2016 Medicare Provider Directory - NENY Home

386 Pages·2016·1.44 MB·English

BlueShield of Northeastern New York
2016 Provider/Pharmacy
Directory
This directory was updated on June 6, 2016.
For more recent information or other questions,
please contact us, BlueShield of Northeastern
New York Customer Service, at:
1-800-329-2792
or, for TTY users 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
or visit
bsneny.com/medicare
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.
The pharmacy network and/or provider network may change at any time. You will
receive notice when necessary.
Y0086_MRK1591 Accepted
BlueShield of Northeastern New York
Senior Blue HMO and HMO-POS, Forever Blue Medicare PPO and Forever
Blue Medicare PPO Value Plan
Provider/Pharmacy Directory
This directory provides a list of Senior Blue HMO and HMO-POS, Forever Blue
Medicare PPO and Forever Blue Medicare PPO Value's network providers and
pharmacies.
The directory is for Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer,
Saratoga, Schenectady, Warren and Washington counties, New York.

This directory is current as of June 6, 2016. 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 Senior Blue HMO and HMO-POS, Forever Blue
Medicare PPO and Forever Blue Medicare PPO Value’s network providers in your
area, you can visit bsneny.com/medicare or call our Customer Service Department at
1-800-329-2792, 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. TTY users should call 711.
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.
The pharmacy network and/or provider network may change at any time. You will
receive notice when necessary.
Y0086_MRK1591 Accepted
AMED3.PPO_06/05/2016
Section 1 - Introduction
This directory provides a list of Senior Blue HMO and HMO-POS, Forever Blue
Medicare PPO and Forever Blue Medicare PPO Value’s network providers. To get
detailed information about your health care coverage, please see your Evidence of
Coverage. To get a complete description of your prescription coverage, including how
to fill your prescriptions, please review the Evidence of Coverage and Senior Blue
HMO and HMO-POS, Forever Blue Medicare PPO and Forever Blue Medicare PPO
Value’s formulary.
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 the directory.
The “network providers” listed in this directory have agreed to provide you with your
health care services. 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 to go to that same provider. In some cases, you may get covered services
from non-network providers.
If you are a member of Senior Blue HMO-POS, you have the option to obtain care
outside of the service area for an additional cost. There is a limit to what our plan will
cover under your Point-of-service (POS) benefit. Not all services are available under
your Point-of-service (POS) benefit. Please reference your Evidence of Coverage
(EOC) for more details.
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. You
may also go to any provider without any indicator.
You must use plan providers except in emergency or urgent care situations or for
out-of-area renal dialysis. If you obtain routine care from out-of-network providers,
neither Medicare nor Senior Blue HMO and HMO-POS will be responsible for the
costs.
When you receive a bill from a non-contracted Medicare participating provider, you are
only responsible for paying your share of the cost, not for the entire cost. You should
submit the bill to the plan first to determine what your share of the cost will be.
To get detailed information about out of area coverage and emergency coverage;
including, the processes and procedures to obtain emergency services, please see
your Evidence of Coverage.
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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.
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 also go to any provider without any indicator.
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 BlueCross BlueShield plan.
Forever Blue Medicare PPO 750 and 799 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.
When you receive a bill from a non-contracted Medicare participating provider, you are
only responsible for paying your share of the cost, not for the entire cost. You should
submit the bill to the plan first to determine what your share of the cost will be.
To get detailed information about out of area coverage and emergency coverage;
including, the processes and procedures to obtain emergency services, please see
your Evidence of Coverage.
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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 Senior Blue HMO and HMO-POS, Forever Blue Medicare PPO and
Forever Blue Medicare PPO Value. In most cases, your prescriptions are covered
under Senior Blue HMO and HMO-POS, Forever Blue Medicare PPO and Forever
Blue Medicare PPO Value only if they are filled at a network pharmacy or through our
mail order pharmacy service. Once you go to one pharmacy, 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.
All network pharmacies may not be listed in this directory. Pharmacies may have been
added or removed from the list after this directory was printed. This means the
pharmacies listed here may no longer be in our network, or there may be newer
pharmacies in our network that are not listed. This list is current as of June 6, 2016.
