TX PPO Dallas ENG - 2017 Provider Directory

1380 Pages·2017·3.53 MB·English

2018 Provider Directory
Blue Cross Medicare Advantage Choice Plus (PPO)SM
Blue Cross Medicare Advantage Choice Premier (PPO)SM
Last updated 11/18 Dallas
725416.1118
Y0096_BEN_TX_PPOPRDRD18_NM
Blue Cross Medicare AdvantageSM
2018 Provider Directory
This directory is current as of November 21, 2018.
This directory provides a list of Blue Cross Medicare Advantage’s current network providers.
This directory is for the entire Blue Cross Medicare Advantage provider network offered to
people that are Medicare eligible and residing in Collin, Dallas, Denton, and Tarrant counties.
To access Blue Cross Medicare Advantage’s online provider directory, you can visit
getbluetx.com/mapd/providers. For any questions about the information contained in this
directory (hardcopy or online), please call our Customer Service Department at 1-877-774-8592,
8:00 a.m.- 8:00 p.m., local time, 7 days a week. TTY/TDD users should call: 711.
PPO plans provided by Blue Cross and Blue Shield of Texas, which refers to HCSC Insurance Services
Company (HISC), an Independent Licensee of the Blue Cross and Blue Shield Association. HISC is a Medicare
Advantage organization with a Medicare contract. Enrollment in HISC’s plan depends on contract renewal.
ATTENTION: If you speak English, language assistance services, free of charge, are available to you. Call
1-877-774-8592 (TTY: 711) We are open between 8:00 a.m. and 8:00 p.m., local time, 7 days a week. If you are
calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used
on the weekends and holidays.
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al
1-877-774-8592 (TTY: 711). Nuestro horario es de 8:00 a.m. a 8:00 p.m., hora local, los 7 días de la semana.
Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarán
tecnologías alternas (por ejemplo, correo de voz).
This document is available in other formats such as Braille and large print. For additional information, call us at
1-877-774-8592. (TTY/TDD users should call 711).
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Table of Contents
Section 1 – Introduction .......................................................................................................................iii
What is the service area for Blue Cross Medicare Advantage? ...................................................iv
How do you find Blue Cross Medicare Advantage providers in your area? .................................iv
Section 2 – List of Network Providers ..................................................................................................1
Medical/Surgical Hospitals ............................................................................................................1
Urgent Care Centers ....................................................................................................................20
Ancillaries ....................................................................................................................................42
Primary Care Practitioners .........................................................................................................128
Specialists ..................................................................................................................................345
Supervised and Sponsored Providers ......................................................................................1416
Behavioral Health Facilities ......................................................................................................1695
Behavioral Health Practitioners ...............................................................................................1706
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Section 1 – Introduction
This directory provides a list of Blue Cross Medicare Advantage’s network providers. To get detailed information
about your health care services, please see your Evidence of Coverage.
Blue Cross Medicare Advantage is a Preferred Provider Organization (PPO) plan. All Blue Cross Medicare
Advantage plan providers are available to members through self-referral, with the exception of services that
require prior authorization.
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 the same provider. In some cases, you may get covered services from non-
network providers. If you use providers within the Blue Cross Medicare Advantage network your co-pays and/or
co-insurance will be less than going to non-network providers.
Out-of-network providers are under no obligation to treat Blue Cross Medicare Advantage enrollees, except
in emergencies. 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 Department at 1-877-774-8592. TTY/TDD users should call 711. You may also refer to your
Evidence of Coverage for more information, including the cost sharing that applies to out-of-network services.
You do not need prior authorization to seek medical help in an urgent or emergency situation.
If an out-of-network provider asks you to pay for covered services you receive, please call Customer Service at
1-877-774-8592 (TTY/TDD: 711) or send the bill(s) with a note explaining the situation to:
Blue Cross Medicare Advantage (PPO)
P.O. Box 660044
Dallas, TX 75266-0044
You should never pay any out-of-network provider more than what the provider is allowed by Medicare. Ask the
out-of-network provider to bill us first. If you have already paid for the covered services, we will reimburse you for
our share of the cost. If you get a bill for the services, you can send the bill to us for payment. We will pay your
out-of-network provider for our share of the bill and will let you know the amount, if any, you must pay.
