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r") ) If) ) However) in order to receive credit) you must supply evidence of satisfaction of the Deductible under the prior coverage by providing A vMed written proof of what has been paid by prior coverage. Prior Authorization of Covered Services Before a service is performed, you should verify with your provider that the service has received prior authorization. If you are unable to secure verification from your provider, you may also call AvMed. Please remember that failure to obtain prior authorization of a service will result in a reduction in coverage as shown in the Schedule of Benefits. This reduction will occur regardless of whether such services are deemed Medically Necessary. If an inpatient admission is extended beyond the number of days approved, without authorization, benefits for the extra days will be denied. If your physician is an AvMed Choice Provider, then he or she will handle all authorizations, notifications and utilization reviews with AvMed. If your physician is not an AvMed Participating Physician, you are responsible for making sure your physician or Health Professional contacts AvMed to obtain prior authorization for a covered service when it is required. Please refer to your Member identification card for the telephone number where authorization may be obtained, or have your physician call 1-800-443-41 03. The following services require prior authorization from AvMed: . All inpatient admissions (including Hospital and observation stays, skilled nursing facilities, ventilator dependent care, and/or acute rehabilitation). .. Dialysis services. . Transplantation services. . Certain medications including injectables For more information about which services require prior authorization, contact AvMed at 1-800-882-8633, AvMed requires pre-service notification before you receive certain covered services. Complex diagnostic testing procedures which require pre-service notification include but are not limited to CT, CT A, MR.I, MRA, and PET Scans, Nuclear Cardiac Studies, and Nuclear Medicine. The names and addresses of Participating Providers and Hospitals are set forth in a separate booklet which, by reference, is made a part hereof. The list of Participating Providers, which may change from time to time, will be provided to all Subscribing Groups. The list of Participating Providers may also be accessed from the A vMed website at www.avmed.org. Notwithstanding the printed booklet, the names and addresses of Participating Providers on file with AvMed at any given time shall constitute the official and controlling list of Participating Providers. Also, a list of the PHCS contracted providers is available through a link on the www.avmed.org website or by calling AvMed's Member Services department. Pursuant to Florida Statute, there is a link available on the A vMed website to view the performance outcome and financial data that is published by the Florida Agency for Health Care Administration. Members are encouraged but not required to select a Primary Care Physician (PCP) upon enrollment. You can change your PCP selection at any time, but no more often than once per month. You must notify and receive approval from AvMed prior to changing your PCP. Such change will become effective on the first day of the month after you notifY AvMed. Health Professionals may from time to time cease their affiliation with AvMed or PHCS. You should confirm participation of your selected provider prior to seeking services. MEMBERS ARE RESPONSIBLE AND WILL BE LIABLE FOR APPLICABLE CO-PAYMENTS, DEDUCTIBLES AND/OR CO-INSIDUNCE WHICH MUST BE PAID TO HEALTH CARE PROVIDERS FOR CERTAIN SERVICES, AT THE TIME SERVICES ARE RENDERED, AS SET FORTH IN THE SCHEDULE OF BENEFITS. 9.01 Ambulance services as follows: 24 A V-CHOICE-2009yMP-5320 (10/09)