This directory provides a list of Health Alliance Medicare PPO network providers.

Transcription

1 Illinois Health Alliance Medicare PPO Plan Provider Directory This directory provides a list of Health Alliance Medicare PPO network providers. This directory is for beneficiaries in Adams, Boone, Brown, Bureau, Cass, Champaign, Christian, Clark, Coles, Crawford, Cumberland, De Witt, DeKalb, Douglas, Edgar, Effingham, Ford, Franklin, Hancock, Henry, Iroquois, Jackson, Jasper, Johnson, Kankakee, Knox, Livingston, Logan, Macon, Macoupin, Marshall, Mason, McDonough, McLean, Menard, Mercer, Montgomery, Morgan, Moultrie, Peoria, Perry, Piatt, Pike, Putnam, Rock Island, Saline, Sangamon, Schuyler, Scott, Stark, Tazewell, Vermilion, Williamson, Winnebago and Woodford counties in Illinois. Any changes made to this directory will be reflected within 24 hours. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most up-to-date information about Health Alliance Medicare PPO s network providers in your area, you can visit HealthAllianceMedicare.org or call our Member Service Department at , Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 711. Health Alliance Medicare is a PPO plan with a Medicare contract. Enrollment in Health Alliance Medicare depends on contract renewal. This information is available for free in other languages. Please call Member Services at , Monday through Friday, 8 a.m. to 8 p.m. TTY/TDD users should call 711. The provider network may change at any time. You will receive notice when necessary. cps-ilmedppoproviderdirectory-0616 Y0034_16_31527a_FINAL Accepted

2 Table of Contents Section 1 - Introduction...ii What is the service area for Medicare PPO?... ii How do you find Medicare PPO providers in your area?...iii Section 2 - List of Providers... 1 Specialist... 1 Outpatient Mental Health Providers... 1 Ancillary... 1 Index... I-1 i

3 Section 1 Introduction This directory provides a list of Health Alliance Medicare PPO s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage. The network providers listed in this directory have agreed to provide you with your health care services. You may go to any of our network providers who are 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 going to that same provider. In some cases, you may get covered services from non-network providers. If you receive care from a non-network provider and receive a bill from that provider, you should not pay it. Instead, please submit it to Health Alliance Medicare so we can determine what, if any, of the fees you actually must pay. If you obtain routine care from out-of-network providers, it may cost more than if you went to an in-network provider. PPO members: Emergency care can always be obtained in or out of the service area from the nearest available provider. If you have a medical emergency: Get help as quickly as possible. Call 911 for help or go to the nearest emergency room, Hospital or urgent care center. Call for an ambulance if you need it. You do not need to get approval or a referral first. As soon as possible, make sure to tell Health Alliance Medicare about your emergency. We need to follow up on your Emergency Care. You or someone else should call to tell us about your Emergency Care, usually within 48 hours. Emergency and urgent services care can always be obtained in or out of the service area from the nearest available provider. If you obtain routine care from out-of-network providers, it may cost more than if you went to an in-network provider. What is the service area for Health Alliance Medicare PPO? The counties in our service area are listed below. Adams, Boone, Brown, Bureau, Cass, Champaign, Christian, Clark, Coles, Crawford, Cumberland, De Witt, DeKalb, Douglas, Edgar, Effingham, Ford, Franklin, Hancock, Henry, Iroquois, Jackson, Jasper, Johnson, Kankakee, Knox, Livingston, Logan, Macon, Macoupin, Marshall, Mason, McDonough, McLean, Menard, Mercer, Montgomery, Morgan, Moultrie, Peoria, Perry, Piatt, Pike, Putnam, Rock Island, Saline, Sangamon, Schuyler, Scott, Stark, Tazewell, Vermilion, Williamson, Winnebago and Woodford counties in Illinois. i

