Care from Out-of-Network Providers
Your Primary Care Physician/Provider (PCP) must be part of our network. You will receive the majority of your healthcare services from your PCP.
But there may be times when you receive care from an out-of-network provider. If you receive a bill from a provider who is not part of Prominence Health Plan’s network, please do not pay the bill. Rather, send the bill to us at:
Prominence Health Plan
P.O. Box 15859
Tampa, FL 33684-5859
If the service you received is covered, we will pay the bill. If it is not, we will send you a notice to inform you why we determined the service was not covered. The notice will include your appeal rights.
You can also call our Member Service Department at 855-969-5882 (TTY: 711). Our hours of operation are:
- October 1 to March 31: Seven days a week from 8 a.m. to 8 p.m.
- April 1 to September 30: Monday through Friday from 8 a.m. to 8 p.m.
Why Use Network Providers?
Your PCP is a provider with the licensing, education and training to provide basic medical care and coordinate all your healthcare needs. PCPs are considered your “medical home” and you must see your PCP for most of your routine healthcare needs.
Our network providers have agreed to provide you with your healthcare coverage. Your PCP will help you determine the type of care you need and will help you if you need other services like hospitalization or physical therapy. You can switch PCPs within our network at any time.
It is important to know which providers are part of our network. With limited exceptions, while you are a member of our plan you must use network providers to get your medical care and network pharmacies to get your prescription drugs. The only exceptions are emergencies, urgently needed services when a network provider is not available (generally worldwide emergency and urgent care), out-of-area dialysis services, and cases in which we authorize use of out-of-network providers. If you obtain routine care from out-of-network providers, neither Medicare nor Prominence Health will be responsible for the costs.
Please refer to your Evidence of Coverage (EOC) for more information.
Last update 9/25/2019