Presorted Standard U.S. POSTAGE PAID New York, NY Permit No. 3700 330 West 42nd Street New York, NY 10036-6977
Fall 2007
Your Key to the 1199SEIU Benefit Funds
Are You Prescribing Medications From the New 1199SEIU Preferred Drug List? You can help your 1199SEIU patients avoid unnecessary out-ofpocket prescription costs by prescribing preferred medications from the Fund’s revised Preferred Drug List (PDL), which went into effect October 1. We’ve included a copy of the full PDL in this edition of 1199SEIU Provider News for you to keep on hand.
Online Live Directory Coming This Fall Beginning this fall, the Fund will be introducing a live directory on our website at www.1199SEIUFunds.org. The live directory will allow us to update provider information more frequently, making sure that our members and referring providers have the most current information on our network. You can help us by checking the Fund’s website now to make sure your information is accurate. If it needs to be updated, let us know by emailing us at Providers@1199Funds.org.
The Fund’s clinicians and Medco expanded the PDL by adding 16 new drug categories. Each drug category contains generic and sometimes brand-name options. If you prescribe any medication in these categories, your 1199SEIU patients won’t incur costs for their medication. If you prescribe non-preferred medications, members will be responsible for the full difference in price between preferred and non-preferred and this can be very costly.
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If you are prescribing a medication from a category that the Fund covers, but it is not included on the PDL, simply prescribe any generic or single source brand in that category. If you believe your patient needs a non-preferred drug in a covered category, or a brand-name drug when a generic is available, you will need to demonstrate that the preferred medications are not appropriate for a particular patient for the Fund to cover it. We encourage you to discuss the new PDL with your patients. All Fund members have received information on these prescription drug benefit changes and may have questions about new medications. If you have any questions, email us at Providers@1199Funds.org or call our Provider Hotline at (646) 473-7160 Coming January 1 – Check Claims Status Automatically, 24 Hours a Day Many of our providers already use the Fund’s Interactive Voice Response system (IVR) to quickly verify their 1199SEIU members’ eligibility 24 hours a day, 7 days a week. Coming in January, you’ll also be able to check the status of your Fund claims automatically at any time that’s convenient for you. To check eligibility, just call (888) 819-1199 and enter your tax ID number, the member’s ID number and date of birth. The system allows you to check an unlimited number of members in one call. You’ll receive more information on checking claims status later in the year. It’s another way we’re improving our service to you.