsku dostępna jest bezpłatna pomoc językowa. Zadzwoń pod numer (TTY: 711). PORTUGUESE ATENÇÃO: Se fala português, estão disponíveis serviços gratuitos de assistência linguística na sua língua. Telefone para (TTY: 711). ITALIAN ATTENZIONE: Se lei parla italiano, sono disponibili servizi gratuiti di assistenza linguistica nella sua lingua. Chiami (TTY: 711). JAPANESE お知らせ : 日本語での対応を望まれる方には 無料で通訳サービスをご利用になれま す 電話番号 (TTY: 711) までお問い合わせ下さい GERMAN BITTE BEACHTEN: Wenn Sie Deutsch sprechen, stehen Ihnen unsere Dolmetscher unter der Nummer (TTY: 711) kostenlos zur Verfügung. 6 April-18

8 Table of Contents Section 1 - Introduction What is the service area for Clover Health How do you find Clover Health providers in your area? Section 2 - List of Network Care Providers Primary Care Physician New Jersey - Middlesex...24 Family Medicine Geriatric Medicine Internal Medicine...27 Nurse Practitioner, Adult Health Nurse Practitioner, Family...35 Nurse Practitioner, Primary Care...40 Obstetrics and Gynecology...41 Obstetrics and Gynecology, Gynecology Obstetrics and Gynecology, Obstetrics...45 New Jersey - Monmouth Family Medicine Geriatric Medicine Internal Medicine...49 Nurse Practitioner, Adult Health Nurse Practitioner, Family...55 Nurse Practitioner, Primary Care...60 Obstetrics and Gynecology...61 Obstetrics and Gynecology, Gynecology Surgery, Hospice and Palliative Medicine, Internal Medicine New Jersey - Ocean Family Medicine Internal Medicine...66 Nurse Practitioner, Adult Health Nurse Practitioner, Family...69 Obstetrics and Gynecology...72 Obstetrics and Gynecology, Gynecology New Jersey - Somerset...74 Adolescent Medicine Family Medicine Geriatric Medicine Internal Medicine...77 Nurse Practitioner, Family...79 Clover Health Provider Directory April-18 7

9 Nurse Practitioner, Primary Care...80 Obstetrics and Gynecology...81 Obstetrics and Gynecology, Gynecology Specialist New Jersey - Hunterdon...83 Allergy and Immunology...83 Dentist...84 Neurological Surgery...85 Ophthalmology Orthopaedic Surgery, Foot and Ankle Surgery Physical Medicine and Rehabilitation, Pain Medicine Podiatrist Rheumatology...90 Social Worker, Clinical New Jersey - Middlesex...92 Allergy and Immunology...92 Allergy and Immunology, Allergy Audiologist Cardiovascular Disease...95 Chiropractor Clinical Cardiatric Electrophysiology Clinical Genetics Colon and Rectal Surgery Critical Care Medicine Dentist Dentist, General Practice Dentist, Oral and Maxillofacial Surgery Dentist, Orthodontics and Dentofacial Orthopedics Dentist, Pediatric Dentistry Dermatology Dietician, Registered Endocrinology, Diabetes and Metabolism Gastroenterology Hematology Hematology and Oncology Infectious Disease Interventional Cardiology Medical Oncology Midwife, Certified Nurse Nephrology Neurological Surgery April-18

10 Nurse Practitioner Nurse Practitioner, Acute Care Nurse Practitioner, Community Health Nurse Practitioner, Gerontology Nurse Practitioner, Obstetrics and Gynecology Nurse Practitioner, Women s Health Obstetrics and Gynecology, Gynecologic Oncology Ophthalmology Orthopaedic Surgery Otolaryngology Otolaryngology, Facial Plastic Surgery Otolaryngology, Sleep Medicine Physical Medicine and Rehabilitation Physical Medicine and Rehabilitation, Neuromuscular Medicine Physical Medicine and Rehabilitation, Pain Medicine Physical Therapist Physical Therapist, Orthopedic Plastic Surgery Podiatrist Podiatrist, Foot and Ankle Surgery Podiatrist, Foot Surgery Psychiatry and Neurology, Clinical Neurophysiology Psychiatry and Neurology, Neurology Psychiatry and Neurology, Sleep Medicine Psychiatry and Neurology, Vascular Neurology Pulmonary Disease Radiology, Radiation Oncology Rheumatology Sleep Medicine Social Worker, Clinical Surgery Surgery, Plastic and Reconstructive Surgery Surgery, Surgical Oncology Surgery, Vascular Surgery Thoracic Surgery (Cardiothoracic Vascular Surgery) Urology New Jersey - Monmouth Allergy and Immunology Audiologist Audiologist, Assistive Technology Practitioner Cardiovascular Disease April-18 9

