Forethought Life Insurance Company Medicare Select Provider Network

Transcription

1 Forethought Life Insurance Company Medicare Select Provider Network rev 3/09/2012

2 WELCOME Welcome to the individual Medicare SELECT Medicare supplement program from Forethought Life Insurance Company. We are pleased to offer these hospitals to our policyholders. Medicare SELECT has a participating hospital network that is serving the medical needs of your community by containing costs while maintaining quality health care. For information on hospitals located in a specific area, please refer to the provider listings on the following pages. IMPORTANT DIRECTORY INFORMATION With Medicare SELECT Medicare supplement coverage, you have the freedom to choose any participating network hospital in your area. If you need emergency care, your policy pays the Medicare Part A deductible no matter what hospital you use. For non-emergency care, you must use a participating network hospital for the Medicare Part A deductible to be covered. IDENTIFICATION CARD (ID) When you re issued your Medicare SELECT policy, you will receive an ID card. Please present your card whenever you receive medical services. PARTICIPATING HOSPITALS Please understand that this directory lists participating hospitals as of the publication date. From time to time, hospitals may be added or removed from the participating hospital network. Before receiving care from a hospital, ask the hospital if it s still participating in our Medicare SELECT network. For current information on participating hospitals call (877) IF YOU HAVE QUESTIONS Our Customer Service staff will be glad to help with your questions or concerns about your coverage, participating hospitals or the care you receive. Please call Customer Service whenever you have a question, (877) For details about your coverage, please read your policy. Forethought Life Insurance Company does not supervise, control or guarantee the health care services of any hospital, including those participating in its Medicare SELECT hospital network. TABLE OF CONTENTS s 1-7 Forethought Medicare Select Provider Network 03/09/2012

3 GEORGIA Chatham St. Josephs Mercy Blvd Savannah GA Cherokee Northside Cherokee Inc. 201 Rd Canton GA Cook Memorial of Adel 706 N Parrish Ave Adel GA Fannin Fannin Regional 2855 Old Hwy 5 Blue Ridge GA Fulton Kindred Atlanta 705 Juniper St NE Atlanta GA Shepherd Center 2020 Peachtree Rd NW Atlanta GA Greene Minnie G Boswell Memorial 1201 Siloam Rd Greensboro GA Jackson BJC Medical 70 Medical Dr Commerce GA Newton Newton General 5126 Dr NE Covington GA ILLINOIS Cook Holy Family Medical 100 River Rd Des Plaines IL Our Lady of Resurrection Medical 5645 W Addison St Chicago IL Resurrection Medical 7435 W Talcott Ave Chicago IL Cook Saint Joseph Health & 2900 N Lake Shore Dr Chicago IL St Elizabeths 1431 N Claremont Ave Chicago IL St Francis 355 Ridge Ave Evanston IL St Mary of Nazareth 2233 W Division St Chicago IL The University of Chicago s and Health System 5841 S Maryland Ave Chicago IL Westlake Community 1225 W Lake St Melrose Park IL Peoria Proctor 5409 N Knoxville Ave Peoria IL Page 1 of 7 Forethought Medicare Select Provider Network 3/09/2012

4 LOUISIANA Acadia American Legion 1305 Crowley Rayne Hwy Crowley LA Bossier CHRISTUS Schumpert Bossier 2105 Airline Dr Bossier City LA Caddo CHRISTUS Schumpert - St. Mary Place One St Mary Pl Shreveport LA CHRISTUS Schumpert Highland 1453 E Bert Kouns Shreveport LA Calcasieu CHRISTUS St Patrick 524 S Ryan St Lake Charles LA Evangeline Savoy Medical 801 Poinciana Ave Mamou LA Jefferson Doctors of Jefferson 4320 Houma Blvd Metairie LA Kenner Regional Medical 180 W Esplanade Ave Kenner LA Meadowcrest 2500 Belle Chasse Hwy Gretna LA Lafayette Lafayette General Medical 1214 Coolidge St Lafayette LA Lafayette General Surgical 1000 W Pinhook Rd Lafayette LA Rehabilitation of Acadiana 310 Youngsville Hwy Lafayette LA Lincoln Green Clinic Surgical 1118 S Farmerville St Ruston LA Orleans Memorial Medical - Baptist 2700 Napoleon Ave New Orleans LA Memorial Medical - Mercy 301 N Jefferson Davis Pkwy New Orleans LA Methodist 5620 Read Blvd New Orleans LA Ouachita P & S Surgical 312 Grammont St Monroe LA St. Francis Medical Center 309 Jackson St Monroe LA St. Francis North 3421 Medical Prk Dr Monroe LA Page 2 of 7 Forethought Medicare Select Provider Network 3/09/2012

5 Rapides CHRISTUS St Frances Cabrini 3330 Masonic Dr Alexandria LA Red River CHRISTUS Coushatta Health Care 1635 Marvelle St Coushatta LA Saint Landry Opelousas General 539 E Prudhomme St Opelousas LA St. John The Baptist River Parishes 500 Rue De Sante La Place LA St Martin St. Martin 210 Champagne Blvd Breaux Bridge LA St. Tammany Ochsner Medical Center - North Shore 100 Medical Center Dr Slidell LA Terrebonne Terrebonne General Medical 8166 Main St Houma LA Vermilion Abrom Kaplan Memorial 1310 W 7th St Kaplan LA Webster Springhill Medical 2001 Doctors Dr Springhill LA OKLAHOMA Oklahoma Edmond Medical One S Bryant St Edmond OK Midwest Regional Medical 2825 Parklawn Dr Midwest City OK OU Medical 1200 N Everett Dr Oklahoma City OK Presbyterian Tower 700 NE 13th St Oklahoma City OK Tulsa Hillcrest Medical 1120 S Utica Ave Tulsa OK Oklahoma State University Medical 744 W 9th St Tulsa OK TEXAS Anderson Palestine Regional Medical - E Campus 2900 S Loop 256 Palestine TX Palestine Regional Medical - W Campus 4000 S Loop 256 Palestine TX Page 3 of 7 Forethought Medicare Select Provider Network 3/09/2012

