This directory provides a list of Kalos Health Gold Plus HMO SNP Plan network providers and pharmacies. To get detailed information about your health care coverage, please see your Evidence of Coverage.
You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care services from your PCP. Kalos Health Gold Plus is a Dual-Eligible Health Maintenance Organization (HMO). Since we are an HMO, it is necessary for you to select a PCP to utilize while on the plan. We do not guarantee that each provider is still accepting new members.
The “network providers” listed in this directory have agreed to provide you with your health care. You may go to any of our network providers listed in this directory. However, some services may require a referral. If you have been going to one network provider, you are not required to continue to go to that same provider. In some cases, you may get covered services from non-network providers. If you get a bill from a non-network provider, please submit it to Kalos Health Gold Plus for processing. We can help determine how much you are responsible for paying, if any.
Emergency care can always be obtained in or out of the service area from the nearest available provider. When in the service area you must use plan providers for urgent care. When out of the service area, urgent care may be obtained from the first available provider. In addition, when out of the service area, you can obtain dialysis treatment from any qualified dialysis provider. You must use plan providers except in emergency or urgent care situations. If you obtain routine care from out-of-network providers neither Medicare nor Kalos Health Gold Plus HMO SNP Plan will be responsible for the costs.
What is the service area for Kalos Health Gold Plus?
The counties in our service area in Cattaraugus, Erie, Niagara, and Orleans
How do you find Kalos Health Gold Plus providers in your area?
This is a searchable online document and is updated at least monthly. You can enter areas in the fields to narrow down your search. For example, if you enter “New York” in the state field, and “Erie” in the county field, the search engine will generate a list of all providers, hospitals and pharmacies in Erie County, New York. You can also search by provider name, city, or specialty.
If you have questions about Kalos Health Gold Plus or require assistance in selecting a PCP, please call our Member Service Department at 1-800-399-1954, from 8 a.m. to 8 p.m. Monday through Friday. TTY users should call 711 or visit www.kaloshealth.org.
Kalos Health Gold Plus HMO SNP is a Health Plan with a Medicare contract, Enrollment in Kalos Health Gold Plus HMO SNP depends on contract renewal.
The formulary, pharmacy network, or provider network may change at any time. You will receive notice when necessary.