BlueCross BlueShield of Western New York Senior Blue HMO, Senior Blue HMO Select, Forever ...

564 Pages·2017·2.44 MB·English

BlueCross BlueShield of Western New York
Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare PPO, Forever
Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value Plan
Provider/Pharmacy Directory
This directory provides a list of Senior Blue HMO, Senior Blue HMO Select, Forever Blue
Medicare PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO
Value's network providers and pharmacies.
This directory is for Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans
and Wyoming counties, New York.

This directory is current as of September 26, 2017. 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, Senior Blue HMO Select, Forever Blue Medicare
PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value’s
network providers in your area, you can visit bcbswny.com/medicare or call our Customer
Service Department at 1-800-329-2792, October 1st - February 14th 8 a.m. to 8 p.m., 7
days a week. February 15th - September 30th 8 a.m. to 8 p.m., Monday-Friday. TTY users
should call 711.
Changes to our pharmacy network may occur during the benefit year. An updated
pharmacy directory is located on our website at bcbswny.com/medicare. You may also call
Member Services for an updated provider directory.
BlueCross BlueShield of Western New York is a Medicare Advantage plan and enrollment
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_MRK1674
BMED3.PPO_09/24/2017
TABLE OF CONTENTS
Section 1 - Introduction.............................................................................................................................3
What is the service area for Senior Blue HMO, Senior Blue HMO Select, Forever Blue .............5
Medicare PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value?
How do you find Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare PPO, ............5
Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value providers in your
area?
Section 2 - List of Network Providers and Pharmacies..........................................................................9
PRIMARY CARE PHYSICIANS..............................................................................................................9
SPECIALISTS & OTHER PARTICIPATING PROVIDERS...................................................................51
EYEMED VISION PROVIDERS......................................................................................................... 383
FITNESS PROGRAM PROVIDED BY SILVERSNEAKERS®............................................................407
HOSPITALS........................................................................................................................................408
LABORATORY SERVICES................................................................................................................412
OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE TREATMENT............................................417
SKILLED NURSING FACILITIES....................................................................................................... 463
HEARING AIDS AND ROUTINE HEARING EXAMS..........................................................................469
RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES............................................................477
MAIL ORDER PHARMACY................................................................................................................494
HOME INFUSION PHARMACIES......................................................................................................496
LONG-TERM CARE PHARMACIES...................................................................................................499
INDIAN HEALTH SERVICE / TRIBAL / URBAN INDIAN HEALTH PROGRAM (I/T/U) .....................503
PHARMACIES
Section 1 - Introduction
This directory provides a list of Senior Blue HMO, Senior Blue HMO Select, Forever Blue
Medicare PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value’s
network providers and pharmacies. 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 the Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare PPO,
Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value’s formulary.
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.
Senior Blue HMO and Senior Blue HMO Select
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 Senior Blue HMO Select providers are listed in the directory.
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 Senior Blue HMO Select will be responsible for the costs.
There is a limited facility network with the Senior Blue HMO Select plan.
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.
Forever Blue Medicare PPO, Forever Blue Medicare PPO Focus, and Forever Blue
Medicare PPO Value
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.
Out-of-network/non-contracted providers are under no obligation to treat BlueCross
BlueShield of Western New York members, except in emergency situations. For a decision
about whether we will cover an out-of-network service, we encourage you or your provider to
ask us for a pre-service organization determination before you receive the service. Please
call our customer service number or see your Evidence of Coverage for more information,
including the cost sharing that applies to out-of-network services.
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
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exception of emergencies or urgent care, it may cost more to get care from out-of-network
providers.
For emergency care, and urgently needed care, your out of pocket expenses will be the
same both in-network and out-of-network. After the emergency is over, you are entitled to
follow-up care to be sure your condition continues to be stable. Your follow-up care will be
covered by the plan. For further cost sharing information including what your out of pocket
costs are for out-of-network providers in this situation please 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.
The out-of-network service area for Forever Blue Medicare PPO is made up of providers in
all 50 States, who accept either Medicare and/or a BlueCross or BlueShield plan.
There is a limited facility network with the Forever Blue Medicare PPO Focus plan. You must
reside in Erie or Niagara county to enroll in this plan.
Forever Blue Medicare PPO 751 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 Network Sharing 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.
