Community Blue Medicare HMO Plan Provider Directory

Community Blue Medicare HMO

Plan Provider Directory

This directory provides a list of Community Blue Medicare HMO's network providers.

This directory is for the following counties: Allegheny, Armstrong, Beaver, Bedford, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland.

This directory is current as of "VHVTU, 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 Community Blue Medicare HMO's network providers in your area, you can visit medicare or call our Customer Service Department at 1-888-234-5397, Monday through Sunday, 8:00 a.m. to 8:00 p.m. TTY users should call 711.

This document may be available in an alternate format such as CD-ROM. Please call our Customer Service Department at 1-888-234-5397, Monday through Sunday, 8:00 a.m. to 8:00 p.m. to inquire about this material's availability in alternate formats and/ or languages. TTY users call 711.

Highmark Choice Company is an HMO plan with a Medicare contract. Enrollment in Highmark Choice Company depends on contract renewal.

H3957_16_0644

Physician Quality Rating

Our Provider Directory provides you with insight into the practice-level performance of network physicians participating in the 2015 Highmark Medicare Advantage Incentive Program. The Quality Rating program was developed by Highmark and is based on the clinical measures monitored by the Centers for Medicare and Medicaid Services. The measures on which physician practices were rated are clinically-supported standards of care that we expect all of our members to receive. The directory displays the overall rating earned by the physician practice. Our members consider many factors in the selection of a physician or physician practice, and we offer these ratings to help you choose quality care. Practice level performance of network physicians participating in the 2015 Highmark Medicare Advantage Incentive Program were measured at a designated point of time. The current rating will remain in place until a new rating is available. You can find this overall score listed in the directory as Physician practice quality rating.

Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company are Medicare Advantage plans with a Medicare contract. Enrollment in Highmark Choice Company, Highmark Senior Health Company, and Highmark Senior Solutions Company depends on contract renewal. The provider network may change at any time. You will receive notice when necessary.

H3957_H3916_H5106_16_0886 Accepted

Table of Contents

Section 1 ? Introduction .................................................................................................................. 3 What is the service area for Community Blue Medicare HMO? ........................................ 6MMM How do you find Community Blue Medicare HMO providers in your area? ...................................................................................................................................... 7MMM

Section 2 ? List of Network Providers ............................................................................................ 8 Preferred Providers/Primary Care Providers Index ......................................................... 11MMM Preferred Providers/Primary Care Providers ................................................................... 27MMM Language Index for Preferred Providers ........................................................................103MMM Specialist Physicians Index ..............................................................................................109MMM Specialist Physicians ........................................................................................................137MMM Routine Hearing Care Providers ......................................................................................459MMM Routine Vision Care Providers .........................................................................................463MMM Facilities ............................................................................................................................523MMM Laboratories ......................................................................................................................545MMM Diagnostic Mammography Providers .............................................................................553MMM Durable Medical Equipment Providers ...........................................................................557MMM Ambulatory Infusion Suite Providers .............................................................................575MMM Non-emergency Ambulance Providers ...........................................................................579MMM Dental Providers ............................................................................................................... 585MMM Behavioral Health Providers ............................................................................................651MMM Chain Pharmacies .............................................................................................................711MMM Pharmacies ........................................................................................................................715MMM Out-of-State Pharmacies ..................................................................................................735MMM

Section 1- Introduction

This directory provides a list of Community Blue Medicare HMO's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

From time to time, contract status may change, meaning that a provider's listing in the directory does not guarantee that the provider is still in the network or accepting new patients. If you regularly see a network provider, and that provider's contract is terminated, Community Blue Medicare HMO will notify you in writing regarding your options 30 calendar days before the effective date of the termination.

You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). The term "PCP" will be used throughout this directory. Generally, you must get your health care services from your PCP. For all covered care, you may choose to see your PCP or go directly to any Network specialist without a referral. You may change your PCP for any reason, at any time by notifying Customer Service Monday through Sunday between 8:00 a.m. and 8:00 p.m., at 1888-234-5397. TTY users should call 711.

The "network providers" listed in this directory have agreed to provide you with your health care/vision/dental 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.

We cover certain health care services that you get from non-network providers. These include care for a medical emergency, urgently needed care, renal dialysis (kidney) that you get when you are outside the plan's service area, care that has been approved in advance by Highmark Blue Shield, and any services which were covered through an appeals process. 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 Community Blue Medicare HMO will be responsible for the costs.

