Provider and Pharmacy Directory - BlueCross BlueShield of

420 Pages·2014·3.41 MB·English

MEDICARE ADVANTAGE
2015

Provider and Pharmacy
Directory
Senior Blue HMO and Senior Blue HMO Select
Forever Blue Medicare PPO
If you have any questions, we’re here to help!
bcbswny.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.
BlueCross BlueShield of Western New York is a Medicare
Advantage plan with a Medicare contract and enrollment
depends on contract renewal.
BlueCross BlueShield of Western New York

Senior Blue HMO, Senior Blue HMO Select, Forever Blue Medicare

PPO and Forever Blue Medicare PPO Value Plan
Provider Directory
This directory provides a list of BlueCross BlueShield of Western New York's network
providers.
The directory is for Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans
and Wyoming 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 BlueCross BlueShield's network providers in your area, you can visit
www.bcbswny.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.
BlueCross BlueShield of Western New York is a Medicare Advantage organization with a
Medicare contract. Enrollment in BlueCross BlueShield of Western New York depends on
contract renewal.
This document may be available in other formats such as Braille, large print or other
alternate formats.
Y0086_MRK1385 Accepted
BMED3.PPO
Section 1 - Introduction
This directory provides a list of BlueCross BlueShield of Western New York's network
providers. To get detailed information about your health care coverage, please see your
Evidence of Coverage.
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 this directory.
If a provider has an indicator "SBO," he or she only participates with our Senior Blue HMO
and Senior Blue HMO Select plans and not with our Forever Blue Medicare PPO plans.
If you are a member of Senior Blue HMO and Senior Blue HMO Select, you must use plan
providers except in emergency or urgent situations. If you obtain routine care from
out-of-network providers neither Medicare nor BlueCross BlueShield will be responsible
for the costs.
Members of Senior Blue HMO and Senior Blue HMO Select 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.
If you are a member of Senior Blue HMO Select, you can receive non-emergent care only
from certain facilities, including hospitals, skilled nursing facilities, and home health
agencies. These facilities are listed in the directory with "£". You can receive care from
any physician or specialist who has no indicator or an "SBO" indicator.
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 BlueCross BlueShield will be responsible
for the costs.
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 Senior Blue HMO Select
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 BlueCross BlueShield plan.
Forever Blue Medicare PPO 751 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 Senior Blue HMO Select 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. Senior
Blue HMO Select members can only go to a hospital, SNF or home health provider
marked with "£". 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 Senior Blue HMO Select and Forever
Blue Medicare PPO do not require referrals; however a prior authorization may be
3
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.
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 BlueCross BlueShield. In most cases, your prescriptions are covered under BlueCross
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 BlueCross BlueShield of Western New York?
The counties in our service area are listed below:
Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming
counties.
How do you find BlueCross BlueShield of Western 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.bcbswny.com/medicare or call customer
service.
If you have questions about BlueCross BlueShield of Western 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.bcbswny.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
[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 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 Senior Blue HMO Select Plan only.
FBO Provider participates in the Forever Blue Medicare PPO Plan only.
é Wheelchair accessible
£ Senior Blue HMO and Senior Blue HMO Select members can only go to a hospital, SNF or
home health provider with this symbol.
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).
5
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 12
Physical Therapy 59
Physical Therapy 65

PHYSICIANS - Totals by Podiatry 59
Podiatry 66

County
Pulmonary Disease 60
Pulmonary Disease 66

PRIMARY CARE 13
Radiology 60
Radiation Oncology 66

PHYSICIANS Skilled Nursing Facility 60
Radiology 67

ALLEGANY 13
Transportation (Land) 60
Radiology/MRI 67

Urology 60
Rheumatology 67

CATTARAUGUS 13

Skilled Nursing Facility 67

CATTARAUGUS 61

CHAUTAUQUA 15

Sleep Medicine 67

Allergy & Immunology 61

ERIE 18

Speech Therapy 68

Audiology 61

GENESEE 43
Sports Medicine 68

Cardiovascular Disease 61

Thoracic Surgery 68

NIAGARA 45
Certified Nurse Midwife 61

Transportation (Land) 68

Chiropractor 62

ORLEANS 51

Urgent Care Center 68

Colon and Rectal Surgery 62

WYOMING 51

Urology 68

Community Flu Clinics 62

SPECIALISTS & OTHER 53
Vascular Surgery 68

Dermatology 62

PARTICIPATING
Wheelchair Vans 68

Diabetic Education 62

PROVIDERS - Totals by
Services CHAUTAUQUA 68

County and Specialty
Durable Medical Equipment 62
Allergy & Immunology 68

SPECIALISTS & OTHER 58

Endocrinology 62
Audiology 69

PARTICIPATING
Gastroenterology 62
Cardiovascular Disease 69

PROVIDERS
General Surgery 63
Certified Nurse Midwife 70

ALLEGANY 58

Gynecology Only 63
Chiropractor 70

Cardiovascular Disease 58

Hearing Aid 63
Community Flu Clinics 70

Certified Nurse Midwife 58

Home Health Agency - 63 Dermatology 70

Chiropractor 58
Certified
Diabetic Education 70

Community Flu Clinics 58
Home Health Agency - 63
Services
Diabetic Education 58
Licensed
Dialysis Facility 71

