2014 Provider/Pharmacy Directory - BlueShield of Northeastern

520 Pages·2013·1.6 MB·English

MeDicare aDvanTage
2014
Provider and Pharmacy
Directory
Senior Blue HMO, HMO-POS
Forever Blue Medicare PPO
If you have any questions, we’re here to help!
www.bsneny.com/medicare
1-877-258-SHLD (7453)
(TTY 1-877-286-5710)
October 1-February 14
8 a.m. to 8 p.m., 7 days a week
February 15-September 30
8 a.m. to 8 p.m., Monday-Friday
During non-business hours, your call will be answered
by our automated phone system. A representative
will return your call the next business day.
A division of HealthNow New York Inc., an independent
licensee of the BlueCross BlueShield Association.
BlueShield of Northeastern New York is a Medicare Advantage
plan with a Medicare contract. Enrollment in BlueShield of
Northeastern New York depends on contract renewal.
BlueShield of Northeastern New York
Senior Blue HMO and HMO-POS and Forever Blue Medicare
PPO Plan
Provider Directory
This directory provides a list of BlueShield of Northeastern New York's network
providers.
The directory is for Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga,
Schenectady, Warren and Washington counties, New York.
This directory is current as of October 1, 2013. Some network providers may have been
added or removed from our network after this directory was printed. We do not
guarantee that each provider is still accepting new members. To get the most up-to-date
information about BlueShield's network providers in your area, you can visit
www.bsneny.com/medicare or call our Customer Service Department at 1-800-329-2792.
TTY users should call 1-877-834-6918. We are available:
October 1 - February 14 8 a.m. to 8 p.m., 7 days a week
February 15 - September 30 8 a.m. to 8 p.m., Monday - Friday
During non-business hours, your call will be answered by our automated phone system. A
representative will return your call the next business day.
BlueShield of Northeastern New York is a Medicare Advantage organization with a
Medicare contract. Enrollment in BlueShield of Northeastern New York depends on
contract renewal.
This document may be available in other formats such as Braille, large print or other
alternate formats.
Y0086_MRK1255 Accepted
Last Updated September 11, 2013
AMED3.PPO
Section 1 - Introduction
This directory provides a list of BlueShield of Northeastern New York's network
providers. To get detailed information about your health care coverage, please see your
Evidence of Coverage.
Senior Blue HMO and HMO-POS
You will have to choose one of our providers who are listed in this directory to be your
Primary Care Physician (PCP). The term "PCP" will be used throughout this directory.
Generally, you must get your health care coverage from your PCP. Participating Senior
Blue HMO and HMO-POS providers are noted with "SB".
If you are a member of Senior Blue HMO and HMO-POS, you must use plan providers
except in emergency or urgent situations. If you obtain routine care from
out-of-network providers neither Medicare nor BlueShield of Northeastern New York
will be responsible for the costs.
Members of Senior Blue HMO and HMO-POS must receive care from in-network
providers in most circumstances, however urgent, emergent, lab and dialysis services are
covered nationwide. In certain circumstances, certain medically necessary services are
covered outside of our service area. To find out if a medically necessary service is
covered outside of our network, please contact customer service at the number listed
on the front page.
The "network providers" listed in this directory have agreed to provide you with your
health care coverage. You may go to any of our network providers listed in this
directory. If you have been going to one network provider, you are not required to
continue going to that same provider. In some cases, you may get covered services from
non-network providers.
You must use plan providers except in emergency or urgent care situations or for
out-of-area renal dialysis or other services. If you obtain routine care from
out-of-network providers neither Medicare nor BlueShield of Northeastern New York
will be responsible for the costs.
If your plan has a point-of-service (POS) benefit, you may get care from providers not in
our network under certain conditions. For more information, please call the customer
service.
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Forever Blue Medicare PPO
Forever Blue Medicare PPO provides "in-network" and "out-of-network" coverage and
does not require members to have a Primary Care Physician (PCP). Plan providers in our
service area are called in-network providers. A health care service you receive from a
non-plan provider is known as an out-of-network service. Participating Forever Blue
Medicare PPO providers are noted with "FB".
