When you first join Advicare Advocate, you can continue seeing the providers you see now for 180 days or until we have completed your comprehensive assessment and created a transition plan that you agree with. If you need to continue seeing your out-of-network providers after your first 180 days in our plan, we will only cover that care if the provider enters a single case agreement with us. If you are getting ongoing treatment from an out-of-network provider and think they may need a single case agreement in order to keep treating you, contact Member Services at 1-844-564-0143 (TTY/TDD 711 or 1-888-357-7188), 8:00 a.m. until 8:00 p.m., seven days a week. Alternative technologies will be used on weekends and holidays.

Usually, Advicare Advocate will not cover services or items from a provider who has not joined Advicare Advocate’s network.  There are, however, certain circumstances under which this rule does not apply.   To learn about getting approval to see an out-of-network provider, see the Member Handbook for complete information.

  • The plan covers emergency or urgently needed care from an out-of-network provider in certain situations.
  • If you need care that our plan covers and our network providers cannot give it to you, you can get the care from an out-of-network provider. In this situation, we will cover the care as if you got it from a network provider and at no cost to you.
  • The plan covers services and items from out-of-network providers and pharmacies when a provider or pharmacy is not available within a reasonable distance from your home.
  • The plan covers kidney dialysis services when you are outside the plan’s service area for a short time. You can get these services at a Medicare-certified dialysis facility.

 

Disclaimer

Advicare Advocate (Medicare-Medicaid Plan) is a health plan that contracts with both Medicare and South Carolina Healthy Connections Medicaid to provide benefits of both programs to enrollees. This information is available in other formats, such as Braille, large print, and audio. This information is also available for free in other languages.  Please call our customer service number at 1-844-564-0143 (TTY/TDD 711 or 1-888-357-7188), 8:00 a.m. until 8:00 p.m., seven days a week. The call is free.

Esta información está disponible de forma gratuita en otros idiomas. Por favor llame a nuestro número de atención al cliente al 1-844-564-0143 (TTY/TDD 711 o 1-888-357-7188), 8:00 a.m. hasta las 8:00 p.m., los siete días de la semana. La llamada es gratuita.

This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply.  For more information, call Advicare Advocate Member Services or refer to the Advicare Advocate Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks, and/or copayments may change from time to time throughout the year and on January 1 of each year.

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Plans are available in the following counties: Abbeville, Aiken, Allendale, Anderson, Bamberg, Barnwell, Berkeley, Beaufort, Calhoun, Charleston, Cherokee, Chester, Chesterfield, Clarendon, Colleton, Dillon, Dorchester, Edgefield, Fairfield, Florence, Georgetown, Greenville, Greenwood, Hampton, Jasper, Kershaw, Laurens, Lee, Lexington, Marion, Marlboro, McCormick, Newberry, Oconee, Orangeburg, Pickens, Richland, Saluda, Spartanburg, Union,Williamsburg.

Page Last Updated: July 15, 2015