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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: This document may be available in an Allegheny, Armstrong, Beaver, Bedford, Butler, alternate format such as CD-ROM. Please Cambria, Cameron, Clarion, Clearfield, Crawford, call our Customer Service Department at Elk, Erie, Fayette, Forest, Greene, Huntingdon, 1-888-234-5397, Monday through Sunday, Indiana, Jefferson, Lawrence, McKean, Mercer, 8:00 a.m. to 8:00 p.m. to inquire about this Somerset, Venango, Warren, Washington, and material’s availability in alternate formats and/ Westmoreland. or languages. TTY users call 711. This directory is current as of August 30, 2016. Highmark Choice Company is an HMO plan Some network providers may have been added with a Medicare contract. Enrollment in or removed from our network after this directory Highmark Choice Company depends on was printed. We do not guarantee that each contract renewal. 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 www.highmarkblueshield.com/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. H3957_16_0644 Table of Contents Section 1 – Introduction .................................................................................................. 3 What is the service area for Community Blue Medicare HMO? ................................ 5 How do you find Community Blue Medicare HMO providers in your area? .............. 6 Section 2 – List of Network Providers .......................................................................... 7 Preferred Providers/Primary Care Providers Index ................................................... 9 Preferred Providers/Primary Care Providers .......................................................... 29 Language Index for Preferred Providers .............................................................. 111 Specialist Physicians Index ................................................................................. 117 Specialist Physicians ........................................................................................... 159 Routine Hearing Care Providers .......................................................................... 273 Routine Vision Care Providers ............................................................................. 281 Hospitals, SNFs, and Ambulatory Surgical Centers............................................. 299 Laboratories ......................................................................................................... 313 Diagnostic Mammography Providers .................................................................... 317 Durable Medical Equipment Providers .................................................................. 321 Ambulatory Infusion Suite Providers ..................................................................... 329 Non-emergency Ambulance Providers ................................................................. 333 Dental Providers ................................................................................................... 337 Behavioral Health Providers ................................................................................. 357 Chain Pharmacies ................................................................................................ 381 Pharmacies ........................................................................................................... 384 2 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 1­ 888-234-5397. 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 non- network 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 3 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. 4 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

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