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Insurance Plans - Puerto Rico
Select the name of your insurance company to find out where to get forms
and to find contact information for your plan if you need to request prior
authorization or an exception.
This information was collected from the Web sites of the plans, and in
some cases from e-mails and phone calls to the plans. It is provided here
in an effort to make the information more conveniently available to you.
We do not endorse any particular plan and we are not responsible if any
plan has been inadvertently omitted from this list. We have not verified
this information. In addition, we cannot be responsible for ensuring that
the information is always up to date. Please notify
us if you are aware that any of the information provided has changed.
If you would like more detailed and current information, we suggest that
you consult the Medicare
Web site.
AMERICAN HEALTH, INC.
AUXILIO PLATINO, INC.
Where to Get Forms: Call 504-461-4156 and ask to have form sent.
Phone # to request Prior Authorization: 504-461-4156
Phone # to request Exception: 504-461-4156
Fax #: 504-468-3611
E-mail Address: rosy.nicoll@peopleshealth.com Updated: May 2006
COOPERATIVA DE SEGUROS DE VIDA DE PUERTO RICO
FIRST HEALTH LIFE & HEALTH INSURANCE COMPANY
Where to Get Forms: Call 1-800-551-2694 and ask to have form faxed.
Phone # to request Prior Authorization: 1-800-551-2694
Phone # to request Exception: 1-800-551-2694
Fax #: Call 1-800-551-2694 and ask for fax number.
E-mail Address: Not Available
Updated: May 2006
HUMANA HEALTH PLAN, INC.
MCS LIFE INSURANCE COMPANY (H4006)
Where to Get Forms: Not Available
Phone # to request Prior Authorization: Not Available
Phone # to request Exception: Not Available
Fax #: 787-622-2440
E-mail Address: asantiago@medicalcardsystem.com Updated: May 2006
MEMBERHEALTH, INC.
MMM HEALTHCARE, INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: medicareDHPMS@express-scripts.com Updated: May 2006
PHARMACY INSURANCE CORPORATION OF AMERICA
PREFERRED MEDICARE CHOICE, INC.
Where to Get Forms: Call 1-866-516-7703 and ask to have form sent.
Phone # to request Prior Authorization: 1-866-516-7703
Phone # to request Exception: Not Available
Fax #: 787-999-9501
E-mail Address: bouc@phmonline.net Updated: May 2006
SDM HEALTHCARE MANAGEMENT, INC.
Where to Get Forms: Call 1-877-665-6609 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6609
Phone # to request Exception: 1-800-207-2568
Fax #: 1-866-617-6685
E-mail Address: Nicole.Tascher@walgreens.com Updated: May 2006
TRIPLE-S, INC.
Where to Get Forms: Call 787-749-4232 and ask to have form sent.
Phone # to request Prior Authorization: 787-749-4232
Phone # to request Exception: 787-749-4232
Fax #: 787-286-6042
E-mail Address: soto.elizabeth@mc-21.com Updated: May 2006
UNITED HEALTHCARE INSURANCE COMPANY
Where to Get Forms: Call 1-877-665-6651 and ask to have form faxed.
Phone # to request Prior Authorization: 1-877-665-6651
Phone # to request Exception: 1-800-207-2610
Fax #: 1-866-617-6727
E-mail Address: provider.relations@walgreens.com Updated: May 2006
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