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2014 Provider/Pharmacy Directory - BlueShield of Northeastern PDF

520 Pages·2013·1.6 MB·English
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Preview 2014 Provider/Pharmacy Directory - BlueShield of Northeastern

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. 2 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. 3 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. 4 To assist you in using our directory we have illustrated a provider listing. Provider Name & Title 123 Street Address City, State 12345 (999) 999-9999 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: 5 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 6 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 7 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 8 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 9

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