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. In most cases, your
prescriptions are covered under Senior Blue HMO, Senior Blue HMO Select, Forever Blue
Medicare PPO, Forever Blue Medicare PPO Focus, 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 but can switch to any other 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 September 26, 2017. For the most current list, please
contact us. Our contact information appears on the front and back cover pages.
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If you're enrolled in a plan that offers both Preferred and Standard cost-shares for
prescription drugs, we have marked Preferred pharmacies with 'P' to distinguish them from
other pharmacies in our network that offer Standard cost sharing. To get more information
about your cost-sharing for prescription drugs, please see your Evidence of Coverage.
You can get prescription drugs shipped to your home through our network mail order delivery
program, which is called Express Scripts. For more information, please contact us or see the
mail order section of this directory.
If you have questions about any of the above, 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, Senior Blue HMO Select, Forever Blue
Medicare PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO
Value?
The counties in our service area are listed below.
The service area for Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare
PPO and Forever Blue Medicare PPO Value includes Allegany, Cattaraugus, Chautauqua,
Erie, Genesee, Niagara, Orleans, and Wyoming counties in New York State.
The service area for Forever Blue Medicare PPO Focus includes Erie and Niagara counties
in New York State.
How do you find Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare
PPO, Forever Blue Medicare PPO Focus, and Forever Blue Medicare PPO Value
providers in your area?
This directory is organized by county so you can easily find a doctor or pharmacy near you.
The • symbol in the columns next to each provider's name indicates which network(s) the
provider participates in.
Use the key below to find the abbreviation for your plan name.
2017 Plan Name Abbreviation
Senior Blue HMO HMO
Senior Blue HMO Select Select
Forever Blue Medicare PPO
PPO
Forever Blue Medicare PPO Value
Forever Blue Medicare PPO Focus Focus
A list of SilverSneakers® providers can be found on their website at www.silversneakers.com.
To request a printed listing of these providers please contact our Customer Service
department. This number can be found on the front and back covers of this book.
If you would like to view the full provider/pharmacy directory or are in need of one, visit our
website at bcbswny.com/medicare or call customer service.
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If you have questions about Senior Blue HMO, Senior Blue HMO Select, Forever Blue
Medicare PPO, Forever Blue Medicare PPO Focus, 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 1st - February 14th 8 a.m. to 8 p.m., 7 days a week. February 15th -
September 30 th 8 a.m. to 8 p.m., Monday-Friday. TTY users should call 711. Or, visit
bcbswny.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, State 12345 [phone] PCP# 123456789012 AM/IM/PED
• • • •
Other Languages: éìnxoüÑx-u A B C D E BDB1 BDB2 BDB3 BDB4 BDB5 P S
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.
Other Languages:
All provider offices speak English. Only additional languages spoken in provider's office by
either the provider or provider's office staff are listed.
• Indicates which network(s) the provider participates in.
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).
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.
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HMO
Select
PPO
Focus
o Accepting Developmental Disabled Patients Only.
ü Accepting Native American Patients Only.
u Providers with the u indicator should be utilized for diagnostic visits. For the routine hearing
exam and hearing aid benefit you must contact TruHearing for a participating provider.
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 - Cancer
BDB4 Blue Distinction - Hip and Knee.
BDB5 Blue Distinction - Spine Surgery.
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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Section 2 - List of Network Providers and Pharmacies
PRIMARY CARE PHYSICIANS - Totals by County
ALLEGANY 15
CATTARAUGUS 45
CHAUTAUQUA 71
ERIE 578
GENESEE 43
NIAGARA 145
ORLEANS 12
WYOMING 23
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PRIMARY CARE PHYSICIANS
ALLEGANY
City/Town of ALFRED
Andrew L Call MD 28 Church St, Alfred NY 14802 [phone] PCP#000911818005 FP én • • • •
City/Town of ANDOVER
James R Rummel Jr DO 20 Main St, Andover NY 14806 [phone] PCP#000533706001 FP éìx • • • •
City/Town of BELMONT
Steven M Collins MD 5877 Old State Rd 19, Belmont NY 14813 [phone] PCP#000527798002 FP • • • •
éì
Keith A Gembusia DO 5877 Old State Rd 19, Belmont NY 14813 [phone] PCP#000532535006 FP • • • •
éìn
City/Town of BOLIVAR
Elizabeth R Osborn MD 120 1st St, Bolivar NY 14715 [phone] PCP#000534469001 FP éìn • • • •
City/Town of CANASERAGA
Daniel J Curtin MD 12 N Church St, Canaseraga NY 14822 [phone] PCP#000918292003 FP • • • •
éìnx
City/Town of CUBA
Leo Cusumano MD 38 Water St, Cuba NY 14727 [phone] PCP#000527072008 PED Other • •
Languages: Italianéx
Rajan Gulati MD 45 W Main St, Cuba NY 14727 [phone] PCP#000508641017 IM/GER éìnx • • • •
Naga P Meka MD 132 West Main Street, Cuba NY 14727 [phone] PCP#000539408001 IM éì • • • •
City/Town of HOUGHTON
Naga P Meka MD 9864 Lucky Dr, Houghton NY 14744 [phone] PCP#000539408002 IM éì • • • •
Calvin L Schierer DO 9734 Route 19, Houghton NY 14744 [phone] PCP#000510717001 FP éì • • • •
City/Town of WELLSVILLE
Christopher R Depner MD 12 Martin St, Wellsville NY 14895 [phone] PCP#000510373003 FP én • • • •
Lu-Ann S Kaye MD 127 N Main St, Wellsville NY 14895 [phone] PCP#000526840001 FP éìnx • • • •
Pasquale A Picco MD 15 Loder St, Wellsville NY 14895 [phone] PCP#000526788001 IM Other • • • •
Languages: Italianéì
Pasquale A Picco MD 15 Loder St, Wellsville NY 14895 [phone] PCP#000526788002 IM Other • • • •
Languages: Italianéìn
CATTARAUGUS
City/Town of ALLEGANY
Ben M Hwang MD 112 W Main St, Allegany NY 14706 [phone] PCP#000506940003 IM éx • • • •
Shafi Raza MD 112 W Main St, Allegany NY 14706 [phone] PCP#000533309005 FP én • • • •
City/Town of ELLICOTTVILLE
William G Cihak MD 6133 Rt 219, Ste 1006, Ellicottville NY 14731 [phone] PCP#000525884003 IM • • • •
é
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HMO
Select
PPO
Focus