Take These Steps to Request
After-Hours/Emergency Part D Prescriptions
If you require a coverage determination
for a medication outside
of normal business hours or
during an emergency, simply
follow these steps.
Hours of operation
The Windsor Medicare Extra Member
Services department is available
at
1-800-316-2273. Normal business
hours are 7 a.m. to 8 p.m.,
Central Time, seven days a week.
During an emergency
Contact Member Services at
1-800-316-2273 or
615-782-7878
(TTY:
1-800-848-0298). If the
Windsor Medicare Extra pharmacy
staff determines that without the
medication your health may be in
jeopardy, they will execute a onetime
emergency fill. Then they will
process the request as quickly as
possible while the coverage determination
is under review.
After hours
The after-hours process for requesting
standard or expedited coverage
determinations begins with faxing
the request to
615-782-7869.
Windsor Medicare Extra pharmacy
staff is alerted electronically
that a fax has been received.
Additionally, you may call the
emergency after-hours cell
phone at 615-557-2453, and
issue verbal expedited or
standard coverage determination
requests. The after-hours
contact information is
also posted online at
www.WindsorExtra.com.
All expedited and standard
requests outside
business hours will be
accepted.
Windsor Medicare Extra is a product of Windsor Health Plan, Inc., a Medicare Advantage organization with a Medicare contract.
The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan.
Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change on January 1, 2011.
You must continue to pay your Medicare Part B premium.
People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If eligible, Medicare could pay for up to one hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't even know it. for more information about this Extra Help, contact your local Social Security Office at 1-800-772-1213 between 7 am and 7 pm, Monday through Friday. TTY users should call 1-800-325-0778. Or you can call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.
To request materials in alternative formats (i.e. large print or audio compact disk) or other languages, please contact our Customer Service department at 1-800-316-2273 (TTY: 1-866-460-7617) 7 a.m. - 8 p.m. Central Time, seven days a week.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances, and quantity limitations and restrictions may apply.
You must use plan 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 Windsor Medicare Extra will be responsible for the costs.
Windsor Medicare Extra Comp Plus Plan (HMO SNP) is available to all persons with Medicare who also receive Medical Assistance from their state Medicaid/Tenncare programs. Premiums, co-pay, co-insurance and deductible amounts are based on the level of Extra Help you receive. You should check with your state to confirm your eligibility level, or contact the plan for further details.
Windsor Medicare Extra Diabetes Plan (HMO SNP) is available to all persons with Medicare who have been diagnosed with diabetes mellitus by a physician. Physician documentation of your condition to demonstrate your eligibility for the plan will be required to complete your enrollment in the plan.
Windsor Medicare Extra Fusion Plan (HMO SNP) is available to all persons with Medicare who have been diagnosed with the following chronic or disabling conditions: bipolar disorder, major depression, paranoid disorder, schizophrenia, schizoaffective disorder. Physician documentation of your condition to demonstrate your eligibility for the plan will be required to complete your enrollment in the plan.