11 Chiropractor Clinical Cardiatric Electrophysiology Colon and Rectal Surgery Critical Care Medicine Dentist Dentist, General Practice Dentist, Oral and Maxillofacial Surgery Dentist, Orthodontics and Dentofacial Orthopedics Dentist, Pediatric Dentistry Dermatology Dietician, Registered Endocrinology, Diabetes and Metabolism Gastroenterology Hematology Hematology and Oncology Infectious Disease Interventional Cardiology Medical Oncology Midwife, Certified Nurse Nephrology Neurological Surgery Nurse Practitioner Nurse Practitioner, Acute Care Nurse Practitioner, Community Health Nurse Practitioner, Gerontology Nurse Practitioner, Women s Health Obstetrics and Gynecology, Gynecologic Oncology Obstetrics and Gynecology,Female Pelvic Medicine and Reconstructive Surgery Ophthalmology Orthopaedic Surgery Otolaryngology Physical Medicine and Rehabilitation Physical Therapist Podiatrist Podiatrist, Foot and Ankle Surgery Podiatrist, Foot Surgery Podiatrist, Primary Podiatric Medicine Psychiatry and Neurology, Clinical Neurophysiology Psychiatry and Neurology, Neurology Pulmonary Disease Rheumatology April-18

12 Sleep Medicine Social Worker, Clinical Sports Medicine Student, Health Care Surgery Surgery, Surgical Oncology Surgery, Vascular Surgery Thoracic Surgery (Cardiothoracic Vascular Surgery) Urology New Jersey - Ocean Cardiovascular Disease Chiropractor Chiropractor, Orthopedic Colon and Rectal Surgery Dentist Dentist, General Practice Dentist, Oral and Maxillofacial Surgery Dentist, Pediatric Dentistry Dentist, Periodontics Dermatology Dietician, Registered Gastroenterology Hematology Hematology and Oncology Hepatology Interventional Cardiology Midwife, Certified Nurse Nephrology Neurological Surgery Nurse Practitioner Nurse Practitioner, Community Health Ophthalmology Orthopaedic Surgery Otolaryngology Otolaryngology, Sleep Medicine Pain Medicine, Pain Medicine Physical Medicine and Rehabilitation Physical Therapist Podiatrist Podiatrist, Foot and Ankle Surgery Psychiatry and Neurology, Neurology April-18 11

13 Pulmonary Disease Radiology, Radiation Oncology Rheumatology Social Worker, Clinical Student, Health Care Surgery Surgery, Vascular Surgery Thoracic Surgery (Cardiothoracic Vascular Surgery) Urology New Jersey - Somerset Adult Medicine Allergy and Immunology Cardiovascular Disease Chiropractor Clinical Nurse Specialist, Adult Health Critical Care Medicine Dentist Dentist, General Practice Dentist, Orthodontics and Dentofacial Orthopedics Dermatology Dietician, Registered Endocrinology, Diabetes and Metabolism Gastroenterology Hematology Hematology and Oncology Interventional Cardiology Medical Oncology Midwife, Certified Nurse Nephrology Neurological Surgery Neuromusculoskeletal Medicine and OMM Nurse Practitioner Nurse Practitioner, Community Health Ophthalmology Orthopaedic Surgery Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery Otolaryngology Otolaryngology, Facial Plastic Surgery Otolaryngology, Otolaryngology, Facial Plastic Surgery Physical Medicine and Rehabilitation Physical Medicine and Rehabilitation, Pain Medicine April-18

14 Physical Therapist Plastic Surgery Podiatrist Podiatrist, Foot and Ankle Surgery Podiatrist, Foot Surgery Psychiatry and Neurology, Neurology Pulmonary Disease Rheumatology Sleep Medicine Social Worker, Clinical Sports Medicine Surgery Surgery, Surgical Oncology Urology Hospital New Jersey - Hunterdon Hospitals, Rehabilitation Hospital New Jersey - Middlesex Hospitals, General Acute Care Hospital Hospitals, Rehabilitation Hospital New Jersey - Monmouth Hospital Units, Rehabilitation Unit Hospitals, General Acute Care Hospital Hospitals, Rehabilitation Hospital New Jersey - Ocean Hospitals, General Acute Care Hospital Hospitals, Rehabilitation Hospital Skilled Nursing Facility New Jersey - Hunterdon New Jersey - Middlesex New Jersey - Monmouth New Jersey - Ocean New Jersey - Somerset Outpatient Mental Health Provider New Jersey - Hunterdon Psychologist New Jersey - Middlesex Psychiatry Psychologist Psychologist, Clinical Psychologist, Counseling April-18 13