4 How do you find Health Alliance Medicare PPO providers in your area? This directory is organized alphabetically by city and by category (Primary Care Physicians, Specialty Care, etc.). Or, you can use the index that begins on page I-1 to find an alphabetical listing of all providers. If you have questions about Health Alliance Medicare PPO or require assistance in selecting a PCP, please call our Member Services Department at , Monday through Friday, 8 a.m. to 8 p.m. TTY\TDD users should call 711. Or, visit HealthAllianceMedicare.org. Section 2 List of Network Providers ii

5 Specialist / Outpatient Mental Section 2 - List of Network Providers Midlevel providers (including nurse practitioners and physician assistants) cannot be selected as Primary Care Physicians. However, you may use the services of a midlevel provider by selecting his or her supervising physician as your designated Primary CarePhysician. Midlevel providers are indicated by italics. TRUHEARING PROVIDER AUDIOLOGY TRUHEARING CALL FOR IN-NETWORK PROVIDERS NEAR YOU. TRUHEARING PROVIDER PHONE: HEARING AIDS TRUHEARING CALL FOR IN-NETWORK PROVIDERS NEAR YOU. TRUHEARING PROVIDER PHONE: PEORIA, IL NEONATOLOGY KUMAR, PRAVEEN, MD MALE E-PRESCRIBE: NO PROVIDER #: NPI #: U OF I COLLEGE OF MEDICINE 530 NE GLEN OAK AVE PEORIA, IL PEORIA COUNTY PHONE: (309) NORMAL, IL PSYCHOLOGY MEYER, REGINA L., PHD FEMALE E-PRESCRIBE: NO PROVIDER #: NPI #: DISCOVERY OF HOPE COUNSELING AND PSYCHOLOGICAL SER 706 OGLESBY AVE STE 105 NORMAL, IL MCLEAN COUNTY PHONE: (312) EAST MOLINE, IL MENTAL HEALTH MANLEY, KRISTI A., LMHC FEMALE E-PRESCRIBE: NO PROVIDER #: NPI #: LUTHERAN FAMILY SERVICES HUBBARD RD EAST MOLINE, IL ROCK ISLAND COUNTY PHONE: (515) ST LOUIS, MO MENTAL HEALTH / SUBSTANCE ABUSE BARNES-JEWISH PSYCHIATRIC UNIT PROVIDER #: NPI #: BARNES JEWISH HOSPITAL PLZ ST LOUIS, MO SAINT LOUIS CITY COUNTY PHONE: (314) URBANA, IL CHAMPAIGN URBANA DIALYSIS CENTER PROVIDER #: NPI #: W PARK ST STE 100 URBANA, IL CHAMPAIGN COUNTY PHONE: (217) TAYLORVILLE, IL TAYLORVILLE DIALYSIS PROVIDER #: NPI #: W SPRESSER ST TAYLORVILLE, IL CHRISTIAN COUNTY PHONE: (217) CHARLESTON, IL MATTOON DIALYSIS PROVIDER #: NPI #: DEVELOPMENT DR CHARLESTON, IL COLES COUNTY PHONE: (217) ARLINGTON HGHTS, IL ARLINGTON HEIGHTS RENAL PROVIDER #: NPI #: W GOLF RD ARLINGTON HGHTS, IL PHONE: (866) BUFFALO GROVE, IL BUFFALO GROVE DIALYSIS PROVIDER #: NPI #: W DUNDEE RD BUFFALO GROVE, IL PHONE: (847)

