2022 Provider and Pharmacy Directory Introduction (Preamble)

This directory is current as of October 1, 2022

This directory provides a list of Simpra Advantage’s current network providers and pharmacies.

This directory is for Simpra Advantage’s residents of Alabama

Statement of Nondiscrimination and Alternate Formats

Simpra Advantage complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-844-637-4770 (TTY 1-833-312-0044).

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Introduction for Provider Directory

This directory provides a list of Simpra Advantage’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). 

You will have to choose one of our network providers in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care coverage from your PCP. Your PCP works in collaboration with your Simpra Advantage Nurse Practitioner to assure you receive seamless, patient-centered care.

The network providers listed in this directory have agreed to provide you with health care services. You may go to any of our network providers listed in this directory; however, some services may require a referral. To obtain a referral, please contact your PCP or Nurse Practitioner.

For a complete listing of services that require prior authorization, or a referral, please refer to the Member Resources section of the Simpra Advantage website at Simpra.com or call our Member Services Department at 1-844-637-4770 (TTY 1-833-312-0044).

Introduction for Pharmacy Directory

This search tool provides a list of Simpra Advantage’s network pharmacies.  To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and Simpra Advantage’s formulary. 

When this pharmacy directory refers to “we,” “us”, or “our,” it means sponsor name>. When it refers to “plan” or “our plan,” it means Simpra Advantage plan name.

We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under Simpra Advantage only if they are filled at a network pharmacy or through our mail order pharmacy service.  Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies.  We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage.  

All network pharmacies may not be listed in this directory.  Pharmacies may have been added or removed from the list after this directory was printed. This means the pharmacies listed here may no longer be in our network, or there may be newer pharmacies in our network that are not listed. This list is current as of October 1, 2022  . For the most current list, please contact us. Our contact information appears on the front and back cover pages.

You can get prescription drugs shipped to your home through our network mail order delivery program. For more information, please contact us or see the mail order section of this pharmacy directory.

If you have questions about any of the above, please see the first and last cover pages of this directory for information on how to contact Simpra Advantage.

About the Simpra Advantage Provider Network 

Our network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment and your cost-sharing amount as payment in full. 

You may go to any of our network providers listed in this directory, and you may also receive services from out-of-network providers. Before receiving services from an out-of-network provider, you may want to contact Simpra Advantage to confirm if prior authorization is required, and if the services you are receiving are covered by the plan.

We have arranged for these providers to deliver covered services to members in our plan. The providers in our network bill us directly for care they give you. When you see a network provider, you pay only your share of the cost for their services. If you use an out-of-network provider, your share of the costs for your covered services may be higher. 

In most cases, the out-of-network provider must be eligible to participate in Medicare. If you receive care from a provider who is not eligible to participate in Medicare, you will be responsible for the full cost of the services you receive. Check with your provider before receiving services to confirm that they are eligible to participate in Medicare.

If you receive a bill from an out-of-network provider, you should not pay the bill, unless you have received an Explanation of Benefits (EOB) that details what the plan will pay for your service, and any remaining balance you need to pay. The out-of-network provider may also bill you for any remaining balance not paid by Simpra Advantage.

If you have already paid for the covered services, Simpra Advantage will reimburse you for our share of the cost, if prior approval is obtained. If you have any questions, visit Simpra.com or call member services at 1-844-637-4770 (TTY 1-833-312-0044).

Payment for services is contingent upon:

1. The services you received are included in Simpra Advantage benefits as outlined in the Evidence of Coverage (EOC) that can be found on the plan website
2. The provider, or medical facility, you received services from is eligible for payment from Simpra Advantage
3. The service(s) meet requirement for medical necessity and authorization is obtained where necessary

Out-of-network providers are under no obligation to treat Simpra Advantage enrollees, except in emergencies. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Member Services at 1-844-637-4770 (TTY 1-833-312-0044). You may also refer to your Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.

The following contact and revision date information is expected to appear on both the front and 

What is the service area for Simpra Advantage?

The counties in our service area are listed below:

• Elmore
• Etowah
• Franklin
• Greene
• Henry
• Jackson
• Lamar
• Lawrence
• Limestone
• Macon
• Marengo
• Marshall
• Monroe
• Morgan
• Pickens
• Randolph
• St. Clair
• Sumter
• Tallapoosa
• Walker
• Wilcox

Last modified: July 27, 2024