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This document provides member and provider contact information for Molina Healthcare, including services such as member services, nurse advice, and billing. It outlines the subscriber and member details for Gabriela I Garcia, including plan specifics like deductibles, cost shares, and out-of-pocket maximums. Additionally, it emphasizes the need for services to be received from participating providers and includes a notice regarding inpatient admissions.

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rodrigosalcedo131
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12 views1 page

File Name

This document provides member and provider contact information for Molina Healthcare, including services such as member services, nurse advice, and billing. It outlines the subscriber and member details for Gabriela I Garcia, including plan specifics like deductibles, cost shares, and out-of-pocket maximums. Additionally, it emphasizes the need for services to be received from participating providers and includes a notice regarding inpatient admissions.

Uploaded by

rodrigosalcedo131
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Member Numbers Provider Numbers

Member Services: (888) 560-5716 CVS Caremark Help desk


TTY/TTD: 711 (888) 407-6425
Marketplace 24/7 Nurse Advice: (888) 275-8750
Prior Authorization/Notification of
Hospital Admission: (855) 322-4076
24/7 Linea de Consejos de Enfermeras:
Subscriber: GABRIELA I GARCIA Member: GABRIELA I GARCIA (866) 648-3537 Medical Claims:
Subscriber ID: 0023515007 Member ID: 0023515007 Molina Healthcare
Plan: Silver 9 150 Effective Date: 01/01/2025 Billing and Payments: PO BOX 22812
Cost Share Deductibles (800) 375-7421
Long Beach, CA 90801
PCP: $9 Medical Indv Deductible: Cost Shares are a summary only.
Inpatient Admissions: Provider to notify
Specialist: $30 $750 Visit MyMolina.com for plan details.
RX Indv Deductible: plan within 24 hours of admission.
Urgent Care: $20
Comb. w/Med Notice: Covered Services must be
ER Visit: 25% after deductible received from Participating Providers.
Pref. Generic Rx: $5 Annual Out of Pocket Maximum (OOPM)
Indv OOPM: $3,050 Refer to your Agreement for exceptions.
Pref. Brand Rx: $65
RxBIN: 025201 RxPCN: MOHMKP RxGRP: RX0846 MyMolina.com This card is for identification purposes only and does not prove eligibility for service.
HMO Molina Healthcare of Florida, Inc.

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