2015 Provider/Pharmacy Directory PDF
Preview 2015 Provider/Pharmacy Directory
MEDICARE ADVANTAGE 2015 Provider and Pharmacy Directory Senior Blue HMO and HMO-POS Forever Blue Medicare PPO If you have any questions, we’re here to help! bsneny.com/medicare 1-800-329-2792 (TTY 711) 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 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 and enrollment depends on contract renewal. BlueShield of Northeastern New York Senior Blue HMO and HMO-POS, Forever Blue Medicare PPO and Forever Blue Medicare PPO Value 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 August 6, 2014. 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 711. 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_MRK1384 Accepted 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 network 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 listed in this directory. If a provider has an indicator "SBO," he or she only participates with our Senior Blue HMO and HMO-POS plans and not with our Forever Blue Medicare PPO plans. 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 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 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. If a provider has an indicator "FBO," he or she only participates with our Forever Blue Medicare PPO plans and not with our Senior Blue HMO and HMO-POS plans. 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 750 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 "SBO" or without an indicator. Forever Blue Medicare PPO members may go to any provider indicated by "FBO" or without any indicator. 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 711. 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 languages Other Languages: spoken in provider's office by either the provider é£ìx n ý-˜%oüA B C D E SBO FBO 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. SBO Provider participates in the Senior Blue HMO and HMO-POS Plan only. FBO Provider participates in the Forever Blue Medicare PPO Plan only. 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: 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) 5 % 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 13 Diabetic Education 65 Optometry 92 PHYSICIANS - Totals by Services Oral & Max Surgery 93 County Dialysis Facility 66 Orthopedic Surgery 94 PRIMARY CARE 14 Durable Medical Equipment 66 Orthotics/Prosthetics 96 PHYSICIANS Durable 66 Otolaryngology 96 Medical/Respiratory ALBANY 14 Pain Management 97 Equipment Pediatric Allergy & 98 COLUMBIA 25 Endocrinology 67 Immunology FULTON 26 Endocrinology & 68 Pediatric Cardiology 98 Metabolism GREENE 28 Pediatric Critical Care 98 Gastroenterology 68 MONTGOMERY 29 Pediatric Endocrinology 98 General Surgery 69 Pediatric Gastroenterology 98 RENSSELAER 30 Geriatric Specialist 72 Pediatric 99 SARATOGA 35 Gynecologic Oncology 72 Hematology/Oncology SCHENECTADY 41 Gynecology Only 72 Pediatric Infectious 99 HIV Experienced 72 Diseases WARREN 46 Hand Surgery 73 Pediatric Nephrology 99 WASHINGTON 49 Hearing Aid 73 Pediatric Neurological 99 SPECIALISTS & OTHER 51 Hematology 73 Surgery PARTICIPATING Home Health Agency - 74 Pediatric Ophthalmology 99 PROVIDERS - Totals by Certified Pediatric Otolaryngology 99 County and Specialty Home Health Agency - 74 Pediatric Pulmonary 99 SPECIALISTS & OTHER 57 Licensed Disease PARTICIPATING Home Infusion/Durable 74 Pediatric Radiology 99 PROVIDERS Medical Equipment Pediatric Rheumatology 100 ALBANY 57 Hospice 74 Pediatric Surgery 100 Adolescent Medicine 57 Infectious Disease 74 Pediatric Urology 100 Specialist Interventional Cardiology 75 Physical Medicine & Rehab 100 Allergy & Immunology 