6 Angelina Memorial Medical of East Texas 1201 Frank Lufkin TX Memorial Specialty 1201 Frank Lufkin TX Bee CHRISTUS Spohn Beeville 1500 E Houston St Beeville TX Bexar Christus Santa Rosa 519 W Houston St San Antonio TX Christus Santa Rosa Medical 2827 Babcock Rd San Antonio TX Christus Santa Rosa Rehab 2827 Babcock Rd-1st Floor San Antonio TX Brazos St. Josephs Home Health 3030 E 29th St Ste 108 Bryan TX St. Josephs Regional Health 2801 Franciscan Dr Bryan TX St. Josephs Regional Rehabilitation 1600 Joseph Dr Bryan TX Burleson Burleson St. Joseph Health 1101 Woodson Dr Caldwell TX Somerville Family Medicine Clinic 600 Avenue C Somerville TX St. Joseph - Caldwell Family Medical Clinic 1103 Woodson Dr Caldwell TX Cherokee Colorado Rice Medical 600 S Austin Rd Eagle Lake TX Ector Medical - Odessa 500 W 4th St Odessa TX Gregg Good Shepherd Medical 700 E Marshall Ave Longview TX Allegiance Specialty of Kilgore 1612 S Henderson Blvd Kilgore TX Longview Regional Medical 2901 N 4th St Longview TX Grimes Grimes St. Joseph Health 210 S Judson St Navasota TX Mother Frances - Jacksonville 2026 S Jackson Jacksonville TX Page 4 of 7 Forethought Medicare Select Provider Network 3/09/2012

7 Harris CHRISTUS St. Catherine Health & Wellness 701 S Fry Rd Katy TX CHRISTUS St. John St John Dr Nassau Bay TX St. Joseph Medical Center 1401 St Joseph Prkwy Houston TX Hidalgo Edinburg Regional Medical 1102 W Trenton Edinburg TX McAllen Medical 301 W Expwy 83 McAllen TX Jasper CHRISTUS Jasper Memorial 1275 Marvin Hancock Dr Jasper TX Jefferson CHRISTUS St. Mary 3600 Gates Blvd Port Arthur TX CHRISTUS Outpatient 3701 Hwy 73 Port Arthur TX Memorial Hermann Baptist Beaumont 3576 College St Beaumont TX Jim Wells CHRISTUS Spohn Alice 2500 E Main St Alice TX Jones Anson General 101 Avenue J Anson TX Kaufman Medical at Terrell 1551 Hwy 34 S Terrell TX Kleberg CHRISTUS Spohn Kleberg 1300 General Cavazos Blvd Kingsville TX Lee Burleson St. Joseph Lexington Family Medical Clinic 609 Main St Lexington TX Leon Powell Memorial Health 102 E Main Centerville TX St. Joseph - Normangee Family Medical Clinic Hwy 3 W Main and 9th St Normangee TX Lubbock University Medical 602 Indiana Ave Lubbock TX Madison J B Heath Family Health 100 W Cross St Madisonville TX Page 5 of 7 Forethought Medicare Select Provider Network 3/09/2012

8 Madison St. Joseph Health 100 W Cross St Madisonville TX Nacogdoches Nacogdoches Medical 4920 NE Stallings Dr Nacogdoches TX Nueces CHRISTUS Spohn Corpus Christi - Memorial 2606 Blvd Corpus Christi TX CHRISTUS Spohn Corpus Christi - Shoreline 600 Elizabeth St Corpus Christi TX CHRISTUS Spohn Corpus Christi - South 5920 Saratoga Blvd Corpus Christi TX Corpus Christi Medical Bay Area Surgery 7101 S Padre Island Dr Corpus Christi TX Corpus Christi Medical 7101 S Padre Island Dr Corpus Christi TX Doctors Regional Medical 3315 S Alameda St Corpus Christi TX Northwest Regional NW Blvd Corpus Christi TX Orange Memorial Hermann Baptist Orange 608 Strickland Orange TX Panola East Texas Medical - Carthage 409 W Cottage Rd Carthage TX Polk Memorial Medical - Livingston 1717 Hwy 59 Bypass Livingston TX Potter Baptist St. Anthonys Health System - Baptist Campus 1600 Wallace Blvd Amarillo TX Baptist St. Anthonys Health System - St. Anthonys Campus 200 NW 7th Amarillo TX Physicians Surgical 6819 Plum Creek Amarillo TX Physicians Surgical 7100 W 9th Amarillo TX Robertson St. Joseph - Franklin Family Medicine Clinic 305 Gay St Franklin TX St. Joseph - Hearne Family Medicine Clinic 709 Barton St Hearne TX San Augustine Corpus Christi Medical The Heart Memorial Medical - San 7002 Williams Dr Augustine Corpus Christi TX S San Augustine TX Page 6 of 7 Forethought Medicare Select Provider Network 3/09/2012

9 San Patricio North Bay 1711 W Wheeler Ave Aransas Pass TX Shelby Shelby Regional Medical 602 Hurst St Center TX Smith Trinity Mother Frances Health Systems 800 E Dawson Tyler TX Tyler ContinueCARE 800 E Dawson Tyler TX UT Health at Tyler US Hwy 271 Tyler TX Page 7 of 7 Forethought Medicare Select Provider Network 3/09/2012