VNSNY CHOICE Total (HMO SNP) 2019 Provider and Pharmacy Directory
This is an introduction of the VNSNY CHOICE Total Provider and Pharmacy Directory. Follow this link to use our online search directory.
The service area for VNSNY CHOICE Total includes the Bronx, Kings (Brooklyn), Nassau, New York (Manhattan), Queens, Richmond (Staten Island), Suffolk, and Westchester.
The directory is current as of the date noted as “last date update” noted on the left-hand column of the directory. For more information or other questions, please contact VNSNY CHOICE Total Member Services. Prospective members can call 1-866-783-1444 (TTY 711), 7 days a week, from 8 am – 8 pm.
You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP), also known as your doctor. Generally, you must get your health care coverage from your PCP.
Your PCP is a network doctor or nurse practitioner who meets state requirements and is trained to provide your basic medical care. The term “PCP” will be used throughout this directory. When you enroll in our plan, you must select a PCP who is part of the VNSNY CHOICE Total network. If you do not select a network PCP, one will be assigned to you. You do not need a referral to make appointments with your PCP.
You may change your PCP at any time. Call Member Services and we will check to make sure that the new is accepting new patients. When you change your PCP, Member Services will also change your membership record to show the name of your new PCP. Member Services will also tell you when this change takes effect and will send you a new Membership ID card that includes updated information about our PCP.
Generally, you will see your PCP for most of your routine health care needs. Your PCP can also help you arrange or coordinate many of the covered services you receive as a plan member. Your PCP also contacts other plan providers for updates about your care and/or treatment. In some instances, your doctor may request that you receive additional diagnostic tests or procedures. In these instances, your doctor will need to obtain prior authorization from VNSNY CHOICE Total. All of the doctors who participate in VNSNY CHOICE Total have received a handbook that tells them what they need to do to obtain an authorization and the procedures they need to follow.
The network providers listed in the Total 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 an authorization. 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.
You can see a specialist without a referral from VNSNY CHOICE Total or your PCP. If you get other services from any doctor, hospital, or other health care provider without getting an authorization in advance from VNSNY CHOICE Total, you may have to pay for services yourself — even if you get services from a plan provider. Please see your Evidence of Coverage (2019 and 2020) for more information about the types of services you can get on your own without approval in advance from VNSNY CHOICE Total.
While you are a member of VNSNY CHOICE Total, you must use our network providers to get covered services, except in limited cases such as emergency care, urgently needed care when our network is not available for out-of-service area dialysis. If an out-of-network provider asks you to pay for these services, please do not pay the bill. You can call Member Services or send us the bill for payment. If you have already paid for the covered services, you can send the bill to us and we will reimburse you for services that are the plan’s responsibility.
Emergency care can always be obtained in or out of the service area from the nearest available provider. When you are in our service area, you must use plan providers for urgent care. When you are out of the service area, urgent care may be obtained from the first available provider. In addition, when you are out of the service area, you can obtain dialysis treatment from any qualified dialysis provider. If you obtain routine care from out-of-network providers, neither Medicare nor VNSNY CHOICE Total will be responsible for the costs.
If you have an emergency:
- Get help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital or urgent care center. You don’t need to get approval or a referral from your doctor or other network provider.
- Make sure that we know about your emergency as soon as possible. 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. Please call Member Services.
We will talk with the doctors who are providing your emergency care to help manage and follow up on your care. When the doctors who are giving you emergency care say that your condition is stable and the medical emergency is over, you are still entitled to follow-up post-stabilization care. 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.
Urgently needed care refers to a non-emergency situation where you are:
- Inside the United States or when you travel outside of the United States
- Temporarily absent from the Plan’s authorized service area
- In need of medical attention right away for an unforeseen illness, injury or condition, and it is not reasonable given the situation for you to obtain medical care through the plan’s participating provider network
Under unusual and extraordinary circumstances, care may be considered urgently needed and paid for by our plan when you are in the service area, but the provider network of the plan is temporarily unavailable or inaccessible.
The counties in our service area for VNSNY CHOICE Total are listed below.
- The Bronx
- Kings (Brooklyn)
- New York (Manhattan)
- Richmond (Staten Island)
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 Medicaid and more. To see the full detailed information for a provider, 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 VNSNY CHOICE Total or need assistance in selecting a PCP, please call Member Service at 1-866-783-1444 (TTY 711), 7 days a week, from 8 am – 8 pm.
The directory provides a list of VNSNY CHOICE Total’s network pharmacies.
To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage (2019 and 2020) and VNSNY CHOICE Total’s formulary (2019 and 2020).
We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under VNSNY CHOICE Total only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage.
The directory listings are current as of the date noted as “last date update” noted at the bottom of the web search tool page or on 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 Postal Prescription Services. For more information, please contact Member Services or see the mail order section below.
For a listing of the service area, see the section above called What is the service area for VNSNY CHOICE Total? There are more pharmacies where your prescriptions may be covered by our Plan. For information on more pharmacies in our plan network not listed in this directory, please call Member Services at 1-866-783-1444 (TTY 711), 7 days a week from 8 am – 8 pm.
- Retail Pharmacies
- 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 service, please call Member Services or visit our Member Services page and download the prescription mail order form.
For refills of your mail order prescriptions, please contact us 14 days before you think the drugs you have on hand will run out to make sure your next order is shipped to you in time. Typically, you should expect to receive your prescription 14 days from the time that the mail order pharmacy receives the order. If you do not receive your prescription drug(s) within this time, please contact us at
1-866-783-1444 (TTY 711).
- Home Infusion Pharmacies
VNSNY CHOICE Total 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.
- Your prescription drug is not otherwise covered under our plan’s medical benefit.
- 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 VNSNY CHOICE 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 Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) Pharmacies through VNSNY CHOICE Total’s 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 Indian Health Service / Tribal / Urban Indian Health Program (I/T/U) pharmacies that are in the plan’s network. If you need additional services, please call Member Services at 1-866-783-1444 (TTY: 711), 7 days a week, from 8 am – 8 pm.
- Retail Pharmacies
Last updated: 10/18/2019