15 New Jersey - Monmouth Nurse Practitioner, Psychiatric, Mental Health Psychiatry Psychologist New Jersey - Ocean Nurse Practitioner, Psychiatric, Mental Health Psychiatry Psychologist Psychologist, Clinical Other Health Care Provider New Jersey - Hunterdon Clinic, Center, Rehabilitation Laboratories, Clinical Medical Laboratory New Jersey - Middlesex Clinic, Center, Rehabilitation Clinic-Center, Ambulatory Surgical Clinic-Center,Urgent Care Durable Medical Equipment and Medical Supplies Laboratories, Clinical Medical Laboratory Nursing and Custodial Care Facilities, Assisted Living Facility Prosthetic, Orthotic Supplier New Jersey - Monmouth Clinic, Center, Rehabilitation Clinic-Center, Ambulatory Surgical Clinic-Center,Urgent Care Durable Medical Equipment and Medical Supplies Laboratories, Clinical Medical Laboratory Prosthetic, Orthotic Supplier New Jersey - Ocean Agencies, Home Health Clinic, Center, Rehabilitation Clinic-Center, Ambulatory Surgical Clinic-Center,Urgent Care Durable Medical Equipment and Medical Supplies Laboratories, Clinical Medical Laboratory Prosthetic, Orthotic Supplier New Jersey - Somerset Clinic-Center Clinic-Center,Urgent Care Laboratories, Clinical Medical Laboratory Nursing and Custodial Care Facilities, Assisted Living Facility April-18

16 Vision New Jersey - Middlesex New Jersey - Monmouth New Jersey - Ocean New Jersey - Somerset Dental Index April-18 15

17 Section 1 Introduction This directory provides a list of Clover Health s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. You may choose one of our network providers who are listed in this directory to be your Primary Care Provider (P). The term P will be used throughout this directory. Generally, you should get your health care services from your P. A Primary Care Provider (P) is someone that you see for all of your basic medical needs such as preventive care, illness, and injury visits. While our plan doesn t require you to select a P, we strongly encourage you to do so as there are many benefits to having one. A P will often assist you with referrals to specialists and behavioral health care providers. A P can also coordinate access to hospital services when necessary. When prior authorization for a service is needed, your P will contact us before you have services to determine if they will be covered. We have network providers for all services covered under Original Medicare. You can still receive covered services from non-network providers who do not have a signed contract with our plan, as long as those providers agree to accept our plan s terms and conditions of payment. See Section 1.2 of Chapter 3 in your Evidence of Coverage and on our website at: The network providers listed in this directory have agreed to provide you with your health care and vision services. You may go to any of our network providers listed in this directory. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers. Out-of-network/non-contracted providers are under no obligation to treat Clover Health members, except in emergency situations. For a decision about whether we will cover an out-ofnetwork service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our member services number at TTY users should call 711. We are open 8 a.m. 8.p.m EST, 7 days a week. From February 15th through September 30th, alternate technologies (For example, voic ) will be used on the weekends and holidays,or see your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers. Non-contracted providers should bill Clover Health directly. If a non-contracted provider submits a bill directly to you, you should not pay the bill, but should submit it to the plan for processing and determination of your liability, if any, as described below. If you receive a bill from a non-contracted provider, send us your request for payment, along with your bill and documentation of any payment you have made. It s a good idea to make a 16 April-18

18 copy of your bill and receipts for your records. To make sure you are giving us all the information we need to make a decision, please fill out our claim form to make your request for payment. Either download a copy of the form from our website ( or call Member Services and ask for the form. Mail your request for payment for medical services, together with any bills or receipts to us at this address: Clover Health Attention: Medical Claims PO Box 471 Jersey City, NJ You must submit your claim to us within 12 months of the date you received the service or item. Mail your request for payment for eyewear or your out-of-network routine eye exam, together with copy of your Clover Member ID card and any bills or receipts, to us at this address: EyeQuest PO Box 527 Thiensville, WI You can expect to receive reimbursement within 7 to 10 days after EyeQuest has received your receipts. Questions? Please call EyeQuest at Mail your request for payment for the prescription(s), together with any bills or receipts to us at this address: CVS Caremark PO Box Phoenix, AZ You must submit your prescriptions(s) claim to us within 36 months of the date you received the service or item. When you are outside the service area and cannot get care from a network provider, our plan will cover emergency care, urgently needed services, or out-of-area dialysis. Except for emergency care, we cannot pay a provider who is not eligible to participate in Medicare. If you receive care from a provider who is not eligible to participate in Medicare, you may be responsible for the full cost of the services you receive. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers. If you have a medical emergency: Get help as quickly as possible. Call 911 for help or go to the nearest emergency room or April-18 17

19 hospital. Call for an ambulance if you need it. You do not need to get approval or a referral first from your P. 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, at (TTY only, call 711). We re available from 8 am 8 pm, local time, 7 days a week. From February 15 through September 30, alternate technologies (for example, voic ) will be used on the weekends and holidays. If you need assistance locating urgent care services, please call Member Services at the number listed on the back of this book, or visit cloverhealth.com/doctors to locate a network provider. You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health. Our plan does not cover urgently needed services or any other care you receive outside of the United States or its territories 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. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. After the emergency is over, you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. If you get your follow-up care from out-of-network providers, you may pay a higher out-of-network costsharing. 18 April-18