You may use non-plan providers to receive your covered services, although your out of
pocket costs may be higher than if you use our plan providers listed in this directory.
With the exception of emergencies or urgent care, it may cost more to get care from
out-of-network providers.
For emergency care, including hospital care after you are stable, and urgently needed
care, your out of pocket expenses will be the same both in-network and out-of-network.
For cost sharing information see your Evidence of Coverage.
There are special rules for out-of-network services. Certain services that we offer are
not covered out-of-network. Also, you do not need to receive a referral or prior
authorization when you receive out-of-network care from non-plan providers. However,
before receiving an out of network service, you may want to check to see if the services
you are receiving are covered by your plan and are medically necessary. For more
information, please see your Evidence of Coverage.
Forever Blue Medicare PPO’s out-of-network service area is made up of providers in all
50 States, who accept either Medicare and/or a BlueShield plan.
Forever Blue Medicare PPO members also have an option that will allow them to see
out-of-network providers and only be charged an in-network copayment. The providers
must participate in the BlueCard Medicare Advantage program.
Providers
The "network providers" listed in this directory have agreed to provide you with your
health care coverage. You may go to any of our network providers listed in this
directory. Senior Blue HMO and HMO-POS members may go to any provider indicated
by "SB". Forever Blue Medicare PPO members may go to any provider indicated by "FB". If
you have been going to one network provider, you are not required to continue going to
that same provider. In some cases, you may get covered services from non-network
providers. Senior Blue HMO and HMO-POS and Forever Blue Medicare PPO do not
require referrals; however a prior authorization may be required in some circumstances.
If you have questions about whether or not a procedure requires a prior authorization
please contact customer service at the number listed on the front page.
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Pharmacies
We call the pharmacies on this list our "network pharmacies" because we have made
arrangements with them to provide prescription drugs to plan members. A network
pharmacy is a pharmacy where beneficiaries obtain prescription drug benefits provided
by BlueShield. In most cases, your prescriptions are covered under BlueShield only if they
are filled at a network pharmacy or through our mail order pharmacy service. Once you
go to one, you are not required to continue going to the same pharmacy to fill your
prescription. You can go to any of our network pharmacies. We will fill prescriptions at
non-network pharmacies under certain circumstances as described in your Evidence of
Coverage.
What is the service area for BlueShield of Northeastern New York?
The counties in our service area are listed below:
Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady,
Warren and Washington counties.
How do you find BlueShield of Northeastern New York providers in your area?
We've organized this directory of physicians and pharmacies by county so you can easily
find a physician or pharmacy whose location is close to your home or place of
employment. If you would like to view the full provider/pharmacy directory or are in
need of one, simply visit our website at www.bsneny.com/medicare or call customer
service.
If you have questions about BlueShield of Northeastern New York or require assistance
in selecting a PCP, please call our Customer Service Department at 1-800-329-2792. TTY
users should call 1-877-834-6918. We are available:
October 1 - February 14 8 a.m. to 8 p.m., 7 days a week
February 15 - September 30 8 a.m. to 8 p.m., Monday - Friday
During non-business hours, your call will be answered by our automated phone system. A
representative will return your call the next business day. Or, visit,
www.bsneny.com/medicare.
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To assist you in using our directory we have illustrated a provider listing.
Provider Name & Title
123 Street Address
City, State 12345
[phone]
Other Languages: All
provider offices speak PCP # 123456789012 AM/FP
English.
Only additional Other Languages:
languages spoken in
éìx n ý-˜%oüA B C D E SB/FB
provider's office by
either the provider
or provider's office
staff are listed
Please use this table as a reference for the symbols used throughout this directory
PCP # PCP Number: This number identifies the provider in our system. For example,
through our automated system, members can change their primary care physicians
by indicating the identification number of the physician they want to select.
SB Provider participates in the Senior Blue HMO and HMO-POS Plan. If you are
enrolled in a Senior Blue HMO and HMO-POS Plan, you must choose a PCP
from the enclosed list of Primary Care Physicians who have this symbol.
FB Provider participates in the Forever Blue Medicare PPO Plan. If you are enrolled in
a
Forever Blue Medicare PPO Plan, you may choose any provider with this symbol.