6 Ancillary CHICAGO, IL LOOP RENAL CENTER PROVIDER #: NPI #: S CANAL ST CHICAGO, IL PHONE: (866) LITTLE VILLAGE DIALYSIS PROVIDER #: NPI #: W CERMAK RD CHICAGO, IL PHONE: (773) WOODLAWN DIALYSIS PROVIDER #: NPI #: S STATE ST CHICAGO, IL PHONE: (773) CHILDRENS DIALYSIS CENTER PROVIDER #: NPI #: N HALSTED ST CHICAGO, IL PHONE: (773) WOODLAWN DIALYSIS PROVIDER #: NPI #: E 55TH ST CHICAGO, IL PHONE: (773) STONEY ISLAND DIALYSIS PROVIDER #: NPI #: S STONY ISLAND AVE CHICAGO, IL PHONE: (773) STONY ISLAND DIALYSIS PROVIDER #: NPI #: S STONY ISLAND AVE CHICAGO, IL PHONE: (773) GRAND CROSSING DIALYSIS PROVIDER #: NPI #: S COTTAGE GROVE AVE CHICAGO, IL PHONE: (773) BEVERLY DIALYSIS PROVIDER #: NPI #: S WESTERN AVE CHICAGO, IL PHONE: (773) WEST LAWN DIALYSIS PROVIDER #: NPI #: S PULASKI RD CHICAGO, IL PHONE: (773) MONTCLARE DIALYSIS CENTER PROVIDER #: NPI #: W BELMONT AVE CHICAGO, IL PHONE: (773) WOODLAWN DIALYSIS PROVIDER #: NPI #: S MARYLAND AVE CHICAGO, IL PHONE: (773) LINCOLN PARK DIALYSIS PROVIDER #: NPI #: N ELSTON AVE CHICAGO, IL PHONE: (773) KENWOOD DIALYSIS PROVIDER #: NPI #: S COTTAGE GROVE AVE STE 100 CHICAGO, IL PHONE: (773) MT GREENWOOD DIALYSIS PROVIDER #: NPI #: W 111TH ST CHICAGO, IL PHONE: (773) COUNTRY CLUB HI, IL COUNTRY HILL DIALYSIS PROVIDER #: NPI #: TH ST COUNTRY CLUB HI, IL PHONE: (708) EVANSTON, IL EVANSTON RENAL CENTER PROVIDER #: NPI #: DEMPSTER ST EVANSTON, IL PHONE: (847)

7 Ancillary HAZEL CREST, IL HAZEL CREST RENAL CENTER PROVIDER #: NPI #: W 183RD ST HAZEL CREST, IL PHONE: (866) NILES, IL BIG OAK DIALYSIS PROVIDER #: NPI #: W TOUHY AVE NILES, IL PHONE: (847) OAK LAWN, IL STONEY CREEK DIALYSIS PROVIDER #: NPI #: W 95TH ST OAK LAWN, IL PHONE: (708) ORLAND PARK, IL PALOS PARK DIALYSIS PROVIDER #: NPI #: S LA GRANGE RD ORLAND PARK, IL PHONE: (708) SCHAUMBURG, IL SCHAUMBURG RENAL CENTER PROVIDER #: NPI #: S ROSELLE RD SCHAUMBURG, IL PHONE: (847) SOUTH HOLLAND, IL SOUTH HOLLAND RENAL CENTER PROVIDER #: NPI #: LA SALLE ST SOUTH HOLLAND, IL PHONE: (708) ROBINSON, IL ROBINSON DIALYSIS PROVIDER #: NPI #: N ALLEN ST STE B ROBINSON, IL CRAWFORD COUNTY PHONE: (618) SYCAMORE, IL CRIMSON RIDGE HOME TRAINING PROVIDER #: NPI #: HAUSER ROSS DR STE 200 SYCAMORE, IL DEKALB COUNTY PHONE: (815) SYCAMORE DIALYSIS PROVIDER #: NPI #: GATEWAY DR SYCAMORE, IL DEKALB COUNTY PHONE: (815) EFFINGHAM, IL EFFINGHAM DIALYSIS PROVIDER #: NPI #: MEDICAL PARK DR STE 1 EFFINGHAM, IL EFFINGHAM COUNTY PHONE: (217) VANDALIA, IL VANDALIA DIALYSIS PROVIDER #: NPI #: MATTES AVE VANDALIA, IL FAYETTE COUNTY PHONE: (618) BENTON, IL BENTON DIALYSIS PROVIDER #: NPI #: ROUTE 14 W BENTON, IL FRANKLIN COUNTY PHONE: (618) MT VERNON, IL MOUNT VERNON DIALYSIS PROVIDER #: NPI #: N WATER TOWER PL MT VERNON, IL JEFFERSON COUNTY PHONE: (618)

