Providers

Let us contact you about what Senior Whole Health can do for you today. It's simple & easy!

 

Providers

 

Effective January 1, 2012

  • Walgreens Pharmacy will no longer be affiliated with ExpressScripts, the
    prescription vendor for Senior Whole Health (SWH). As a
    result, SWH members may not fill prescriptions at Walgreens. To find a participating
    pharmacy near you, please
    refer to the SWH Pharmacy Directory posted on the
    website.
  • Please contact Provider Relations at 1-866-211-1777
    with any questions.
doctor

"SWH is one of our favorite insurance companies to deal with. They always pay the claims in a timely fashion."

Providers

We are glad you and your patient have chosen Senior Whole Health of New York HMO SNP (SWH). SWH is a new health care plan for people who qualify for both NYS Medicaid and Medicare and who live in the SWH service area. SWH is a Medicare Special Needs Program that is committed to providing health care to New York State’s dual-eligible population.

SWH is a free, voluntary program. The only cost your patient is responsible for are the pharmacy co-payments and non-covered services.

SWH offers two programs to ensure we can service your patient’s individual needs:

  • SWH (Medicare and Medicaid Advantage) provides health care benefits and coordinated care for anyone aged 65 or older and who has NYS Medicaid and Medicare and live in the SWH service area.
  • SWH Plus (Medicare and Medicaid Advantage Plus) provides long term care benefits to people aged 65 years or older and chronically ill who need medical and social support services. This plan is offered to maintain people in their homes who are eligible for NYS Medicaid and Medicare.

Upon your patient’s enrollment with SWH, you will notice that we are definitely not your typical health care plan. SWH offers comprehensive care, including preventive services, physician services, hospital care, pharmacy, and support services to help care for your patient whether they live at home, in congregate housing, or in an assisted living or nursing facility.

SWH understands that providing comprehensive care to individuals in the community requires coordinated case management.

This approach allows for services to be tailored to a member’s needs assuring an appropriate and effective plan of care that will keep our members secure and living in the community. Our high-touch case management services assist individuals to gain access to health care support services, nurses, social workers, and other professional and community-based agencies. SWH also offers monitoring of the individual’s care plan, reducing any gaps in service.

The case manager provides the leadership to assure that communication is clear and consistent and that all members of the team are providing services to achieve and deliver the best care possible.

If you have any questions, please call us:

  • 1-866-211-1777 (toll-free)
  • 711 (TTY) for the hearing impaired.

We are available for provider inquiries Monday through Friday, from 5 A.M. to 5 P.M.

Last modified: 01/27/2012