The counties in our service area are listed below.

• Albany
• The Bronx
• Kings (Brooklyn)
• Nassau
• New York (Manhattan)
• Queens 
• Rensselaer
• Richmond (Staten Island)
• Schenectady
• Suffolk
• Westchester

A Person Centered Service Plan (PCSP) is a care plan developed by the member’s care manager and based on his/her assessment of the member’s medical, social, and environmental needs and history, functional level and support systems.

Providers are health professionals and support providers such as doctors, nurses, pharmacists, therapists, and other people who provide care and services. Services include medical care, long-term services and supports (LTSS), supplies, prescription drugs, equipment, and other services. 

The term “providers” also includes facilities such as hospitals, clinics, and other places that provide medical services, medical equipment, and LTSS.

Providers that are a part of our plan’s network are called network providers.

Network providers have contracted with us to deliver services to members of our plan. Network providers participate in our plan. That means they accept members of our plan and provide services that our plan covers. The providers in our network generally bill us directly for care they give you. A primary care provider (PCP) is a network physician or nurse practitioner who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time.

A primary care provider (PCP) is a network physician or nurse practitioner who gives you routine health care. Your PCP will keep your medical records and get to know your health needs over time.

Specialists are doctors who provide health care services for a specific disease or part of the body. There are many kinds of specialists. Here are a few examples:

• Oncologists care for patients with cancer.
• Cardiologists care for patients with heart conditions.
• Orthopedists care for patients with certain bone, joint, or muscle conditions.

You can get services from any provider who is in our network and is accepting new members.

When you become a member of our plan, you will choose a PCP who is part of our plan network. This provider will be your PCP.

If you did not choose a PCP or would like to make a change to your PCP, go to the search tool, and choose a provider:

• That you use now
• Who has been recommended by someone you trust
• Whose offices are easy for you to get to

If you need help in choosing a PCP, please call us.

If you do not select a network PCP, one will be assigned to you.

If you have questions about whether we will pay for any medical service or care that you want or need, call us at the number in the introductory paragraph at the top of this page and ask before you get the service or care.

You must get all your covered services from providers within our network. If you go to providers who are not in our network (without prior authorization or approval from us), you will have to pay the bill.

A prior authorization is an approval from the plan before you can get a specific service or drug or see an out-of-network provider. The plan may not cover the service or drug if you don’t get approval.

The exceptions to this rule are when you need urgent or emergency care or dialysis and cannot get to a provider in the plan, such as when you are away from home. Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area, you must use plan providers for urgent care. In addition, when out of the service area, you can obtain dialysis treatment from any qualified dialysis provider. You can also go outside the plan for other non-emergency services if the plan gives you permission first.

• You may change providers within the network at any time during the year. If you have been going to one network provider, you do not have to keep going to that same provider. You may change your PCP at any time during your enrollment in the plan. You may choose only PCPs in the network. To change a PCP, please call us at the number noted at the top of this page.
• The plan works with all the providers in our network to accommodate the needs of people with disabilities. As applicable, the list of network providers in this directory includes information about the accommodations they provide.
•  If you need to see a provider and are not sure if they offer the accommodations you need, we can help you. Talk to your Care Team for assistance.

Our directory includes providers for both Medicare services.

To find a provider near you, or that fits your specific need, select the type of provider you are looking for and filter by location.

Icons in the provider listings will indicate additional information such as if a provider is wheelchair accessible, speaks other languages, accepts new patients, and more. To see the full detailed information for a provider while using the online search tool, click the View Full Profile button on the listing. The Map button will provide you with access to ways you may be able to get to the provider’s office.

If you have questions about this plan or need assistance in selecting a PCP, please call us.

You may obtain services from out-of-network providers in the following situations:

• You are out of the service area and need dialysis.
• You are in need of a special service that is not available from one of the in-network providers.
• You have an emergency or are in need of urgent care.

Except in an emergency, you must obtain authorization from VNS Health. Contact us at the number noted at the top of this page for more information or to arrange for services.