8 Ancillary BOURBONNAIS, IL KANKAKEE COUNTY DIALYSIS PROVIDER #: NPI #: WILLIAM R LATHAM SR DR STE 104 BOURBONNAIS, IL KANKAKEE COUNTY PHONE: (815) BARRINGTON, IL BARRINGTON CREEK DIALYSIS PROVIDER #: NPI #: W NORTHWEST HWY BARRINGTON, IL LAKE COUNTY PHONE: (847) LAKE VILLA, IL LAKE VILLA DIALYSIS PROVIDER #: NPI #: N IL ROUTE 59 LAKE VILLA, IL LAKE COUNTY PHONE: (847) VERNON HILLS, IL LAKE COUNTY DIALYSIS PROVIDER #: NPI #: LAKEVIEW PKWY STE 176 VERNON HILLS, IL LAKE COUNTY PHONE: (847) WAUKEGAN, IL WAUKEGAN RENAL CENTER PROVIDER #: NPI #: GRAND AVE STE 100 WAUKEGAN, IL LAKE COUNTY PHONE: (847) DIXON, IL DIXON KIDNEY CENTER PROVIDER #: NPI #: N GALENA AVE DIXON, IL LEE COUNTY PHONE: (815) LINCOLN, IL LINCOLN DIALYSIS PROVIDER #: NPI #: TH ST LINCOLN, IL LOGAN COUNTY PHONE: (217) DECATUR, IL DECATUR EAST WOOD DIALYSIS PROVIDER #: NPI #: E WOOD ST DECATUR, IL MACON COUNTY PHONE: (217) MACON COUNTY DIALYSIS PROVIDER #: NPI #: W MCKINLEY AVE DECATUR, IL MACON COUNTY PHONE: (217) RCG CENTRAL ILLINOIS- DECATUR PROVIDER #: NPI #: W HAY ST STE 207 DECATUR, IL MACON COUNTY PHONE: (217) ALTON, IL ALTON DIALYSIS PROVIDER #: NPI #: HOMER M ADAMS PKWY ALTON, IL MADISON COUNTY PHONE: (618) HOME HEALTH CARE BJC HOME CARE SERVICES - ALTON PROVIDER #: NPI #: COLLEGE AVE STE B ALTON, IL MADISON COUNTY PHONE: (618) EDWARDSVILLE, IL EDWARDSVILLE DIALYSIS PROVIDER #: NPI #: S BUCHANAN ST EDWARDSVILLE, IL MADISON COUNTY PHONE: (618)

9 Ancillary GRANITE CITY, IL GRANITE CITY DIALYSIS CENTER PROVIDER #: NPI #: AMERICAN VLG GRANITE CITY, IL MADISON COUNTY PHONE: (618) CENTRALIA, IL CENTRALIA DIALYSIS PROVIDER #: NPI #: STATE ROUTE 161 CENTRALIA, IL MARION COUNTY PHONE: (618) LITCHFIELD, IL LITCHFIELD DIALYSIS PROVIDER #: NPI #: SAINT FRANCIS WAY LITCHFIELD, IL MONTGOMERY COUNTY PHONE: (217) JACKSONVILLE, IL JACKSONVILLE DIALYSIS PROVIDER #: NPI #: W WALNUT ST JACKSONVILLE, IL MORGAN COUNTY PHONE: (217) OLNEY, IL OLNEY DIALYSIS PROVIDER #: NPI #: N BOONE ST OLNEY, IL RICHLAND COUNTY PHONE: (618) SPRINGFIELD, IL SPRINGFIELD CENTRAL DIALYSIS PROVIDER #: NPI #: N GRAND AVE W SPRINGFIELD, IL SANGAMON COUNTY PHONE: (217) SPRINGFIELD MONTVALE DIALYSIS PROVIDER #: NPI #: MONTVALE DR STE A SPRINGFIELD, IL SANGAMON COUNTY PHONE: (217) RUSHVILLE, IL RUSHVILLE DIALYSIS PROVIDER #: NPI #: SULLIVAN DR RUSHVILLE, IL SCHUYLER COUNTY PHONE: (217) BELLEVILLE, IL SHILOH DIALYSIS PROVIDER #: NPI #: N GREEN MOUNT RD BELLEVILLE, IL ST. CLAIR COUNTY PHONE: (618) METRO EAST DIALYSIS PROVIDER #: NPI #: W MAIN ST BELLEVILLE, IL ST. CLAIR COUNTY PHONE: (618) E ST LOUIS, IL SAUGET DIALYSIS PROVIDER #: NPI #: GOOSE LAKE RD E ST LOUIS, IL ST. CLAIR COUNTY PHONE: (618) FREEPORT, IL DRIFTWOOD DIALYSIS PROVIDER #: NPI #: S WEST AVE FREEPORT, IL STEPHENSON COUNTY PHONE: (815) FREEPORT DIALYSIS PROVIDER #: NPI #: S KUNKLE BLVD FREEPORT, IL STEPHENSON COUNTY PHONE: (815)