20 What is the service area for Clover Health? The county in our service area is listed below: Atlantic, Bergen, Essex, Hudson, Mercer, Monmouth, Passaic, Somerset and Union, Burlington, Cumberland,Gloucester,Middlesex,Morris,Ocean How do you find Clover Health providers in your area? The directory is organized by provider type. You may search for a provider by his or her type and use the office address provided to determine the most easily accessible location. If you have questions about Clover Health, you can visit cloverhealth.com/doctors or call our Member Services number at (TTY users should call 711) from 8 am 8 pm, local time, 7 days a week. From February 15 through September 30, alternate technologies (for example, voic ) will be used on the weekends and holidays. April-18 19

21 Sección 1 Introducción Este directorio ofrece una lista de los proveedores de la red de Clover Health. Para obtener información detallada sobre su cobertura de atención médica, consulte su Evidencia de cobertura. Usted puede elegir a uno de los proveedores de nuestra red incluidos en este directorio para que sea su proveedor de atención primaria (Primary Care Provider, P). El término P se usará en todo este directorio. En general, usted debe recibir sus servicios de atención médica de su P. Un proveedor de atención primaria (P) es a quien acude para satisfacer todas sus necesidades médicas básicas, como visitas de atención preventiva, por enfermedad o lesión. Nuestro plan no exige que seleccione un P, le recomendamos especialmente que lo haga porque tiene muchos beneficios. Con frecuencia, un P lo ayudará con sus referidos a especialistas y proveedores de salud conductual. Un P también puede coordinar el acceso a servicios hospitalarios, si es necesario. Si se requiere autorización previa para un servicio, su P se comunicará con nosotros antes de que usted reciba los servicios a fin de determinar si tendrán cobertura. Contamos con proveedores de la red para todos los servicios cubiertos por Medicare Original. También puede recibir servicios cubiertos de proveedores que no forman parte de la red y no tienen un contrato firmado con nuestro plan, siempre que esos proveedores acepten los términos y las condiciones de pago de nuestro plan. Consulte la Sección 1.2 del Capítulo 3 de su Evidencia de cobertura o visite nuestro sitio web en Los proveedores de la red incluidos en este directorio han aceptado brindarle sus servicios de atención médica y atención de la visión. Usted puede acudir a cualquiera de los proveedores de la red incluidos en este directorio. Si usted ha visitado a un proveedor de la red, no es obligatorio que continúe acudiendo al mismo proveedor. En algunos casos, es posible que reciba servicios cubiertos de proveedores que no forman parte de la red. Tenga en cuenta que los proveedores fuera de la red/sin contrato no tienen la obligación de tratar a los miembros de Clover Health, salvo en caso de emergencia. Si desea saber si cubriremos un servicio fuera de la red, le recomendamos que usted o su proveedor solicite una determinación de la organización previa al servicio antes de recibir el servicio. Llame a Servicios para los miembros o consulte su Evidencia de cobertura para obtener más información, incluidos los costos compartidos que se aplican a los servicios fuera de la red. Salvo en caso de emergencia o 20 April-18

22 urgencia, es posible que recibir atención de proveedores fuera de la red tenga un costo más alto. Los proveedores sin contrato le facturarán directamente a Clover Health. Si un proveedor sin contrato le envía una factura directamente a usted, no debe pagarla; en cambio, debe enviarla al plan para que la procese y determine su responsabilidad, si corresponde, como se describe a continuación. Si recibe una factura de un proveedor sin contrato, envíenos su solicitud de pago junto con la factura y la documentación de cualquier pago que haya realizado. Es buena idea hacer una copia de su factura y de los recibos para sus registros. Para asegurarse de que nos esté proporcionando toda la información que necesitamos para tomar una decisión, complete nuestro formulario de reclamos para solicitar su pago. Descargue una copia del formulario de nuestro sitio web ( o llame a Servicios para los miembros para solicitarla. Envíenos por correo su solicitud de pago de servicios médicos junto con cualquier factura o recibo a esta dirección: Clover Health Attention: Medical Claims PO Box 471 Jersey City, NJ Debe enviar su reclamo dentro de los 12 meses a partir de la fecha en que recibió el servicio o artículo. Envíenos por correo su solicitud de pago de anteojos o examen de la vista de rutina fuera de la red junto con una copia de su tarjeta de identificación de miembro de Clover y cualquier factura o recibo a esta dirección: EyeQuest PO Box 527 Thiensville, WI Recibirá un reembolso en un plazo de 7 a 10 días después de que EyeQuest haya recibido sus recibos. Alguna pregunta? Llame a EyeQuest al Envíenos por correo su solicitud de pago de los medicamentos con receta junto con cualquier factura o recibo a esta dirección: CVS Caremark PO Box Phoenix, AZ Debe enviarnos su reclamo de medicamentos con receta dentro de los 36 meses a partir de la fecha en que recibió el servicio o artículo. April-18 21

