All of the Piedmont Medicare Advantage plans utilize the same extensive Piedmont network our members have come to know and appreciate in the community. This includes most local physicians and hospitals.
Our plans will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary. However, if out-of-network providers are used, your share of costs for your services may be higher and that provider must participate in Medicare. Our Provider/Pharmacy Directory lists providers that participate in our network. Piedmont Medicare Advantage verifies the information in its provider directories through its credentialing process and quarterly outreach to providers.
Provider & Pharmacy Directory
The Provider/Pharmacy Directory provides a list of Primary Physicians, Specialists, Hospitals, Skilled Nursing Facilities, Outpatient Mental Health Providers, Other Professionals, Ancillary Facilities, Retail and Chain Pharmacies, Mail Order Pharmacies, Home Infusion Pharmacies, Long Term Care Pharmacies, and Network Pharmacies Outside the Service Area in our network.
Effective January 1, 2019 you can go to all the pharmacies on the pharmacy list, but your costs for some drugs may be less at pharmacies in the pharmacy list that offer preferred cost-sharing.
You may access our online searchable directory listed below. In order to find a provider closest to your home you may look up providers first by specialty, then by city or county. If you require assistance in finding a network provider and or pharmacy, please call 434-947-3671 or toll-free 1-877-210-1719. TTY users should call 711. To request a hard copy of the Provider/Pharmacy Directory CLICK HERE.
Piedmont Medicare Advantage is a PPO plan with a Medicare contract. Enrollment in Piedmont Medicare Advantage depends on contract renewal. Out-of-network/non-contracted providers are under no obligation to treat Piedmont Medicare Advantage members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Piedmont Medicare Advantage’s pharmacy network includes limited lower-cost, preferred pharmacies in Amherst, Appomattox, Bedford*, Campbell, Charlotte, Halifax, Lynchburg City, Pittsylvania, and Prince Edward. The lower cost advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call 1-877-210-1719 (TTY - 711) or consult the online Provider/Pharmacy Directory above.
*denotes partial county (specifically zip codes: 24095, 24104, 24121, 24122, 24174, 24502, 24503, 24523, 24526, 24536, 24550, 24551, 24556, 24570, and 24571).
You can get prescription drugs shipped to your home through our network mail order delivery service. Usually a mail-order pharmacy order will arrive in no more than 14 days. If your prescription drugs have not arrived within the estimated timeframe, please call 1-866-494-9927, 24 hours a day, seven days a week. TTY users should call 711.