10 Ancillary STERLING, IL WHITESIDE DIALYSIS PROVIDER #: NPI #: E LINCOLNWAY STERLING, IL WHITESIDE COUNTY PHONE: (815) MARION, IL MARION DIALYSIS PROVIDER #: NPI #: S 4TH ST MARION, IL WILLIAMSON COUNTY PHONE: (618) HUTCHINS PARK, IL ROCKFORD DIALYSIS PROVIDER #: NPI #: N ROCKTON AVE HUTCHINS PARK, IL WINNEBAGO COUNTY PHONE: (800) ROCKFORD, IL STONECREST DIALYSIS PROVIDER #: NPI #: E STATE ST ROCKFORD, IL WINNEBAGO COUNTY PHONE: (815) CHURCHVIEW DIALYSIS PROVIDER #: NPI #: WARE AVE ROCKFORD, IL WINNEBAGO COUNTY PHONE: (815) CHURCHVIEW DIALYSIS PROVIDER #: NPI #: CHURCHVIEW DR ROCKFORD, IL WINNEBAGO COUNTY PHONE: (815) ROXBURY DIALYSIS PROVIDER #: NPI #: ROXBURY RD ROCKFORD, IL WINNEBAGO COUNTY PHONE: (815) WASHINGTON, IN DAVIESS COUNTY DIALYSIS PROVIDER #: NPI #: NE 14TH ST WASHINGTON, IN DAVIESS COUNTY PHONE: (812) JASPER, IN JASPER DIALYSIS PROVIDER #: NPI #: W 13TH ST STE 105 JASPER, IN DUBOIS COUNTY PHONE: (812) PRINCETON, IN PRINCETON DIALYSIS PROVIDER #: NPI #: SHERMAN DR PRINCETON, IN GIBSON COUNTY PHONE: (812) VINCENNES, IN VINCENNES DIALYSIS PROVIDER #: NPI #: WILLOW ST VINCENNES, IN KNOX COUNTY PHONE: (877) INDIANAPOLIS, IN EAGLE HIGHLANDS DIALYSIS PROVIDER #: NPI #: SHORE TER INDIANAPOLIS, IN MARION COUNTY PHONE: (317) EVANSVILLE, IN NORTH EVANSVILLE DIALYSIS PROVIDER #: NPI #: W BUENA VISTA RD EVANSVILLE, IN VANDERBURGH COUNTY PHONE: (812) EAST EVANSVILLE DIALYSIS PROVIDER #: NPI #: PROFESSIONAL BLVD EVANSVILLE, IN VANDERBURGH COUNTY PHONE: (812)