é Wheelchair accessible
ì Board certification. A (ì) indicates certification by the ABMS (American Board of
Medical Specialties) or American Board of Osteopathic Physicians. The Physician
has successfully completed an approved educational program and passed an exam
designed to assess the knowledge, skills and experience required to provide quality
care in that specialty.
You'll notice that some providers are listed as Board Certified in the specialty
listed. Board Certification is a voluntary process of additional testing and
evaluation in a specialty area that some providers choose to undergo. A physician
should not be considered more qualified or unqualified based solely on
certification. There are many certification boards in the United States and other
countries. To be identified as Board Certified in this directory, a Practitioner must
be Board Certified in one of the following Boards:
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The American Board of Medical Specialties
The American Board of Oral & Maxillofacial Surgery
The American Board of Podiatric Surgery
The American Board of Podiatric & Primary Podiatric Medicine
The American Osteopathic Association Board
x Current Patients Only
n Practitioner is sponsoring physician for mid-level practitioners. Mid-level
practitioners available at the office listed include the following practitioners: Nurse
Practitioners (NP), Physician Assistants (PA) and Certified Nurse Midwife (CNM).
ý 90 day supply at retail pharmacy
˜ Provider is designated as a Patient Centered Medical Home (PCMH)
% Member of the Association for Medical Ethics (AME)
- AIDS Designated Centers
o Accepting Developmental Disabled Patients Only
ü Accepting Native American Patients Only
A Location is not wheelchair accessible. Provider will refer to a local hospital that is
wheelchair accessible. Please contact the office for additional details.
B Location is not wheelchair accessible. Provider will perform services at member's
residence. Please contact the office for additional details.
C Location is not wheelchair accessible. Provider will refer to a local clinic that is
wheelchair accessible. Please contact the office for additional details.
D Location is not wheelchair accessible. Provider will service member at a facility that
is wheelchair accessible. Please contact the office for additional details.
E Location is not wheelchair accessible. Provider will refer to another office or
location that is wheelchair accessible. Please contact the office for additional
details.
BDB1 Blue Distinction - Cardiac
BDB2 Blue Distinction - Bariatric
BDB3 Blue Distinction - Transplant
Primary Care Physician (PCP) Abbreviations
AM - Adolescent Medicine GER - Geriatric Medicine IM - Internal Medicine
FP - Family Practice GP - General Practice PED - Pediatrics
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TABLE OF CONTENTS
PRIMARY CARE PHYSICIANS - Totals 17 Chiropractor 92
by County
Colon and Rectal Surgery 93
PRIMARY CARE PHYSICIANS 18 Critical Care Medicine 94
Dermatology 95
ALBANY 18
Dermatology MOHS 96
COLUMBIA 35 Developmental Pediatrics 96
Diabetic Education Services 96
FULTON 38
Dialysis Facility 98
GREENE 40
Durable Medical Equipment 98
Durable Medical/Respiratory 99
MONTGOMERY 42
Equipment
RENSSELAER 44 Endocrinology 99
Endocrinology & Metabolism 101
SARATOGA 51
Gastroenterology 101
SCHENECTADY 61
General Surgery 103
Geriatric Specialist 107
WARREN 67
Gynecologic Oncology 107
WASHINGTON 72
Gynecology Only 108
SPECIALISTS & OTHER 75 HIV Experienced 108
PARTICIPATING PROVIDERS - Totals
Hand Surgery 108
by County and Specialty
Head and Neck Surgery 108
SPECIALISTS & OTHER 84
Hearing Aid 108
PARTICIPATING PROVIDERS
Hematology 109
ALBANY 84 Home Health Agency - Certified 109