23 Cuando está fuera del área de servicio y no puede recibir atención de un proveedor de la red, el plan cubrirá los servicios de atención de emergencia, de urgencia y de diálisis fuera del área. Excepto por la atención de emergencia, no podemos pagarle a un proveedor que no es elegible para participar en Medicare. Si recibe atención de un proveedor que no es elegible para participar en Medicare, es posible que usted sea responsable del costo total de los servicios que reciba. Salvo en caso de emergencia o urgencia, es posible que recibir atención de proveedores fuera de la red tenga un costo más alto. Si tiene una emergencia médica: Busque ayuda lo más rápido posible. Llame al 911 para pedir ayuda o acuda a la sala de emergencias u hospital más cercano. Si la necesita, llame para pedir una ambulancia. No es necesario que primero obtenga la aprobación o un referido de su P. Asegúrese lo antes posible de que le hayan avisado al plan acerca de la emergencia. Necesitamos hacer el seguimiento de la atención de emergencia que reciba. Usted o alguna otra persona debe llamarnos para avisarnos sobre la atención de emergencia, por lo general, en un plazo de 48 horas, al (para TTY únicamente, llamar al 711). Nuestro horario de atención es de 8 a. m. a 8 p. m., hora local, los 7 días de la semana. Desde el 15 de febrero hasta el 30 de septiembre, se usarán tecnologías alternativas (por ejemplo, correo de voz) los fines de semana y los días feriados. Si necesita ayuda para saber dónde acudir en caso de que necesite servicios de atención de urgencia, llame a Servicios para los miembros al número que aparece en el reverso de este libro, o visite cloverhealth.com/doctors para encontrar un proveedor de la red. Usted puede obtener atención médica de emergencia cubierta cuando lo necesite, en cualquier lugar de los Estados Unidos o sus territorios. El plan cubre los servicios de ambulancia en los casos en los que ir a la sala de emergencias de alguna otra manera podría poner en peligro su salud. Nuestro plan no cubre servicios de urgencia ni ningún otro servicio si los recibe fuera de los Estados Unidos o sus territorios. Si se presenta una emergencia, hablaremos con los médicos que le están brindando atención de emergencia para colaborar en el manejo y el seguimiento de su atención. Los médicos que le brindan atención de emergencia decidirán en qué momento se estabiliza la condición y finaliza la emergencia médica. Una vez que finaliza la emergencia, usted tiene derecho a recibir atención de seguimiento para garantizar que su condición siga estable. Nuestro plan cubrirá la atención de seguimiento. Si recibe atención de seguimiento de proveedores fuera de la red, es posible que usted pague un costo compartido más alto. Cuál es el área de servicio de Clover Health? Los condados en nuestra área de servicio se enumeran a continuación. 22 April-18

24 Condados de Atlantic, Bergen, Essex, Hudson, Mercer, Monmouth, Passaic, Somerset and Union, Burlington, Cumberland,Gloucester,Middlesex,Morris,Ocean. Cómo puede encontrar proveedores de Clover Health en su área? Si tiene preguntas acerca de Clover Health o necesita ayuda para seleccionar un P, visite nuestro sitio web en cloverhealth.com/doctors, o llame a nuestro Departamento de Servicios para los miembros al , (los usuarios de TTY deben llamar al 711). Nuestro horario de atención es de 8 a. m. a 8 p. m., hora local, los 7 días de la semana. Desde el 15 de febrero hasta el 30 de septiembre, se usarán tecnologías alternativas (por ejemplo, correo de voz) los fines de semana y los días feriados. April-18 23

25 Primary Care Physician New Jersey - Middlesex - Family Medicine Bhattacharyya, Adity MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Carnes, Joy-lynne MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Chae, Sung MD JFK Medical Center Family Practice 65 James Street Phone: (732) Fax: (732) Deora, Sonia DO Garden State Physicians, 1002 Amboy Avenue Edison, NJ Phone: (732) Fax: (732) Flores Dieppa, Maria MD JFK Medical Associates PA 616 Grove Avenue Phone: (732) Fax: (732) Kandula, Sridevi MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Kayastha, Shital DO JFK Medical Group 111 James Street Phone: (732) Fax: (732) Lawrence, Denise MD JFK Medical Associates PA 225 May Street Suite F Edison, NJ Phone: (732) Fax: (732) Metz, Deborah MD JFK Medical Center Family Practice 65 James Street Phone: (732) Fax: (732) Metz, John MD JFK Medical Center Family Practice 65 James Street Phone: (732) Fax: (732) Milne, Charlene MD JFK Medical Center Family Practice 65 James Street Phone: (732) Fax: (732) Patel, Dipesh DO JFK Medical Center Family Practice 65 James Street Phone: (732) Fax: (732) Patel, Kalpeshkumar MD Maruti Family and Sleep Medicine LLc 2177 Oak Tree Rd Ste 202 Phone: (732) Fax: (732) PATEL, RAHIL MD Rahil Patel MD LLC 98 James St Ste 105 Phone: (732) Picciano, Anne MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Sinha, Gopal MD Gopal K Sinha MD PA 2 Ethel Rd Edison, NJ Phone: (732) Fax: (732) Wilkis, Michelle MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Winter, Robin MD Community Hospital Group, Inc 65 James Street Phone: (732) Fax: (732) Bordieri, Joseph DO Central Jersey Family Medical Group, PA 333 Forsgate Drive Suite 205 Jamesburg, NJ Phone: (732) Newman, Jared DO Central Jersey Family Medical Group, PA 333 Forsgate Drive Suite 205 Jamesburg, NJ Phone: (732) Garcia, Maria MD JFK Medical Associates PA 561 Middlesex Avenue Metuchen, NJ Phone: (732) Fax: (732) Jasani, Anita MD JFK Medical Associates PA 561 Middlesex Avenue Metuchen, NJ Phone: (732) Fax: (732) Rossy, William MD JFK Medical Associates PA 561 Middlesex Avenue Metuchen, NJ Phone: (732) Fax: (732) Kline, Bradley DO Brunswick-Princeton Family Practice 4105 US Highway 1 Suite 1 Monmouth Juncti, NJ Phone: (732) April-18