11 Ancillary NEWBURGH, IN NEWBURGH DIALYSIS PROVIDER #: NPI #: STATE ROUTE 261 STE A NEWBURGH, IN WARRICK COUNTY PHONE: (812) MINNEAPOLIS, MN DURABLE MEDICAL EQUIPMENT TACTILE SYSTEMS TECHNOLOGY INC PROVIDER #: NPI #: TYLER ST NE STE 200 MINNEAPOLIS, MN HENNEPIN COUNTY PHONE: (612) SULLIVAN, MO HOME HEALTH CARE BHC HOME CARE SERVICES - SULLIVAN PROVIDER #: NPI #: PROGRESS PKWY SULLIVAN, MO CRAWFORD COUNTY PHONE: (573) CLINTON, MO KANSAS AVENUE DIALYSIS PROVIDER #: NPI #: KANSAS AVE CLINTON, MO HENRY COUNTY PHONE: (660) HANNIBAL, MO HANNIBAL DIALYSIS PROVIDER #: NPI #: PROGRESS RD HANNIBAL, MO MARION COUNTY PHONE: (573) FARMINGTON, MO HOME HEALTH CARE BJC HOME CARE SERVICES - PARKLAND PROVIDER #: NPI #: WEBER RD FARMINGTON, MO SAINT FRANCOIS COUNTY PHONE: (573) BELLEVUE, NE DIALYSIS CLINIC INC BELLEVUE PROVIDER #: NPI #: TWIN CREEK DR BELLEVUE, NE SARPY COUNTY PHONE: (402) TWINSBURG, OH DURABLE MEDICAL EQUIPMENT EDGEPARK PROVIDER #: NPI #: SUMMIT COMMERCE PARK TWINSBURG, OH SUMMIT COUNTY PHONE: (800)

12 Index A ALTON DIALYSIS... 4 ARLINGTON HEIGHTS RENAL... 1 B BARNES-JEWISH PSYCHIATRIC UNIT... 1 BARRINGTON CREEK DIALYSIS... 4 BENTON DIALYSIS...3 BEVERLY DIALYSIS... 2 BHC HOME CARE SERVICES - SULLIVAN... 7 BIG OAK DIALYSIS... 3 BJC HOME CARE SERVICES - ALTON... 4 BJC HOME CARE SERVICES - PARKLAND...7 BUFFALO GROVE DIALYSIS... 1 C CENTRALIA DIALYSIS... 5 CHAMPAIGN URBANA DIALYSIS CENTER... 1 CHILDRENS DIALYSIS CENTER...2 CHURCHVIEW DIALYSIS... 6, 6 COUNTRY HILL DIALYSIS... 2 CRIMSON RIDGE HOME TRAINING... 3 D DAVIESS COUNTY DIALYSIS... 6 DECATUR EAST WOOD DIALYSIS... 4 DIALYSIS CLINIC INC BELLEVUE... 7 DIXON KIDNEY CENTER... 4 DRIFTWOOD DIALYSIS... 5 E EAGLE HIGHLANDS DIALYSIS... 6 EAST EVANSVILLE DIALYSIS... 6 EDGEPARK... 7 EDWARDSVILLE DIALYSIS... 4 EFFINGHAM DIALYSIS...3 EVANSTON RENAL CENTER... 2 F FREEPORT DIALYSIS...5 G GRAND CROSSING DIALYSIS... 2 GRANITE CITY DIALYSIS CENTER...5 H HANNIBAL DIALYSIS... 7 HAZEL CREST RENAL CENTER... 3 J JACKSONVILLE DIALYSIS... 5 I-1

