Senior Blue Select (HMO), Bluesaver
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BlueCross BlueShield of Western New York Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO) Plan 2021 Provider/Pharmacy Directory for Bordering Counties This directory was updated on September 13, 2021. For more recent information or other questions, please contact us, BlueCross BlueShield of Western New York at 1-800-329-2792 or, for TTY users, 711, October 1st - March 31st 8 a.m. to 8 p.m., 7 days a week. April 1st - September 30th 8 a.m. to 8 p.m., Monday - Friday, or visit www.bcbswny.com/medicare. This directory provides a list of Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO)'s current network of providers and pharmacies for the specific counties mentioned below. This directory lists providers or pharmacies located in neighboring counties outside of our primary service area. The providers or pharmacies participating with our plan but located in Pennsylvania are in Erie, McKean, Potter, Tioga, and Warren counties. The providers or pharmacies participating with our plan but located in another county of New York are in Livingston, Monroe, Steuben, and Wayne counties. You are not limited to visiting these plan providers. To view the full directory of providers located inside our service area please visit our website www.bcbswny.com/medicare. To access Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO)’s online provider/pharmacy directory, you can visit www.bcbswny.com/medicare. For any questions about the information contained in this directory, please call our Customer Service department at 1-800-329-2792, October 1st - March 31st 8 a.m. to 8 p.m., 7 days a week. April 1st - 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 provider/pharmacy directory is located on our website at www.bcbswny.com/medicare. You may also call Customer Service for an updated provider/pharmacy directory. 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_COM590_C June 2020_BCMED3.MA_Tiered TABLE OF CONTENTS Section 1 — Introduction...........................................................................................................................3 What is the service area for Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue ..........5 Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO)? How do you find Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), ..........6 BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO) providers that serve your area? Section 2 - List of Network Providers and Pharmacies..........................................................................9 PRIMARY CARE PROVIDERS (PCPs)..................................................................................................9 SPECIALISTS.......................................................................................................................................45 FITNESS PROGRAM PROVIDED BY SILVERSNEAKERS®............................................................246 HOSPITALS........................................................................................................................................247 LABORATORY SERVICES................................................................................................................250 OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE TREATMENT PROVIDERS......................253 SKILLED NURSING FACILITIES (SNFs)...........................................................................................266 HEARING AIDS AND ROUTINE HEARING EXAMS..........................................................................268 MEDICARE DIABETES PREVENTION PROGRAM (MDPP) PROVIDERS.......................................273 COMMUNITY WELLNESS PROGRAM..............................................................................................276 OVER-THE-COUNTER (OTC) MAIL ORDER BENEFIT....................................................................277 TELEMEDICINE.................................................................................................................................278 DAVIS VISION® PROVIDERS...........................................................................................................279 MEALS (POST-DISCHARGE)............................................................................................................298 RETAIL PHARMACIES, INCLUDING CHAIN PHARMACIES............................................................299 MAIL ORDER PHARMACIES.............................................................................................................311 HOME INFUSION PHARMACIES......................................................................................................315 LONG-TERM CARE PHARMACIES...................................................................................................318 INDIAN HEALTH SERVICE / TRIBAL / URBAN INDIAN HEALTH PROGRAM (I/T/U) .....................322 PHARMACIES Section 1 — Introduction This directory provides a list of Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO)’s network providers and pharmacies for specific counties. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). 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 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), Senior Blue 699 (HMO), Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO), and Forever Blue 799 (PPO)’s formulary. The network providers listed in this directory have agreed to provide you with your health care, hearing, and vision services. You may go to any of our network providers listed in this directory. Our plan does not require any provider to obtain referrals in order for you to receive care. Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), and Senior Blue 699 (HMO) You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. Participating Senior Blue 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), and Senior Blue 699 (HMO) providers are listed in the directory for specific counties. You can select a Primary Care Provider (PCP) during the enrollment application process or by contacting Customer Service. Your PCP is a health care professional who meets state requirements and is trained to give you basic medical care. Your PCP is usually a doctor, but may be a physician assistant or a nurse practitioner. In most cases you will receive your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you receive as a Plan member. Your PCP is often involved in your care for a long time, so it is important to select someone whom you will work well with. Your PCP will provide much of your care, and will help arrange or coordinate the rest of the covered services you receive as a Plan member. 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 601 (HMO), Senior Blue 651 (HMO), Senior Blue Select (HMO), BlueSaver (HMO), and Senior Blue 699 (HMO) will be responsible for the costs. 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. If you receive a bill from an out-of-network provider, please submit the bill to our plan first. Do not pay the bill until you have received a determination from our plan on what your liability is, if any. Customer Service can assist you with your request. Your Evidence of Coverage (EOC) also provides details on how to request reimbursement. There are limited circumstances when our plan allows you to obtain out-of-network care. If you have any questions about 3 whether we will pay for any medical service or care that you are considering, you have the right to ask us whether we will cover it before you get it. Freedom Nation (PPO), Forever Blue Value (PPO), Forever Blue 751 (PPO), Forever Blue 799 Value (PPO),