| SERVICE | PriorityHMOSM, PriorityPPOSM, PriorityPOSSM, Medicaid, MyPriority | Priority Health Medicare |
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Doctor visits with your primary care doctor or other primary care provider
- Routine physical exams and allergy care
- Pulmonary function test
- Flu shot and/or pneumonia vaccine
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You may have to pay a copay.
Talk with your doctor about what is best for you. |
Covered under Medicare Part B, which is included in Medicare Advantage plans.
You may have to pay a copay.
Talk with your doctor about what is best for you. |
Specialist visits and education
- Hospital-sponsored asthma education classes
- Allergist visits
- Pulmonologist visits
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Talk to your doctor about seeing an in-network specialist. Your doctor and specialist can work together to coordinate your care.
You may have to pay a copay. |
Covered under Medicare Part B, which is included in Medicare Advantage plans. - You may see a specialist without a referral. If you have a primary care doctor, it's always good to have your primary doctor coordinate your care.
- You'll pay less if you see a specialist who has a Priority Health Medicare contract.
- You may have to pay a copay.
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Mental Health and substance abuse care
Get the help you need if you have feelings of depression for more than two weeks or if you suffer from substance abuse. |
- If you need help finding a mental health or substance abuse treatment provider or selecting a treatment option, call our Behavioral Health department at 800 673-8043. A case manager will assist you.
- You don't need a referral to get help.
- Medicaid members will need to call our Behavioral Health department at 800 673-8043 to authorize services.
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- The first step is calling our Behavioral Health department at 800 673-8043. A case manager will determine what treatment options are appropriate and authorize services.
- For outpatient mental health care, you may see any mental health provider without a referral.
- For some outpatient substance abuse services, you will need a referral.
- You'll pay less when you see a mental health provider who has a contract with Priority Health Medicare.
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| Medications by mail |
Covered by your pharmacy benefit. Check your member ID card to verify that you have prescription coverage.
Use our home delivery pharmacy to save money. Your doctor must write you a prescription for a 90-day supply. Then you'll pay one or two copays instead of three for a 90-day supply, and shipping is free.
Learn more about our home delivery pharmacy. |
Covered by your Medicare prescription drug benefit, which is included in all Priority Health Medicare Advantage plans and PriorityMedicare RxSM. Learn more about Medicare Parts A, B and D.
- Your doctor must write you a prescription for a 90-day supply. Then you'll pay 2.5 copays instead of 3 for a 90-day supply, and shipping is free.
Learn more about our home delivery pharmacy. |
| Nebulizers, peak flow meters, and related durable medical equipment (DME) |
- Covered by your medical benefit.
- You may have to pay a copay.
- You'll need a prescription for DME supplies from a Priority Health doctor.
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Covered under Medicare Part B under durable medical equipment (DME), which is included in Medicare Advantage plans.
PriorityMedicare Rx (Part D only) members are not covered.
See your Evidence of Coverage booklet for more information on your DME benefits.
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| Spacers (inhaler assist devices) |
- Spacers are available as part of your DME benefit or pharmacy benefit. Supply limitations may apply.
- You may have to pay a copay.
- You'll need a prescription for your spacers (inhaler assist devices) from a Priority Health doctor.
- Money-saving tip: Check your DME copay vs. your pharmacy copay. In some cases, you'll pay less if you get your supplies from a DME provider. If you don't have pharmacy coverage, use your DME benefit.
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Covered under Medicare Part B under durable medical equipment (DME), which is included in Medicare Advantage plans.
PriorityMedicare Rx (Part D only) members are not covered.
See your Evidence of Coverage booklet for more information on your DME benefits |
Priority Health HealthyEncounters Asthma Program
- Telephone counseling with a Priority Health Registered Nurse.
- Customized educational mailings
- Home health care referrals
- Asthma management and medication compliance
- Asthma resource list
- HealthFit discounts on fitness club memberships, training, clothing and equipment
- Asthma Condition Center powered by WebMD® (when you log in to your online member account)
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Covered program for all Priority Health members. |
Covered program for all Priority Health Medicare members with medical coverage.
PriorityMedicare Rx (Part D only) members are not covered. |