13 Index JASPER DIALYSIS... 6 K KANKAKEE COUNTY DIALYSIS...4 KANSAS AVENUE DIALYSIS... 7 KENWOOD DIALYSIS...2 KUMAR, PRAVEEN, MD... 1 L LAKE COUNTY DIALYSIS... 4 LAKE VILLA DIALYSIS...4 LINCOLN DIALYSIS... 4 LINCOLN PARK DIALYSIS...2 LITCHFIELD DIALYSIS... 5 LITTLE VILLAGE DIALYSIS... 2 LOOP RENAL CENTER... 2 M MACON COUNTY DIALYSIS...4 MANLEY, KRISTI A., LMHC... 1 MARION DIALYSIS... 6 MATTOON DIALYSIS... 1 METRO EAST DIALYSIS... 5 MEYER, REGINA L., PHD... 1 MONTCLARE DIALYSIS CENTER... 2 MOUNT VERNON DIALYSIS... 3 MT GREENWOOD DIALYSIS... 2 N NEWBURGH DIALYSIS... 7 NORTH EVANSVILLE DIALYSIS... 6 O OLNEY DIALYSIS...5 P PALOS PARK DIALYSIS... 3 PRINCETON DIALYSIS... 6 R RCG CENTRAL ILLINOIS-DECATUR... 4 ROBINSON DIALYSIS... 3 ROCKFORD DIALYSIS... 6 ROXBURY DIALYSIS...6 RUSHVILLE DIALYSIS... 5 S SAUGET DIALYSIS... 5 SCHAUMBURG RENAL CENTER... 3 SHILOH DIALYSIS... 5 SOUTH HOLLAND RENAL CENTER... 3 SPRINGFIELD CENTRAL DIALYSIS... 5 I-2

14 Index SPRINGFIELD MONTVALE DIALYSIS... 5 STONECREST DIALYSIS... 6 STONEY CREEK DIALYSIS... 3 STONEY ISLAND DIALYSIS... 2 STONY ISLAND DIALYSIS... 2 SYCAMORE DIALYSIS... 3 T TACTILE SYSTEMS TECHNOLOGY INC... 7 TAYLORVILLE DIALYSIS... 1 TRUHEARING... 1, 1 V VANDALIA DIALYSIS...3 VINCENNES DIALYSIS...6 W WAUKEGAN RENAL CENTER... 4 WEST LAWN DIALYSIS... 2 WHITESIDE DIALYSIS... 6 WOODLAWN DIALYSIS... 2, 2, 2 I-3

15 DISCRIMINATION IS AGAINST THE LAW Health Alliance complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. Health Alliance does not exclude people or treat them differently because of race, color, national origin, age, disability or sex. Health Alliance: Provides free aids and services to people with disabilities to communicate effectively with us, such as: o Qualified sign language interpreters o Written information in other formats (large print audio, accessible electronic formats, other formats) Provides free language services to people whose primary language is not English, such as: o Qualified interpreters o Information written in other languages If you need these services, contact customer service. If you believe that Health Alliance has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Health Alliance Medicare, Member Services, 301 S. Vine Street, Urbana, IL or 316 Fifth Street, Wenatchee, WA 98801, telephone for members in Illinois, Indiana, Iowa and Ohio: ; telephone for members in Washington: TTY: 711, fax: , MemberServices@healthalliance.org. You can file a grievance in person or by mail, fax or . If you need help filing a grievance, Member Services is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F, HHH Building, Washington, DC 20201, , TTY: Complaint forms are available at LA DISCRIMINACIÓN ES CONTRA LA LEY Health Alliance cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo. Health Alliance no excluye a las personas ni las trata de forma diferente debido a su origen étnico, color, nacionalidad, edad, discapacidad o sexo. Health Alliance: Proporciona asistencia y servicios gratuitos a las personas con discapacidades para que se comuniquen de manera eficaz con nosotros, como los siguientes: Intérpretes de lenguaje de señas capacitados. Información escrita en otros formatos (letra grande, audio, formatos electrónicos accesibles, otros formatos). Proporciona servicios lingüísticos gratuitos a personas cuya lengua materna no es el inglés, como los siguientes: Intérpretes capacitados. Información escrita en otros idiomas. Si necesita recibir estos servicios, comuníquese con servicio al cliente. Si considera que Health Alliance no le proporcionó estos servicios o lo discriminó de otra manera por motivos de origen étnico, color, nacionalidad, edad, discapacidad o sexo, puede presentar un reclamo a la siguiente persona: Health Alliance Medicare, Member Services, 301 S. Vine Street, Urbana, IL o 316 Fifth St., Wenatchee, WA 98801; Teléfono para los miembros en Illinois, Indiana, Iowa, y Ohio: , Teléfono para los miembros en Washington: , TTY: 711 o , fax: , correo electrónico: MemberServices@healthalliance.org. Puede presentar el reclamo en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para hacerlo, Member Services está a su disposición para brindársela. También puede presentar un reclamo de derechos civiles ante la Office for Civil Rights (Oficina de Derechos Civiles) del Department of Health and Human Services (Departamento de Salud y Servicios Humanos) de EE. UU. de manera electrónica a través de Office for Civil Rights Complaint Portal, disponible en o bien, por correo postal a la siguiente dirección o por teléfono a los números que figuran a continuación: U.S. Department of Health and Human Services 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C , (TDD) Puede obtener los formularios de reclamo en el sitio web ATENCIÓN: Si habla Español, servicios de asistencia lingüística, de forma gratuita, están disponibles para usted. IA, IL, IN, OH: Llame , WA Llame: (TTY: 711). 注意 : 如果你講中文, 語言協助服務, 免費的, 都可以給你 IA, IL, IN, OH: 呼叫 , WA: 呼叫 (TTY: 711) cmp-nondiscnotice15mwwacombo-1216

