The Online Provider Directory Our Provider Directory lists the contracted providers, pharmacies and other health care providers in this area who are part of the Lovelace network. Members can use this directory to select a Primary Care Provider (PCP) for themselves and each covered member of their family. It can also be used to locate participate participating specialists, hospitals and other health care providers. Visit the Provider Directory here

	Member Rights As a Medicare beneficiary and as a member of a Lovelace, you have certain rights to help protect you. Along with your rights you also have certain responsibilities as a member of a Lovelace. This document (PDF format) provides you information on your rights and responsibilities: Member Rights and Responsibilities

	Appeals and Grievances You have the right to make a complaint if you have concerns or problems related to your coverage or care.  “Appeals” and “Grievances” are two different types of complaints you can make... read more

	Quality Matters At Lovelace, improving quality is a constant effort. Those efforts include keeping you informed about our progress and our shortcomings. This page provides extensive information on every aspect of quality management at Lovelace.

	New Online Member Options Our NEW interactive Web site is a valuable source of information. As a member enrolled with a Lovelace, including LSP or Premier Choice, you can verify eligibility, check status of claims, send secure message to Lovelace Customer Center or search for a participating provider and much more. Log in now!

Premier Choice 2007

Premier Choice is a Medicare Advantage Preferred Provider Organization (PPO). Premier Choice is a Medicare replacement product that gives you the flexibility to use in-network or out-of-network services. In-network services are generally provided to you at lower out-of-pocket costs to you. For the flexibility and convenience of using any Medicare provider with your out-of-network benefit, you may pay higher out-of-pocket costs. Premier Choice plans also provide prescription drug coverage better than the Medicare Part D drug benefit.

Premier Choice is available in two distinct service areas in New Mexico including the following New Mexico counties: Bernalillo, Catron, Cibola, Colfax, Dona Ana, Grant, Hidalgo, Los Alamos, Luna, McKinley, Mora, Rio Arriba, San Juan, San Miguel, Sandoval, Santa Fe, Sierra, Socorro, Taos, Torrance and Valencia.

Find out more about eligibility

Low Income Subsidy (LIS):

You may qualify for extra help with your Medicare prescription drug costs and premiums. If you are not getting this extra help you can see if you qualify by calling 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048. You can call this number 24 hours a day, 7 days a week.
To find out what your premiums and drug costs will be if you qualify for extra help:
LIS for Bernalillo, Sandoval, Torrance or Valencia Counties
LIS for any of the counties in Northern or Southern New Mexico covered by Premier Choice

Summary of Benefits:

What you get
You enjoy increased benefits with virtually no claim forms or paperwork and no unexpected out-of-pocket costs when accessing in-network services. Plus you have the flexibility of choosing at each encounter in-network providers for greater cost savings or out of network providers which may cost more in out-of-pocket expenses. You just present your Premier Choice Member Identification Card (not your Medicare card) and make your copayment or coinsurance. (See the Summary of Benefits for more information.)

Prescription Coverage
Premier Choice plans offer prescription coverage better than the Medicare Part D Prescription Drug benefit.  Plus enrollment on Premier Choice includes your Medicare Part D premium.

Worldwide Emergency Coverage…
No one "plans" to get sick. Emergency care is covered 24 hours a day regardless of where you are… even outside the U.S.! A $50 copay applies (waived if admitted).

Vision Benefits…
In addition to covering all medically necessary eye care, you receive a $150 eyewear benefit once every two years.

These documents provides a summary of benefits available under standard and enhanced plans and your out-of-pocket copayments or co-insurance.

Summary of Benefits for Central New Mexico, 2007 includes the counties of Bernalillo, Sandoval, Valencia and Torrance.

Summary of Benefits for Northern and Southern New Mexico, 2007 includes the counties of Catron, Cibola, Colfax, Dona Ana, Grant, Hidalgo Los Alamos, Luna, McKinley, Mora, Rio Arriba, San Juan, San Miguel, Santa Fe, Sierra, Socorro and Taos Counties.

Evidence of Coverage:

These documents explains how to get Medicare services, including Part D pharmacy services, through Lovelace Senior Plan. It explains your benefits, rights and responsibilities as a member of Lovelace Senior Plan and our responsibilities to you.

Premier Choice Evidence of Coverage for all counties in service area, 2007

	Formulary and Pharmacy Coverage Introduction
	Premier Choice Comprehensive Formulary
	Prior Authorization, Step Therapy and Non Formulary Drug Exception Form
	Premier Choice Out-of-Network Claim Form
Information and forms for coverage determinations, appointment of representatives, appeals and grievances

Existing Premier Choice members needing additional information should contact our Customer Care Center at 505-232-1883 or 800-808-7363, Monday through Friday 8:00 a.m. to 5:00 p.m. Staff will be available to accept Part D calls Monday through Sunday from 8:00 a.m. to 8:00 p.m.  The speech and hearing impaired may use 1-800-659-8331. TTY service provided by New Mexico Relay.

Mailing address:

Lovelace
4101 Indian School Rd, NE, Suite 110
Albuquerque, NM 87110

Prospective members wishing to obtain more information on the Premier Choice may call 505-262-3757 or 800-262-3757 or e-mail Suellen.Sullivan@lovelacesandia.com.

Fraud and Abuse Program Policy Statement:
The Lovelace (LHP) Fraud & Abuse Program is dedicated to detecting, investigating, and preventing all forms of suspicious activities related to possible health insurance fraud or abuse, including any reasonable belief that insurance fraud will be, is being, or has been committed. Click here for more information.

HIPAA Privacy Notice :: HIPAA Privacy Notice Spanish

Lovelace Senior Plan and Premier Choice are Medicare Advantage Plans offering a Part D benefit, with a Medicare contract and are open to all individuals entitled to Medicare including the disabled.

* Note: "PDF" files require the Adobe® Reader® to view and print your own copies.

Visit Adobe.com and download the free Adobe® Reader®

 

Revised: 07/02/2007 H3207_206_1006