Adolescent Medicine Specialist 84 Home Health Agency - Licensed 110
Allergy & Immunology 84 Home Infusion/Durable Medical 110
Equipment
Ambulatory Infusion Center 84
Hospice 110
Ambulatory Surgery Center 84
Infectious Disease 110
Audiology 85
Interventional Cardiology 111
Cardiac Electrophysiology 85
Maternal & Fetal Medicine 112
Cardio Thoracic 86
Medical Genetics 112
Cardiovascular Disease 87
Medical Oncology 112
Certified Nurse Midwife 90
Neonatal-Perinatal Medicine 113
Child Neurology 91
Nephrology 114
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Neuro-Oncology 115 Podiatry 163
Neurological Surgery 115 Preventive Medicine 164
Neurology 116 Pulmonary Disease 164
Neuroradiology 120 Radiation Oncology 166
Nuclear Medicine 121 Radiology 167
Obstetrics/Gynecology 121 Radiology/MRI 188
Occupational Medicine 127 Reproductive Endocrinology 188
Occupational Therapy 127 Rheumatology 188
Oncology/Hematology 131 Skilled Nursing Facility 189
Ophthalmology 131 Sleep Center 190
Optometry 136 Sleep Medicine 190
Oral & Max Surgery 138 Speech Therapy 190
Orthopedic Surgery 138 Sports Medicine 193
Orthotics/Prosthetics 141 Surgical Critical Care 193
Otolaryngology 142 Thoracic Surgery 193
Pain Management 144 Transportation (Land) 194
Pediatric Allergy & Immunology 144 Urgent Care Center 194
Pediatric Cardiology 144 Urology 195
Pediatric Critical Care 145 Vasc Interventional Radiology 197
Pediatric Endocrinology 145 Vascular Surgery 198
Pediatric Gastroenterology 145 Wheelchair Vans 200
Pediatric Hematology/Oncology 146
COLUMBIA 200
Pediatric Infectious Diseases 146
Allergy & Immunology 200
Pediatric Nephrology 146
Audiology 201
Pediatric Neurological Surgery 146
Cardiac Electrophysiology 201
Pediatric Ophthalmology 147
Cardiovascular Disease 201
Pediatric Otolaryngology 147
Certified Nurse Midwife 202
Pediatric Pulmonary Disease 147
Child Neurology 202
Pediatric Radiology 147
Chiropractor 202
Pediatric Rheumatology 147
Dermatology 202
Pediatric Surgery 147
Diabetic Education Services 202
Pediatric Urology 148
Dialysis Facility 203
Physical Medicine & Rehab 148
Durable Medical/Respiratory 203
Physical Therapy 149
Equipment
Plastic Surgery 161
Endocrinology 203
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Endocrinology & Metabolism 203 Audiology 212
Gastroenterology 203 Cardiovascular Disease 212
General Surgery 203 Certified Nurse Midwife 212
Gynecology Only 204 Chiropractor 212
Hearing Aid 204 Community Flu Clinics 213
Hematology 204 Critical Care Medicine 213
Home Health Agency - Certified 204 Durable Medical Equipment 213
Home Health Agency - Licensed 204 Gastroenterology 213
Infectious Disease 204 General Surgery 213
Medical Oncology 204 Hearing Aid 213
Nephrology 205 Home Health Agency - Certified 214
Neurology 205 Home Health Agency - Licensed 214
Obstetrics/Gynecology 205 Home Infusion/Durable Medical 214
Equipment
Ophthalmology 205
Hospice 214
Optometry 206
Nephrology 214
Orthopedic Surgery 206
Neurology 214
Orthotics/Prosthetics 206
Obstetrics/Gynecology 214
Otolaryngology 206
Occupational Therapy 214
Pain Management 207
Ophthalmology 214
Physical Therapy 207
Optometry 215
Plastic Surgery 208
Orthopedic Surgery 215
Podiatry 208
Orthotics/Prosthetics 215
Pulmonary Disease 208
Otolaryngology 216
Radiation Oncology 208
Physical Therapy 216
Radiology 208
Podiatry 216
Rheumatology 211
Pulmonary Disease 216
Skilled Nursing Facility 211
Radiology 217
Sports Medicine 211
Skilled Nursing Facility 217
Transportation (Land) 211
Transportation (Land) 218
Urology 211
Urology 218
Urology Gynecology 211
Vascular Surgery 218
Vascular Surgery 211
GREENE 218
FULTON 211
Cardiovascular Disease 218
Allergy & Immunology 211
Certified Nurse Midwife 218
Ambulatory Surgery Center 211
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