26 Primary Care Physician New Jersey - Middlesex - Family Medicine [continued] Mokhashi, Sajida MD Saint Peters Healthcare System 294 Applegarth Road Monroe, NJ Phone: (609) Prasad, Keshav MD Monroe Family Medicine LLC 323 Spotswood Englishtown Rd Monroe, NJ Phone: (732) Fax: (732) Adewunmi, Kafilat DO Jewish Renaissance Medical Center 275 Hobart Street Mobile Unit Newark, NJ Phone: (732) Fax: (732) Raritan Bay Medical Center 3 Hospital Plaza Suite 302 Old Bridge, NJ Phone: (732) Fax: (732) Belder, Olga DO Belder Advanced Medical LLC 69 Highway 516 Old Bridge, NJ Phone: (732) Fax: (732) Faistl, Kenneth MD Group-Primary Care Pc 3 Hospital Plaza Suite 314 Old Bridge, NJ Phone: (732) Fax: (732) Turkish, Jennifer MD Raritan Bay Medical Center 3 Hospital Plaza Suite 302 Old Bridge, NJ Phone: (732) Fax: (732) Patel, Deepa MD JFK Medical Associates PA 3 Parlin Drive Suite F Parlin, NJ Phone: (732) Fax: (732) Adewunmi, Kafilat DO Jewish Renaissance Medical Center 275 Hobart Street SBHC Perth Amboy, NJ Phone: (732) Fax: (732) Flores Dieppa, Maria MD JFK Medical Associates PA 516 Lawrie Street Perth Amboy, NJ Phone: (732) Fax: (732) Fritz, John DO North Logistic Services Inc 214 Smith Street Suite 305 Perth Amboy, NJ Phone: (732) Fax: (732) Oji, Omobola MD Providence Medical Center 345 State St Suite B Perth Amboy, NJ Phone: (732) Fax: (732) Chatterjee, Sonia MD JFK Medical Associates PA 1080 Stelton Road Piscataway, NJ Phone: (848) Fax: (848) Rozehzadeh, Rabin MD Complete Primary Care 1810 Park Avenue South Plainfield, NJ Phone: (908) Fax: (908) Girgis, Linda MD Girgis Family Practice LLC 171 Main St Ste 4 South River, NJ Phone: (732) Fax: (732) Girgis, Moris MD Girgis Family Practice LLC 171 Main St Ste 4 South River, NJ Phone: (732) Fax: (732) April-18 25

27 Primary Care Physician New Jersey - Middlesex - Geriatric Medicine Katseva, Alla MD Alla Katseva MD LLC 561 Cranbury Rd East Brunswick, NJ Phone: (732) Rebba, Bhavana MD JFK Medical Associates PA 225 May Street Suite F Edison, NJ Phone: (732) Fax: (732) Beagin, Erinn MD Saint Peters Healthcare System 294 Applegarth Road Monroe, NJ Phone: (609) Hussain, Aijaz MD Saint Peters Healthcare System 294 Applegarth Road Monroe, NJ Phone: (609) Mokhashi, Sajida MD Saint Peters Healthcare System 294 Applegarth Road Monroe, NJ Phone: (609) Beagin, Erinn MD SPUH Ambulatory Care Group 254 Easton Avenue Phone: (732) Fax: (732) Gubbi, Renukamba MD SPUH Ambulatory Care Group 254 Easton Avenue Phone: (732) Fax: (732) Moondra, Palak DO SPUH Ambulatory Care Group 254 Easton Avenue Phone: (732) Fax: (732) April-18