Services Home Infusion/Durable 63

Durable Medical Equipment 71

Durable Medical Equipment 58
Medical Equipment
Durable 71

General Surgery 58
Medical Oncology 63

Medical/Respiratory
Home Health Agency - 58 Nephrology 63
Equipment
Certified Neurological Surgery 63

Endocrinology 71

Home Health Agency - 58 Neurology 64

Endocrinology & 71

Licensed
Obstetrics/Gynecology 64
Metabolism
Hospital Clinic Setting 58

Occupational Therapy 64
Gastroenterology 71

Interventional Cardiology 59

Oncology/Hematology 64
General Surgery 71

Obstetrics/Gynecology 59

Ophthalmology 64
Gynecology Only 72

Occupational Therapy 59

Optometry 64
Hearing Aid 72

Ophthalmology 59

Oral & Max Surgery 65
Hematology 72

Optometry 59

Orthopedic Surgery 65
Home Health Agency - 72
Orthopedic Surgery 59

Otolaryngology 65
Certified
Otolaryngology 59

Pain Management 65
Home Health Agency - 73
Pain Management 59
Licensed
7
Hospice 73 Certified Nurse Midwife 96 Maxiollofacial Orthotics 129
Medical Oncology 73 Child Neurology 97 Medical Condition - 129
Nephrology 73 Chiropractor 98 Pregnancy
Neurological Surgery 73 Colon and Rectal Surgery 105 Medical Genetics 129
Neurology 73 Community Flu Clinics 106 Medical Oncology 130
Obstetrics/Gynecology 73 Critical Care Medicine 106 Multiple Specialties 131
Occupational Therapy 74 Dermatology 107 Neonatal-Perinatal 131
Medicine
Ophthalmology 74 Dermatopathology 108
Nephrology 132
Optometry 75 Developmental Pediatrics 108
Neuro Ophthalmology 134
Oral & Max Surgery 76 Diabetic Education 108
Orthopedic Surgery 76 Services Neurodevelopmental 134
Disability
Orthotics/Prosthetics 76 Dialysis Facility 110
Neurological Surgery 134
Otolaryngology 76 Durable Medical Equipment 110
Neurology 136
Pain Management 76 Durable 113
Medical/Respiratory Nuclear Medicine 142
Pediatric Cardiology 77
Equipment Obstetrics 144
Physical Medicine & Rehab 77
Endocrinology 113 Obstetrics/Gynecology 144
Physical Therapy 77
Endocrinology & 114 Occupational Therapy 151
Podiatry 78
Metabolism Oncology/Hematology 153
Pulmonary Disease 78
Facial Plastic Surgery 115 Ophthalmology 154
Radiation Oncology 78
Gastroenterology 115 Optometry 159
Radiology 79
General Surgery 117 Oral & Max Pain Manage 169
Radiology/MRI 80
Geriatric Specialist 122 Oral & Max Surgery 169
Skilled Nursing Facility 80
Gynecologic Oncology 122 Orthopedic Surgery 170
Sleep Center 81
Gynecology Only 123 Orthotics/Prosthetics 176
Sleep Medicine 81
HIV Experienced 123 Osteopathic Manipulative 177
Speech Therapy 81
Hand Surgery 124 Medicine
Sports Medicine 81
Head and Neck Surgery 124 Otolaryngology 177
Thoracic Surgery 81
Hearing Aid 124 Pain Management 180
Transportation (Land) 82
Hematology 126 Pediatric Allergy & 181
Urgent Care Center 82
Home Health & Home 126 Immunology
Urology 82
Infusion Pediatric Cardiology 181
Vasc Interventional 82
Home Health Agency - 126 Pediatric Critical Care 181
Radiology
Certified Pediatric Dermatology 181
Wheelchair Vans 82
Home Health Agency - 127 Pediatric Endocrinology 181
ERIE 82 Licensed
Pediatric Gastroenterology 182
Adolescent Medicine 82 Home Health Facility 127
Pediatric 182
Specialist
Home Infusion - Licensed 127 Hematology/Oncology
Allergy & Immunology 82
Home Infusion/Durable 127 Pediatric Infectious 183
Ambulatory Surgery Center 83 Medical Equipment
Diseases
Audiology 83 Hospice 127
Pediatric Nephrology 183
Cardiac Electrophysiology 88 Infectious Disease 128
Pediatric Ophthalmology 183
Cardiac Surgery 89 Infusion Center 129
Pediatric Physical Medicine 183
Cardio Thoracic 89 Interventional Cardiology 129
Pediatric Pulmonary 183
Cardiovascular Disease 90 Maternal & Fetal Medicine 129 Disease
8