Before you pay any bills you receive from any provider either in or out of the Highmark Medicare Advantage Network, call the Customer Service Department for instructions, Monday through Sunday between 8:00 a.m. and 8:00 p.m., at 1-888-234-5397. TTY users should call 711. Eligible services will be paid by Community Blue Medicare HMO. You should never pay any non-network provider more than what the provider is allowed by Medicare. Ask the non-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 nonnetwork provider for our share of the bill and will let you know what, if anything, you must pay. If you pay for any emergency or urgent care you receive from providers who

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are not part of the Network, request reimbursement by submitting the receipt(s) for care you received to the address listed below:

Highmark Medicare Advantage Customer Service P.O Box 1068, Pittsburgh, PA 15230

For emergency care, including post stabilization care, and urgently needed care, your out-of-pocket costs will be the same both in and out-of-network. For cost sharing information see your Evidence of Coverage.

Community Blue Medicare HMO also pays for medically necessary, non-emergency services needed to ensure that the member remains stabilized, from the time the treating hospital requests authorization until the member is discharged from the hospital, placed in the care of a Highmark Medicare Advantage Network doctor, or the treating doctor and Highmark Blue Shield agree to another arrangement.

Community Blue Medicare HMO also pays for treatment members need for illnesses or injuries which are not emergencies, but which could cause serious problems or endanger your health if treatment is delayed. You are covered for such urgent medical needs while you are within or outside the service area. If the Highmark Medicare Advantage Network is not available or accessible due to an unusual event, you are also covered for urgent care you receive from any provider.

When in the service area you must use network providers for urgent care. When out of the service area urgent care may be obtained from the first available provider. In addition, when out of the service area you can obtain dialysis treatment from any qualified dialysis provider. If you obtain routine care from out-of-network providers neither Medicare nor Community Blue Medicare HMO will be responsible for the costs.

Community Blue Medicare HMO pays for emergency care members receive within the service area and while traveling outside of the service area, for both inpatient and outpatient services that are furnished by a qualified provider and needed to evaluate or stabilize an emergency medical condition. When you need emergency care, go directly to a hospital emergency room or call 911 or your local emergency number. Show the hospital your Membership (ID) Card. In an emergency, you never need to contact any plan provider, even your own PCP, for authorization. However, as soon as possible, you or someone else should contact your PCP so that he/she may provide follow-up care.

All Network physicians are carefully screened and credentialed to meet strict quality standards. Before you contact any provider in this directory, please read your Evidence of Coverage for detailed information about your specific plan's benefits, limitations, copayments and coinsurance, and how to receive care.

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Highmark Blue Shield understands the importance of helping our members find Network health care providers who are accessible to people with physical disabilities and who can communicate with people who have sensory disabilities. If you'd like to know if a particular health care provider can accommodate these special needs, please contact the provider's office directly. If you prefer, call the Customer Service Department at1-888-234-5397, Monday through Sunday between 8:00 a.m. and 8:00 p.m., TTY users should call 711, or visit our Website at medicare and click on "Resources", type in your Zip Code and click on "Go To Resources", click on "Learn More" under "Find a Provider."

To view board certification information and the hospital affiliation of your PCP or Network specialist, visit our Website at medicare and click on "Resources", type in your Zip Code and click on "Go To Resources", click on "Learn More" under "Find a Provider." Search for the physician, then click on the provider's name to view this information. In addition to this information, to obtain the full professional qualifications of network providers, including medical schools attended and residencies completed, call a Customer Service Representative at 1-888-234-5397, Monday through Sunday between 8:00 a.m. and 8:00 p.m., TTY users should call 711.

Some hospital facilities in this directory are nationally recognized as Blue Distinction Centers. Blue Distinction? is a designation awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare, under objective selection criteria. The designation is based on rigorous, evidence-based selection criteria established by leading medical specialists and societies. Its goal is to help consumers find quality specialty care on a consistent basis, while enabling and encouraging health professionals to improve the overall quality and delivery of healthcare nationwide.

If you would like to learn more about Blue Distinction Centers, call our Customer Service Department at 1-888-234-5397, Monday through Sunday, 8:00 a.m. to 8:00 p.m. TTY users should call 711. Individuals considering membership may call the telephone number listed in the enrollment materials received with this directory. Both members and individuals considering membership may visit our website at medicare for more information on these facilities and their distinctions.

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What is the service area for Community Blue Medicare HMO?

The counties in our service area are listed below. Allegheny, Armstrong, Beaver, Bedford, Butler, Cambria, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Somerset, Venango, Warren, Washington, and Westmoreland.

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How do you find Community Blue Medicare HMO providers in your area?

This directory lists Network providers available to serve you by provider type and county. A PCP and Specialist index have been included for your convenience. If you have questions about Community Blue Medicare HMO, or require assistance in selecting a PCP, please call our Customer Service Department at 1-888-234-5397 , Monday through Sunday between 8:00 a.m. and 8:00 p.m. TTY users should call 711, or visit medicare. Members of Community Blue Medicare HMO Signature, you can go to all the pharmacies on this list, but your costs for some drugs may be less at pharmacies in this list that offer preferred cost-sharing. We have marked these pharmacies with to distinguish them from other pharmacies in our network that offer standard cost-sharing.

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