Simpra Advantage PPO Plans

2024 Provider and Pharmacy Directory Introduction (Preamble)

This directory preamble is current as of January 2024.

This directory provides a list of Simpra Advantage’s current network providers for the state of Alabama.

To request a hard copy of Simpra Advantage’s provider directory, please call our Member Service Department at 1-844-637-4770, seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30. TTY/TDD users should call 1-833-312-0044. Simpra Advantage will mail a hard copy of the provider directory to you within three (3) business days of your request.  Simpra Advantage may ask whether your request for a hard copy is a one-time request or if you are requesting to receive the provider directory in hard copy permanently.

If you request it, your request for hard copies of the provider directory remains until you leave Simpra Advantage or request that hard copies be discontinued.

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.

To request a directory in an alternate format like Large Print or in another language, call the Member Service Department at 1-844-637-4770. TTY/TDD users should call 1-833-312-0044.

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

Introduction

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

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

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 listed in this directory; however, some services may require a referral. To obtain a referral, please contact your PCP or Nurse Practitioner.

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 Service Department at 1-844-637-4770, seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30.  TTY/TDD users should call 1-833-312-0044. You may also visit Simpra.com to view your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services.

Please note: 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) from Simpra Advantage 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/TDD users should call 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).
  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.

You may obtain emergency services from the closest available provider, and urgently needed services from any qualified provider when out of the plan’s service area or when network providers are unavailable. You may download guidelines for finding providers and pharmacies in an emergency situation for more information. Please be aware that with the exception of emergencies, it may cost more to get care from out-of-network providers.

What is the service area for Simpra Advantage?

Simpra Advantage plans are available in all counties of Alabama.

  • Autauga
  • Baldwin
  • Barbour
  • Bibb
  • Blount
  • Bullock
  • Butler
  • Calhoun
  • Chambers
  • Cherokee
  • Chilton
  • Choctaw
  • Clarke
  • Clay
  • Cleburne
  • Coffee
  • Colbert
  • Conecuh
  • Coosa
  • Covington
  • Crenshaw
  • Cullman
  • Dale
  • Dallas
  • DeKalb
  • Elmore
  • Escambia
  • Etowah
  • Fayette
  • Franklin
  • Geneva
  • Greene
  • Hale
  • Henry
  • Houston
  • Jackson
  • Jefferson
  • Lamar
  • Lauderdale
  • Lawrence
  • Lee
  • Limestone
  • Lowndes
  • Macon
  • Madison
  • Marengo
  • Marion
  • Marshall
  • Mobile
  • Monroe
  • Montgomery
  • Morgan
  • Perry
  • Pickens
  • Pike
  • Randolph
  • Russell
  • Shelby
  • St. Clair
  • Sumter
  • Talladega
  • Tallapoosa
  • Tuscaloosa
  • Walker
  • Washington
  • Wilcox
  • Winston

How do you find Simpra Advantage providers that serve your area? 

Step 1: Select the type of provider you are looking for: “Doctor”, “Hospital, facility, or other service”, “Pharmacy”, “Dentist” or “Find by name or keyword”.

Step 2: Search by a specialty, name of provider, practice, facility or pharmacy, or by zip code and search range distance.

Click the map and zoom in to view the locations of providers found in your search. Click “View Profile” for a specific provider for more information, to view that provider alone on a map, and to get directions to that provider’s location. 

If you have questions about Simpra Advantage or require assistance in selecting a PCP, please call our Member Service Department at 1-844-637-4770 seven days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30. TTY/TDD users should call 1-833-312-0044.  Or you may visit Simpra.com.