As a member of VNS Health Total, you do not need a referral from your primary care provider (PCP) for network specialists or hospitals. Your PCP may provide you with assistance if you need help selecting a specialist or hospital. In some instances, your physician may request that you receive additional diagnostic tests or procedures. In these instances, your physician will need to obtain prior authorization from VNS Health.

You can get additional information on how to access specialty care by calling us at the number in the introduction at the top of this page.

Appointment wait times standards for primary care and behavioral health services are as follow:

• Urgently needed services or emergency—immediately;
• Services that are not emergency or urgently needed, but the enrollee requires medical attention—within 7 business days; and
• Routine and preventive care—within 30 business days.

The online search tool provides a listing of pharmacies in the VNS Health Total’s network. These network pharmacies are pharmacies that have agreed to provide prescription drugs to you as a member of the plan.

You may access pharmacies outside of the plan’s service areas through our nationwide pharmacy network.

• VNS Health Total members must use network pharmacies to get prescription drugs.
• You must use network pharmacies except in emergency or urgent care situations.
• If you go to an out-of-network pharmacy for prescriptions when it is not an emergency, you will have to pay out-of-pocket for the service. Read your Evidence of Coverage/Member Handbook for more information.
• For up-to-date information about the VNS Health Total network pharmacies in your area, please go to our online search tool or call us at the number at the top of this page.

To get a complete description of your prescription coverage, including how to fill your prescriptions, please review your Evidence of Coverage/Member Handbook and the VNS Health Total’s Formulary. You can find these materials here.

Along with retail pharmacies, your plan’s network of pharmacies includes:

• Mail-order pharmacies send covered prescription drugs to members through the mail or shipping companies.
• Home infusion pharmacies prepare prescription drugs that are given through a vein, within a muscle, or in another non-oral way by a trained provider in your home.
• Long-term-care pharmacies serve residents of long-term-care facilities, such as nursing homes.
• Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies

You are not required to continue going to the same pharmacy to fill your prescriptions. You can go to any of the pharmacies in our network.

The directory listings are current as of the date noted as “Last data update” at the bottom of the web search tool page and in the left-hand column of the search tool.

You can get prescription drugs shipped to your home through our network mail-order delivery program, which is called Birdi™.  For more information, please call us at the number at the top of this page, or see the mail-order pharmacies section under “What are the different types of pharmacies in the VNS Health Total network?”

• Retail pharmacies — You can go to any of the pharmacies in our network.
• Mail-order pharmacies — You can get prescription drugs shipped to your home through our network mail-order delivery program, which is called Postal Prescription Services. To enroll in this program, please call us. Or visit our Medications page, and download the prescription mail-order form.
  Typically, you should expect to get your prescription drugs within 14 days from the time that the mail-order pharmacy gets the order. If you do not get your prescription drugs within this time, or if you need to ask for a refund for prescriptions you got that you did not want or need, please call us at the number noted at the top of this page.
• Home infusion pharmacies — We will cover home infusion therapy if:
  • Your prescription drug is on our plan’s formulary, or a formulary exception has been granted for your prescription drug.
  • Our plan has approved your prescription for home infusion therapy.
  • Your prescription is written by an authorized prescriber.
• Long-term-care pharmacies — Residents of a long-term-care facility may access their prescription drugs covered under VNS Health Total through the facility’s long-term-care pharmacy or another network long-term-care pharmacy.
• Indian Health Service/Tribal/Urban Indian Health Program (I/T/U) pharmacies — Only Native Americans and Alaska Natives have access to I/T/U pharmacies through the VNS Health Total pharmacy network. Those other than Native Americans and Alaskan Natives may be able to go to these pharmacies under limited circumstances (e.g., emergencies).

Please refer to the search tool for a list of home infusion, long-term-care, and I/T/U pharmacies that are in the plan’s network. If you need additional services, please call us at the number noted at the top of this page.