28 Primary Care Physician New Jersey - Middlesex - Internal Medicine Goraya, Sukhjender MD Carteret Medical Enterprises 125 Washington Ave Carteret, NJ Phone: (732) Fax: (732) Peter, Andras MD Andras Peter, MD 32 Tennyson St Carteret, NJ Phone: (732) Fax: (732) Isukapalli, Padmaja MD Inman Medical Associates 805 Inman Ave Colonia, NJ Phone: (732) Fax: (732) Jain, Sapna MD Inman Medical Associates 805 Inman Ave Colonia, NJ Phone: (732) Fax: (732) Sahni, Harsha MD Harsha Sahni MD 534 Inman Ave Colonia, NJ Phone: (732) Asif, Mohammed MD CarePoint Medical Group 172 Summerhill Road Suite 6 East Brunswick, NJ Phone: (732) Fax: (732) Babu, Sarath MD Medcenter 51 West Prospect Street Suite #101 East Brunswick, NJ Phone: (732) Fax: (732) Carlucci, Michael MD Saint Peters Healthcare System 6 Brier Hill Court East Brunswick, NJ Phone: (732) Fax: (732) Gabriel, Ahab MD F Gabriel Limited Liability Co 63 West Prospect Street East Brunswick, NJ Phone: (732) Katseva, Alla MD Alla Katseva MD LLC 561 Cranbury Rd East Brunswick, NJ Phone: (732) Moussa, Alber MD Brunswick Medical Associates 73 Brunswick Woods Dr East Brunswick, NJ Phone: (732) Fax: (732) Patel, Arpit MD CarePoint Medical Group 172 Summerhill Road Suite 4 East Brunswick, NJ Phone: (732) Fax: (732) Werthaim, Ofer MD Doctors Care Center PA 579 Cranbury Rd Ste A East Brunswick, NJ Phone: (732) Fax: (732) Zhang, Miaoying MD M. Zhang Md LLC D-2 Brier Hill Court Bangalore, Ramamurthy MD Medical Care Associates 1740 Oak Tree Rd Phone: (732) Blum, Paul MD JFK Medical Associates PA 69 Route 27 Phone: (732) Fax: (732) Bruzzi Ehrlich, Diane MD Medicenter of Edison 1813 Oak Tree Rd Phone: (908) Fax: (908) Bullock, Richard MD JFK Medical Associates PA 225 May Street Suite E Edison, NJ Phone: (732) Fax: (732) Dendi, Preethi MD JFK Medical Associates PA 2 Lincoln Highway Suite 302 Phone: (732) Fax: (732) Johal, Gurvindra DO Medicenter of Edison 1813 Oak Tree Rd Phone: (908) Fax: (908) East Brunswick, NJ Phone: (732) Fax: (732) Johal, Gurvindra DO Urgent Care of Edison PA 1813 Oak Tree Rd Phone: (908) Fax: (908) Long, George MD Qualcare Medi-Center, PA 2 State Route 27 Suite 411 Phone: (732) Fax: (732) Mendu, Srinivas MD Garden State Physicians, 1002 Amboy Avenue Edison, NJ Phone: (732) Fax: (732) Murray, Carl MD JFK Medical Associates PA 225 May Street Suite F Edison, NJ Phone: (732) Fax: (732) Murray, Carl MD JFK Medical Associates PA 3 Hospital Plaza Suite 305 Edison, NJ Phone: (732) Fax: (732) Nigam, Jyoti MD JFK Medical Associates PA 2 Lincoln Highway Suite 302 Phone: (732) Fax: (732) April-18 27

29 Primary Care Physician New Jersey - Middlesex - Internal Medicine [continued] Parikh, Rakesh MD JFK Medical Associates PA 111 James Street Phone: (732) Fax: (732) Parikh, Rakesh MD JFK Medical Group 111 James Street Phone: (732) Fax: (732) Patel, Pankaj MD Oak Tree Patient Care 1941 Oak Tree Rd Suite 203 Phone: (732) Polos, Peter MD New Jersey Neuroscience Institute 65 James Street Phone: (732) Fax: (732) Rajan, Samir MD Associates in Kidney Disease and Hypertension LLC 2177 Oak Tree Rd Ste 204 Phone: (908) Fax: (908) Rajaram, Sri Sujanthy MD Windsor Medical Center PA 64 James St Phone: (732) Shah, Pradip MD Pradip A Shah MD 1964 Oak Tree Rd Phone: (732) Sharma, Madho MD Madho K Sharma MD PA 974 Inman Ave Phone: (908) Fax: (908) Singh, Bikramjit MD North Edison Family Practice LLC Progress St Ste A3 Phone: (908) Fax: (908) Sutaria, Samir MD Associates in Kidney Disease and Hypertension LLC 2177 Oak Tree Rd Ste 204 Phone: (908) Fax: (908) Tawde, Darshana MD JFK Medical Associates PA 225 May Street Suite E Edison, NJ Phone: (732) Fax: (732) Taylor, Marion MD Doctors Associates of Central Jersey LLC 1813 Oak Tree Rd Phone: (732) Fax: (732) Vallabhaneni, Purnima MD JFK Medical Associates PA 111 James Street Phone: (732) Fax: (732) Vallabhaneni, Purnima MD JFK Medical Group 111 James Street Phone: (732) Fax: (732) Sharma, Madho MD Madho K Sharma MD PA 30 Hoy Ave Fords, NJ Phone: (732) Katz, Brian MD Central Jersey Gastroenterology 85 Raritan Ave Ste 125 Highland Park, NJ Phone: (732) Fax: (732) Horvath, Katalin MD JFK Medical Associates PA 1200 Green Street 1st Floor Iselin, NJ Phone: (732) Fax: (732) Patel, Arvind MD JFK Medical Associates PA 1200 Green Street 1st Floor Iselin, NJ Phone: (732) Fax: (732) Carlucci, Michael MD Saint Peters Healthcare System 333 Forsgate Drive Jamesburg, NJ Phone: (732) Fax: (732) Epstein, Christina MD Central Jersey Internal Medicine Associates, PA 111 Union Valley Road Suite 203 Jamesburg, NJ Phone: (609) Fax: (609) Jain, Deepak MD Central Jersey Internal Medicine Associates, PA 111 Union Valley Road Suite 203 Jamesburg, NJ Phone: (609) Fax: (609) Khan, Rizwana MD Saint Peters Healthcare System 333 Forsgate Drive Jamesburg, NJ Phone: (732) Fax: (732) Larose, Jean-Eddy DO Saint Peters Healthcare System 333 Forsgate Drive Jamesburg, NJ Phone: (732) Fax: (732) Patel, Nikesh MD Saint Peters Healthcare System 333 Forsgate Drive Jamesburg, NJ Phone: (732) Fax: (732) April-18