For the most current list, please contact us. Our contact information appears on the
front and back cover pages.
You can go to all the pharmacies on this list, but your costs for some drugs may be
lower at pharmacies in this list that offer preferred cost sharing. We have marked
these pharmacies with 'P' to distinguish them from other pharmacies in our network
that offer standard cost sharing. Cost sharing information can be found in the
Summary of Benefits.
You can get prescription drugs shipped to your home through our network mail order
delivery service. For more information, please contact us or see the mail order section
of this directory.
If you have questions about any of the above, including for instructions on how to
submit claims for prescriptions that you had to fill at a non-network pharmacy, please
see the first and last cover pages of this directory for information on how to contact us.
What is the service area for Senior Blue HMO and HMO-POS, Forever Blue
Medicare PPO and Forever Blue Medicare PPO Value?
The counties in our service area are listed below:
Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady,
Warren and Washington counties.
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How do you find Senior Blue HMO and HMO-POS, Forever Blue Medicare PPO
and Forever Blue Medicare PPO Value 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 bsneny.com/medicare or call customer
service.
If you have questions about Senior Blue HMO and HMO-POS, Forever Blue Medicare
PPO and Forever Blue Medicare PPO Value or require assistance in selecting a PCP,
please call our Customer Service Department at 1-800-329-2792, 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. TTY users should call 711. Or, visit 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 languages Other Languages:
spoken in provider's office
by either the provider éìx n ý-˜%oüA B C D E SB FB P S
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 with Senior Blue HMO and HMO-POS only.
FBO Provider participates with Forever Blue Medicare PPO only.
P Preferred pharmacy.
S Standard pharmacy.
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).
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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 14 Developmental Pediatrics 69 Occupational Medicine 93
PHYSICIANS - Totals by Diabetic Education 69 Occupational Therapy 93
County
Services Oncology/Hematology 96
PRIMARY CARE 15 Diagnostic Testing Facility 70 Ophthalmology 96
PHYSICIANS Dialysis Facility 70 Optometry 99
ALBANY 15 Dietetics & Nutrition 70 Oral & Max Surgery 101
Durable Medical Equipment 70 Orthopedic Surgery 101
COLUMBIA 28
Durable 71 Orthotics/Prosthetics 104
FULTON 29
Medical/Respiratory
Otolaryngology 104
GREENE 30 Equipment
Pain Management 105
Endocrinology 71
MONTGOMERY 32 Pediatric Cardiology 106
Endocrinology & 73
Pediatric Critical Care 106
RENSSELAER 33
Metabolism
Pediatric Endocrinology 106
SARATOGA 37 Gastroenterology 73
Pediatric Gastroenterology 106
SCHENECTADY 44 General Surgery 75
Pediatric 107
Geriatric Specialist 78
WARREN 48 Hematology/Oncology
Gynecologic Oncology 78
Pediatric Infectious 107
WASHINGTON 52
Gynecology Only 78
Diseases
SPECIALISTS & OTHER 54 HIV Experienced 78
Pediatric Nephrology 107
PARTICIPATING
Hand Surgery 79
Pediatric Neurological 107
PROVIDERS - Totals by
Hearing Aid 79 Surgery
County and Specialty
Hematology 79 Pediatric Ophthalmology 107
SPECIALISTS & OTHER 60
Home Health Agency - 79 Pediatric Otolaryngology 107
PARTICIPATING
Certified
Pediatric Pulmonary 107
PROVIDERS
Home Health Agency - 80 Disease
ALBANY 60 Licensed
Pediatric Radiology 107
Adolescent Medicine 60 Home Infusion/Durable 80
Pediatric Rheumatology 108
Specialist Medical Equipment