Emergency Care Services
Emergency Care services are health care services provided in a hospital or comparable facility to evaluate and
stabilize medical conditions of a recent onset and severity, including but not limited to severe pain, that would
lead a prudent layperson possessing an average knowledge of medicine and health to believe that his or her
condition, sickness, or injury is of such a nature that failure to receive immediate medical care could result in:
• Serious jeopardy of the patient’s health;
• Serious impairment to bodily functions;
• Serious dysfunction of any bodily organ or part;
• Serious disfigurement; or
• Serious jeopardy to the health of the fetus, in the case of a pregnant patient.
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Emergency Care services necessary to evaluate and stabilize an emergency medical condition are covered by
Blue Cross Medicare Advantage. Members with an emergency medical condition should be instructed to go to
the nearest Emergency Provider. Evaluation and stabilization of an emergency medical condition in a hospital or
comparable facility does not require precertification. Emergency Care services will be covered at the in network
benefit level. With the exception of emergencies or urgent care, it may cost more to get care from out-of-
network providers.
Out-of-Area Renal Dialysis Services
A member may obtain medically necessary dialysis services from any qualified physician/professional provider
the member selects when he/she is temporarily absent from the Blue Cross Medicare Advantage service area
and cannot reasonably access Blue Cross Medicare Advantage dialysis physicians/professional providers or
other provider. No precertification or notification is required. However, a member may voluntarily advise Blue
Cross Medicare Advantage if he/she will temporarily be out of the service area. Blue Cross Medicare Advantage
may assist the member in locating a qualified dialysis physician/professional provider. With the exception of
emergencies or urgent care, it may cost more to get care from out-of-network providers.
What is the service area for Blue Cross Medicare Advantage?
The counties for the State of Texas in our service area are listed below.
• Collin
• Dallas
• Denton
• Tarrant
How do you find Blue Cross Medicare Advantage providers in your area?
The directory includes hospitals, physicians and other providers participating in the Blue Cross Medicare
Advantage network. Please refer to the provider listings for section names. Each section is organized
alphabetically by city.
Within each city, the city and/or physician names are listed in alphabetical order along with the address and
phone number. For the most updated Blue Cross Medicare Advantage provider information, please visit our
Provider Finder at getbluetx.com/mapd/providers. While every provider listed in this directory is affiliated with
or employed by a contracting medical group, not every provider listed will be accepting new patients. Although
Blue Cross Medicare Advantage has identified those providers who were not accepting patients at the time this
directory was created, the status of any physicians practice may have changed. For the most current information
regarding the status of any physician’s practice, please contact either the physician or the medical group you have
selected at the phone number listed in this directory.
If you have questions about Blue Cross Medicare Advantage or require assistance, please call our Customer
Service Department at 1-877-774-8592. We are open 8:00 a.m. - 8:00 p.m., local time, 7 days a week. If you are
calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on
weekends and holidays. TTY/TDD users should call 711. Or, visit getbluetx.com/mapd/providers.
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HOW TO READ THE PHYSICIAN LISTING
Example:
BASTROP COUNTY (Alphabetical listing of towns and cities)
FAMILY PRACTICE (Specialty)
Smith, John, MD (Physician’s name)
[phone] (Phone number)
1234 First St., Dallas, TX, 75001 (Physician’s address)
This information changes on a frequent basis. Please refer to the online directory or call Customer Service below
for current updates.
Participation by providers in this directory is not guaranteed and may be subject to change. Please ask your
provider whether he/she is still participating in the network. If you have questions about Blue Cross Medicare
Advantage, please call our Customer Service number at 1-877-774-8592 (TTY/TDD users should call 711). We are
open 8:00 a.m. - 8:00 p.m., local time, 7 days a week. If you are calling from February 15 through September 30,
alternate technologies (for example, voicemail) will be used on the weekends and holidays.