16 UWAGA: Jeśli mówić Polskie, usługi pomocy języka, bezpłatnie, są dostępne dla Ciebie. IA, IL, IN, OH: Zadzwoń , WA: Zadzwoń (TTY: 711). Chú ý: Nếu bạn nói Tiếng Việt, các dịch vụ hỗ trợ ngôn ngữ, miễn phí, có sẵn cho bạn. IA, IL, IN, OH: Gọi , WA: Gọi (TTY: 711). 주의 : 당신이한국어, 무료언어지원서비스를말하는경우사용할수있습니다 IA, IL, IN, OH: 전화 WA: 전화 (TTY: 711). ВНИМАНИЕ: Если вы говорите русский, вставки услуги языковой помощи, бесплатно, доступны для вас. IA, IL, IN, OH: Вызов , WA: Вызов (TTY: 711). Pansin: Kung magsalita ka Tagalog, mga serbisyo ng tulong sa wika, nang walang bayad, ay magagamit sa iyo. IA, IL, IN, OH: Tumawag , WA: Tumawag (TTY: 711). انتباه: ا ذا كنت تتكلم العربية فا ن خدمات المساعدة اللغوية متوفرة لك مجانا. ا يلينوي ا نديانا ا وهايو: اتصل بالرقم ولاية واشنطن: اتصل بالرقم: (ا ذا كنت تعاني من الصمم ا و صعوبة في السمع فاتصل على الرقم 711) Aufmerksamkeit: Wenn Sie Deutsch sprechen, Sprachassistenzdienste sind kostenlos, zur Verfügung. IA, IL, IN, OH: Anruf , WA: Anruf (TTY: 711). ATTENTION: Si vous parlez français, les services d'assistance linguistique, gratuitement, sont à votre disposition. IA, IL, IN, OH: Appelez , WA: Appelez (TTY: 711). ધ ય : તમ વ ત ત જર ત, ભ ષ સહ ય સ વ ઓ, મફત, તમ ર મ ટ ઉપલબ છ. IA, IL, IN, OH: ક લ , WA: ક લ (TTY: 711). 注意 : あなたは 日本語 無料で言語支援サービスを 話す場合は あなたに利用可能です IA, IL, IN, OH: コール WA: コール (TTY: 711) LET OP: Als je spreekt pennsylvania nederlandse, taalkundige bijstand diensten, gratis voor u beschikbaar zijn. IA, IL, IN, OH: Bel , WA: Bel (TTY: 711). УВАГА: Якщо ви говорите український, вставки послуги мовної допомоги, безкоштовно, доступні для вас. IA, IL, IN, OH: Виклик , WA: Виклик (TTY: 711). ATTENZIONE: Se si parla italiano, servizi di assistenza linguistica, a titolo gratuito, sono a vostra disposizione. IA, IL, IN, OH: Chiamare , WA: Chiamare (TTY: 711).

17 TTY/TDD 711 HealthAllianceMedicare.org