Pediatric Surgery 108
Allergy & Immunology 60 Hospice 80
Pediatric Urology 108
Ambulatory Infusion Center 60 Hospice Physicians 80
Physical Medicine & Rehab 108
Ambulatory Surgery Center 60 Infectious Disease 80
Physical Therapy 109
Audiology 60 Interventional Cardiology 81
Plastic Surgery 117
Cardiac Electrophysiology 61 Maternal & Fetal Medicine 81
Podiatry 118
Cardio Thoracic 61 Medical Genetics 81
Preventive Medicine 119
Cardiovascular Disease 62 Medical Oncology 81
Pulmonary Disease 119
Certified Nurse Midwife 65 Neonatal-Perinatal 82
Radiation Oncology 120
Child Neurology 65 Medicine
Radiology 121
Chiropractor 65 Nephrology 83
Radiology/MRI 135
Clinical Nutritionists 66 Neuro-Oncology 83
Reproductive 136
Colon and Rectal Surgery 67 Neurological Surgery 83
Endocrinology
Critical Care Medicine 67 Neurology 85
Residential Treatment 136
Dermatology 68 Neuroradiology 88
Facility
Dermatology MOHS 68 Nuclear Medicine 88
Rheumatology 136
Dermatopathology 69 Obstetrics/Gynecology 89
Skilled Nursing Facility 137
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Sleep Center 137 Optometry 149 Pulmonary Disease 155
Sleep Medicine 137 Orthopedic Surgery 149 Radiology 155
Speech Therapy 137 Orthotics/Prosthetics 149 Residential Treatment 156
Sports Medicine 138 Otolaryngology 149 Facility
Surgical Critical Care 139 Pain Management 149 Skilled Nursing Facility 156
Thoracic Surgery 139 Physical Therapy 149 Transportation (Land) 156
Transportation (Land) 139 Plastic Surgery 150 Urology 156
Trauma Surgery 140 Podiatry 150 Vascular Surgery 156
Urgent Care Center 140 Pulmonary Disease 150 GREENE 156
Urology 140 Radiation Oncology 150 Cardiovascular Disease 156
Urology Gynecology 142 Radiology 151 Certified Nurse Midwife 156
Vasc Interventional 142 Rheumatology 152 Chiropractor 156
Radiology Skilled Nursing Facility 152
Dialysis Facility 157
Vascular Surgery 143 Sports Medicine 152
Durable Medical Equipment 157
Wheelchair Vans 145 Transportation (Land) 152
Durable 157
COLUMBIA 145 Urology 152 Medical/Respiratory
Allergy & Immunology 145 Vascular Surgery 152 Equipment
Endocrinology & 157
Audiology 145 FULTON 152
Metabolism
Cardiac Electrophysiology 145 Audiology 152
Gastroenterology 157
Cardiovascular Disease 145 Cardiovascular Disease 152
General Surgery 157
Certified Nurse Midwife 146 Certified Nurse Midwife 152
Gynecology Only 157
Child Neurology 146 Chiropractor 153
Hand Surgery 157
Chiropractor 146 Community Flu Clinics 153
Hearing Aid 157
Dermatology 146 Durable Medical Equipment 153
Home Health Agency - 157
Diabetic Education 146 Gastroenterology 153
Certified
Services
General Surgery 153
Home Health Agency - 157
Dialysis Facility 146
Hearing Aid 153
Licensed
Endocrinology 147
Home Health Agency - 153
Hospice 157
Endocrinology & 147 Certified
Infectious Disease 157
Metabolism
Home Health Agency - 154
Nephrology 157
Gastroenterology 147 Licensed
Neurological Surgery 158
General Surgery 147 Home Infusion/Durable 154
Obstetrics/Gynecology 158
Gynecology Only 147 Medical Equipment
Ophthalmology 158
Hearing Aid 147 Hospice 154
Optometry 158
Hematology 147 Nephrology 154
Orthopedic Surgery 158
Home Health Agency - 147 Neurology 154
Physical Therapy 158
Certified Obstetrics/Gynecology 154
Podiatry 159
Home Health Agency - 147 Ophthalmology 154
Licensed Pulmonary Disease 159
Optometry 154
Infectious Disease 148 Skilled Nursing Facility 160
Orthopedic Surgery 155
Medical Oncology 148 Sports Medicine 160
Orthotics/Prosthetics 155
Nephrology 148 Transportation (Land) 160
Otolaryngology 155
Neurology 148 Urgent Care Center 160
Physical Therapy 155
Obstetrics/Gynecology 148
Podiatry 155 MONTGOMERY 160
Ophthalmology 148 Acute Rehabilitation Center 160
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