Provider List for Medicare Advantage Health Insurance Coverage
Important - please only list providers that are important for you to be in-network.
For example, if you had an ankle surgery 12 years ago, and you'll likely not see that provider again (or you would be flexible to see a different surgeon), then do not list that provider. If you have providers which you don't really care whether or not they are in-network because you'd be 100% OK changing, please don't list them. This list should only reflect providers that you want to make sure are in-network.
Name
*
First Name
Last Name
Please Help Us With Accuracy
*Important - please check the spelling of your providers' names; we recommend googling the doctor, or looking at an official business card, to confirm spelling*
Please fill out the form - please don't forget to include your preferred hospital.
Name of the
Provider
(Full First and Last Name)
*Important*
Zip Code of Provider
Provider Type
(i.e., Doctor - including Specialist, Hospital, Dentist)
Provider 1
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
2
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
3
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
4
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
5
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
6
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
7
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
8
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
9
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Provider
10
Nurse Practitioner or Physician Assistant
Doctor (Primary)
Doctor (Specialist)
Hospital
Dentist
Submit
Should be Empty: