Virginia Premier and Sentara Healthcare Announcement
Virginia Premier is here to help you find quality health care services. We offer members an excellent network of doctors, hospitals and other healthcare providers and a wide range of Medicare services.
The Provider & Pharmacy Directories list the providers and pharmacies in the Virginia Premier network.
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, 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.
Using out-of-network providers
With few exceptions, you must pay for services you receive from providers who are not part of the Virginia Premier network unless Virginia Premier has approved these services in advance. The exceptions are care for a medical emergency, urgently needed care, out-of-area renal (kidney) dialysis services and services that are found upon appeal to be services that we should have paid or covered.
What are “network pharmacies”?
Network pharmacies are pharmacies (drug stores) that have agreed to fill prescriptions for our plan members. Use the Provider & 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.
For additional information regarding the Virginia Premier Medicare Advantage network, please see your plan’s Evidence of Coverage.
You will have certain rights, as well as responsibilities, as a member of a Virginia Premier Medicare Advantage plan. You can think of those rights and responsibilities as a type of agreement with us as part of our partnership for your health care. We also have information for your rights upon disenrollment.
If you believe you have qualified for Extra Help (also called low-income subsidy (LIS) level) and you believe that you are paying an incorrect cost-share amount when you get your prescription(s) at a pharmacy; Virginia Premier has established a process that allows you to provide the evidence you already have to us.
You can provide us one of the following:
- A copy of the Medicaid card with the member’s name and an eligibility date;
- One of the following letters from Social Security Administration showing Extra Help and effective date:
- “Important Information” Letter;
- “Award” Letter;
- “Notice of Change” Letter;
- “Notice of Action” Letter
You may be asked to provide additional documentation if you are institutionalized.
To initiate the BAE review complete the Best Available Evidence Request Form or for further assistance please call Virginia Premier at 1-877-739-1370 (TTY: 711) or see the Centers for Medicare & Medicaid Services (CMS) website for more information.
Empowering a Healthier You
For many, turning 65 is synonymous with Medicare – and for good reason. This is the age when most people start to receive their Medicare benefits.
What is an explanation of benefits? Every once in a while, you’ll get an Explanation of Benefits, also known as an “EOB” from your health insurer. What is it? What is it trying to tell you? Is it a bill? No, it’s not a bill, but it does have useful information.