57 Maternal & Fetal Medicine 75 Physical Therapy 101 Ambulatory Infusion Center 57 Medical Genetics 75 Plastic Surgery 108 Ambulatory Surgery Center 57 Medical Oncology 75 Podiatry 109 Audiology 57 Neonatal-Perinatal 76 Preventive Medicine 110 Cardiac Electrophysiology 58 Medicine Pulmonary Disease 110 Cardio Thoracic 58 Nephrology 76 Radiation Oncology 112 Cardiovascular Disease 58 Neuro-Oncology 77 Radiology 112 Certified Nurse Midwife 61 Neurological Surgery 77 Radiology/MRI 125 Child Neurology 62 Neurology 78 Reproductive 126 Chiropractor 62 Neuroradiology 81 Endo crinology Colon and Rectal Surgery 63 Nuclear Medicine 82 R heumatology 126 Critical Care Medicine 63 Obstetrics/Gynecology 82 Skilled Nursing Facility 126 Dermatology 64 Occupational Medicine 86 Sleep Center 127 Dermatology MOHS 64 Occupational Therapy 86 Sleep Medicine 127 Developmental Pediatrics 65 Oncology/Hematology 88 Speech Therapy 127 Ophthalmology 89 Sports Medicine 128 7 Surgical Critical Care 128 Plastic Surgery 139 Skilled Nursing Facility 145 Thoracic Surgery 129 Podiatry 139 Transportation (Land) 145 Transportation (Land) 129 Pulmonary Disease 139 Urology 145 Urgent Care Center 129 Radiation Oncology 139 Vascular Surgery 145 Urology 130 Radiology 139 GREENE 146 Vasc Interventional 132 Rheumatology 141 Cardiovascular Disease 146 Radiology Skilled Nursing Facility 141 Certified Nurse Midwife 146 Vascular Surgery 133 Sports Medicine 141 Chiropractor 146 Wheelchair Vans 134 Transportation (Land) 141 Dermatology 146 COLUMBIA 134 Urology 141 Dialysis Facility 146 Allergy & Immunology 134 Vascular Surgery 141 Durable Medical Equipment 146 Audiology 134 FULTON 141 Durable 146 Cardiac Electrophysiology 134 Allergy & Immunology 141 Medical/Respiratory Cardiovascular Disease 134 Ambulatory Surgery Center 141 Equipment Certified Nurse Midwife 135 Audiology 141 Endocrinology & 146 Metabolism Child Neurology 135 Cardiovascular Disease 141 Gastroenterology 146 Chiropractor 135 Certified Nurse Midwife 142 General Surgery 146 Dermatology 135 Chiropractor 142 Gynecology Only 146 Diabetic Education 135 Community Flu Clinics 142 Services Hearing Aid 146 Critical Care Medicine 142 Dialysis Facility 135 Home Health Agency - 147 Durable Medical Equipment 142 Certified Endocrinology 135 Gastroenterology 142 Home Health Agency - 147 Endocrinology & 136 General Surgery 142 Licensed Metabolism Hearing Aid 143 Home Infusion/Durable 147 Gastroenterology 136 Home Health Agency - 143 Medical Equipment General Surgery 136 Certified Hospice 147 Gynecology Only 136 Home Health Agency - 143 Infectious Disease 147 Hearing Aid 136 Licensed Nephrology 147 Hematology 136 Home Infusion/Durable 143 Obstetrics/Gynecology 147 Home Health Agency - 136 Medical Equipment Occupational Therapy 147 Certified Hospice 143 Ophthalmology 147 Home Health Agency - 136 Nephrology 143 Licensed Optometry 147 Neurology 143 Infectious Disease 136 Orthopedic Surgery 147 Obstetrics/Gynecology 143 Medical Oncology 137 Physical Therapy 148 Occupational Therapy 143 Nephrology 137 Podiatry 149 Ophthalmology 143 Neurology 137 Pulmonary Disease 149 Optometry 144 Obstetrics/Gynecology 137 Skilled Nursing Facility 149 Orthopedic Surgery 144 Ophthalmology 137 Sports Medicine 149 Orthotics/Prosthetics 144 Optometry 137 Transportation (Land) 149 Otolaryngology 144 Orthopedic Surgery 138 Urgent Care Center 149 Physical Therapy 144 Orthotics/Prosthetics 138 Podiatry 144 MONTGOMERY 149 Otolaryngology 138 Pulmonary Disease 144 Acute Rehabilitation Center 149 Pain Management 138 Radiology 145 Allergy & Immunology 149 Physical Therapy 138 Ambulatory Surgery Center 149 8
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