This information is not a complete description of benefits. Contact the plan for more information. Limitations,
copayments, and restrictions may apply. Benefits and/or co-payments/co-insurance may change on January 1 of
each year. The provider network may change at any time. You will receive notice when necessary.
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ANGELINA COUNTY
LUFKIN Medical/Surgical Hospitals LUFKIN
LUFKIN
ANGELINA COUNTY
GENERAL ACUTE CARE
HOSPITAL
Memorial Medical Center of East
Texas
1201 West Frank Avenue
Lufkin, TX 75904
[phone]
Memorial Medical Center of East
Texas
1201 West Frank Avenue
Lufkin, TX 75904
[phone]
1
BOWIE COUNTY
TEXARKANA Medical/Surgical Hospitals TEXARKANA
TEXARKANA
BOWIE COUNTY
GENERAL ACUTE CARE
HOSPITAL
Christus St Michael Health
System
2600 St Michael Drive
Texarkana, TX 75503
[phone]
LONG TERM ACUTE CARE
Pam Specialty Hospital of
Texarka
1000 Pine Street
6th Floor
Texarkana, TX 75501
[phone]
Pam Specialty Hospital of
Texarka
2400 St Michael Dr
2nd Floor
Texarkana, TX 75503
[phone]
REHABILITATION
FACILITY
Christus St Michael
Rehabilitation Hospital
2400 St Michael Drive
Texarkana, TX 75503
[phone]
Encompass Health Rehabilitation
515 West 12th Street
Texarkana, TX 75501
[phone]
2
CASS COUNTY
ATLANTA Medical/Surgical Hospitals ATLANTA
ATLANTA
CASS COUNTY
GENERAL ACUTE CARE
HOSPITAL
Christus St Michael Hosp Atlanta
1007 S William St
Atlanta, TX 75551
[phone]
3
COLLIN COUNTY
ALLEN Medical/Surgical Hospitals PLANO
Methodist McKinney Hospital
ALLEN REHABILITATION
8000 W Eldorado Pkwy
COLLIN COUNTY FACILITY
McKinney, TX 75070
GENERAL ACUTE CARE [phone] Encompass Health Rehabilitaton
Ho
HOSPITAL
2800 West 15th St
TX Hlth Presbyterian Hosp Allen PLANO Plano, TX 75075
1105 Central Expwy North COLLIN COUNTY [phone]
Allen, TX 75013
Encompass Health Rehabilitaton
[phone] GENERAL ACUTE CARE
Ho
HOSPITAL
2800 West 15th St
REHABILITATION Childrens Medical Center Plano Plano, TX 75075
FACILITY 7601 Preston Rd [phone]
Plano, TX 75024
Pam Rehabilitation Hospital of Al [phone]
1001 Raintree Cir
Childrens Medical Center Plano
Allen, TX 75013
7601 Preston Rd
[phone]
Plano, TX 75024
Pam Rehabilitation Hospital of Al [phone]
1001 Raintree Cir
Medical City Plano
Allen, TX 75013
3901 West 15th St
[phone]
Plano, TX 75075
[phone]
FRISCO TX Hlth Ctr Diagnostics &
COLLIN COUNTY Surgery
6020 W Parker Road
GENERAL ACUTE CARE Plano, TX 75093
HOSPITAL [phone]
Baylor Scott & White Medical TX Hlth Presbyterian Hosp Plano
Cent 6200 West Parker Road
12505 Lebanon Rd Plano, TX 75093
Frisco, TX 75035 [phone]
[phone]
Medical City Frisco A Medical
LONG TERM ACUTE CARE
Cen
5500 Frisco Square Blvd LifeCare Hospitals of Plano
Frisco, TX 75034 6800 Preston Road
[phone] Plano, TX 75024
[phone]
LifeCare Hospitals of Plano
MCKINNEY
6800 Preston Road
COLLIN COUNTY
Plano, TX 75024
[phone]
GENERAL ACUTE CARE
HOSPITAL Plano Specialty Hospital
1621 Coit Road
Medical City McKinney
Plano, TX 75075
4500 Medical Center Drive
[phone]
McKinney, TX 75069
[phone]
4