H2962_Combined PPD v120_C
2020 PROVIDER &
This directory is current as of 11/02/2020.
please call our Member Services Department at 1-888-657-4170, Monday through Sunday 8 a.m. to 8 p.m.
Federal holidays. TTY users should call 711.
This document may be available in other formats such as large print or other alternate formats. If you need
Section 1 – Introduction _________________________________________________________ i
Table of Contents – Preface
What is the service area for Ultimate Health Plans? _____________________________ iii
How do you find Ultimate Health Plans providers and pharmacies in your area? ______ iii
Section 1 – Introduction
This directory provides a list of Ultimate Health Plans’ network providers. To get detailed information about
your health care coverage, please see your Evidence of Coverage (EOC).
This booklet provides a list of our network pharmacies. To get a complete description of your prescription
coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Acclaim by
Ultimate (HMO)’s, Acclaim Plus by Ultimate (HMO)’s, Advantage Care by Ultimate (HMO C-SNP)’s, Ascend
Plus by Ultimate (HMO)’s, Elite by Ultimate (HMO)’s, Premier by Ultimate (HMO)’s and Premier Plus by
Ultimate (HMO)’s formulary.
How to access our plan’s providers and pharmacies
You will have to choose one of our network providers who are listed in this directory to be your Primary Care
Provider (PCP). Generally, you must get your health care coverage from your PCP. Your PCP is a physician
who meets state requirements and is trained to give you medical care. Your PCP serves as your medical home,
and you will get your routine or basic care from your PCP. The types of providers that may act as a PCP are:
General Practice, Family Practice, and Internal Medicine physicians.
You may choose your PCP from the Provider and Pharmacy Directory. You may also view the most up-to-date
Provider and Pharmacy Directory online at www.ChooseUltimate.com. If you require assistance in choosing
your PCP, contact Member Services (phone numbers can be found on the cover of this booklet).
The network providers listed in this 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 a referral.
Your PCP will coordinate and provide you referrals for certain covered services you get as a member of our
plan. In some cases, you may get covered services from non-network providers. Please refer to your Evidence
of Coverage for more information.
Some provider services require a prior authorization. In addition to providing you referrals to a specialist when
needed, your PCP (or specialist in some cases) will obtain prior authorization (approval in advance) from
Ultimate Health Plans for certain services and items, such as elective hospital admissions, MRI/PET scans, etc.
For a complete list of the services that may require Ultimate Health Plans’ approval in advance, please refer to
your Evidence of Coverage.
Your PCP selection may limit the specialists you can see. If there are specific specialists you want to use, find
out whether your PCP sends patients to these specialists, as your PCP may only refer patients to certain
participating providers. Please check first to be sure your PCP can refer you to an in-network specialist, or
hospital you may want to use. If you have been going to one network provider, you are not required to continue
going to that same provider.
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 our plan 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.
All network pharmacies may not be listed in this directory. Pharmacies may have been added or removed from
the list after this directory was printed. This means the pharmacies listed here may no longer be in our network,
or there may be newer pharmacies in our network that are not listed. This list is current as of 11/02/2020. For
the most current list, please contact us. Our contact information appears on the front and back cover pages.
You can get prescription drugs shipped to your home through our network mail order delivery program. For
more information, please contact us or see the mail order section of this Provider and Pharmacy Directory.
If you have questions about any of the above, please see the first and last cover pages of this directory for
information on how to contact us.
Services that don’t require approval in advance
Referrals from your PCP are not required for emergency care or urgently needed care. There are also some
other kinds of care you can get without having approval in advance from your PCP, such as preventive
services, routine women’s health care covered dermatology, podiatry and chiropractic services, covered mental
health services, flu shots and vaccinations.
What to do if you get a bill from a non-contracted provider
There may be times when you get a bill from a non-contracted provider for the full cost of medical care you
have received. You should send this bill to us instead of paying it. We will look at the bill and decide whether
the services should be covered. If we decide they should be covered, we will pay the provider our share of the
cost directly. You will be responsible for paying your share of the cost. For more information on situations in
which you may need to ask us for reimbursement or to pay a bill you have received from a provider (including
where to send your request for payment), see chapter 7 of your Evidence of Coverage (Asking us to pay our
share of a bill you have received for covered medical services or drugs).
Getting Care if you have a medical emergency
A “medical emergency” is when you, or any other prudent layperson with an average knowledge of health and
medicine, believe that you have medical symptoms that require immediate medical attention to prevent loss of
life, loss of a limb, or loss of function of a limb. The medical symptoms may be an illness, injury, severe pain,
or a medical condition that is quickly getting worse.
You may get covered emergency medical care whenever you need it, anywhere in the world. If you have a
medical emergency, get help as quickly as possible. Call 911 for help or go to the nearest emergency room or
hospital. Call for an ambulance if you need it. Our plan covers ambulance services in situations where getting to
the emergency room in any other way could endanger your health. You do not need to get approval or a referral
first from your PCP.
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 your emergency
care is provided by out of network providers, we will try to arrange for network providers to take over your care
as soon as your medical condition and the circumstances allow.
What if you are outside the plan’s service area when you have an urgent need for care?
When you are outside the service area and cannot get care from a network provider, our plan will cover urgently
needed care that you get from any provider. Our plan does not cover urgently needed care or any other non-
emergency care if you receive the care outside of the United States.
You must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis
or other services. If you obtain routine care from out-of-network providers, neither Medicare nor Ultimate
Health Plans will be responsible for the costs.
What is the service area for Ultimate Health Plans?
The counties in our service area are listed below.
The service area for Premier by Ultimate is Hernando County.
The service area for Premier Plus by Ultimate is Citrus, Hernando and Pasco Counties.
The service area for Elite by Ultimate is Citrus and Pasco Counties.
The service area for Acclaim by Ultimate and Acclaim Plus by Ultimate is Pinellas County.
The service area for Ascend Plus by Ultimate is Marion and Sumter Counties.
The service area for Advantage Care by Ultimate is Citrus, Hernando and Pasco Counties.
How do you find Ultimate Health Plans providers and pharmacies that serve your area?
Find Doctors, Hospitals, Skilled Nursing Facilities, Outpatient Mental Health and Ancillary Providers
Ultimate Health Plans’ providers are listed by specialty in Section 2. The PCPs are listed first, followed by
specialists listed by specialty type in alphabetical order (Cardiology, Chiropractic, Endocrinology), then
hospitals, skilled nursing facili