30 Primary Care Physician New Jersey - Middlesex - Internal Medicine [continued] Rao, Megha MD Saint Peters Healthcare System 333 Forsgate Drive Jamesburg, NJ Phone: (732) Fax: (732) Rizvi, Tariq MD Central Jersey Internal Medicine Associates, PA 111 Union Valley Road Suite 203 Jamesburg, NJ Phone: (609) Fax: (609) Verdoni, John MD John A. Verdoni M.D. 11 Centre Drive Suite A Jamesburg, NJ Phone: (609) Doshi, Arvind MD Arvind Doshi Md Pa 5 Stanworth Road Kendall Park, NJ Phone: (732) Kainth, Inderjit MD Brunswick Internal Medicine Group 3270 Route 27 Suite Ste 1300 Kendall Park, NJ Phone: (732) Mongia, Rupa MD Spectrum Medical Associates 3250 State Route 27 Suite 102 and 103 Kendall Park, NJ Phone: (732) Fax: (732) Nair, Swapna MD JFK Medical Associates PA 3084 Route 27 Suite 1 Kendall Park, NJ Phone: (732) Fax: (732) Nair, Swapna MD JFK Medical Group 3084 Route 27 #1 Kendall Park, NJ Phone: (732) Fax: (732) Vallabhaneni, Purnima MD JFK Medical Associates PA 3084 Route 27 Suite 1 Kendall Park, NJ Phone: (732) Fax: (732) Vallabhaneni, Purnima MD JFK Medical Group 3084 Route 27 #1 Kendall Park, NJ Phone: (732) Fax: (732) Kainth, Inderjit MD Brunswick Internal Medicine Group 17 Bridge St Metuchen, NJ Phone: (732) Fax: (732) Lin, Harry MD Bridgepoint Medical Associates 201 Bridge St Metuchen, NJ Phone: (732) Fax: (732) Misko, Gary MD Pemcare LLC 267 Central Avenue Metuchen, NJ Phone: (732) Fax: (732) Zhou, Ren MD Ren Zhou MD 233 Bridge St Bldg F Metuchen, NJ Phone: (732) Fax: (732) Sjolund, Paula DO PAULA SJOLUND, DO, LLC 72 Washington Avenue Milltown, NJ Phone: (732) Regulapati, Saritha MD Sr Medical Center Llc 462 New Road Monmouth Jct., NJ Phone: (732) Arabi, Nida MD Hypertension And Nephrology Specialists Llc 2 Research Way Suite 301 Monroe, NJ Phone: (732) Goldstein, Debra MD Saint Peters Healthcare System 294 Applegarth Road Monroe, NJ Phone: (609) Chokshi, Seema MD Premier Medicine & Wellness Offices 8 Centre Drive Monroe Township, NJ Phone: (609) Foster, Ronald MD JFK Medical Associates PA 7 Centre Drive Suite 13 Monroe Township, NJ Phone: (609) Fax: (732) Katz, Brian MD Central Jersey Gastroenterology 7 Centre Dr Ste 13 Monroe Township, NJ Phone: (732) Fax: (732) Potharlanka, Prathibha MD Premier Medicine & Wellness Offices 8 Centre Drive Monroe Township, NJ Phone: (609) Thomas, Cherryl MD Hamilton Allergy, Asthma & Sinus Center, PA 18 Centre Drive Suite 205 Monroe Township, NJ Phone: (732) Amir, Saba MD SPUH Ambulatory Care Group 123 How Lane Phone: (732) Fax: (732) April-18 29

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