[PARTNERS Medicare Choice/PARTNERS Medicare Options]

2008 Provider Directory This directory provides a list of Blue Medicare HMO plan providers. This directory is for the following North Carolina counties: Alamance, Alexander, Alleghany, Ashe, Avery, Cabarrus, Caldwell, Caswell, Catawba, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Gaston, Guilford, Halifax, Hoke, Iredell, Johnston, Mecklenburg, Nash, Northampton, Orange, Person, Randolph, Richmond, Rockingham, Rowan, Stanly, Stokes, Surry, Wake, Watauga, Wilkes and Yadkin. This directory is current as of October 2007. Some plan providers may have been added or removed from the list after this directory was printed. To get the most up-to-date information about Blue Medicare HMO plan providers in your area, you can visit www.bcbsnc.com/medicare or call our Customer Service Department at: 1-888-310-4110 7 days a week, 8 a.m. – 8 p.m. TTY/TDD users should call 1-888-451-9957. H3449_3777, 9/6/07 PARTNERS National Health Plans of North Carolina, Inc. (PARTNERS) offers Blue Medicare HMO. PARTNERS is a Blue Cross and Blue Shield of North Carolina company. Blue Medicare HMO Plan Provider Directory This directory provides a list of Blue Medicare HMO’s plan providers. This directory is for Alamance, Alexander, Alleghany, Ashe, Avery, Cabarrus, Caldwell, Caswell, Catawba, Chatham, Cumberland, Davidson, Davie, Durham, Forsyth, Gaston, Guilford, Halifax, Hoke, Iredell, Johnston, Nash, Northampton, Mecklenburg, Orange, Person, Randolph, Richmond, Rockingham, Rowan, Stanly, Stokes, Surry, Wake, Watauga, Wilkes, and Yadkin Counties in North Carolina. This directory is current as of September 2008. Some plan providers may have been added or removed from the list after this directory was printed. To get the most up-to-date information about Blue Medicare HMO plan providers in your area, you can visit www.bcbsnc.com/member/medicare or call our Customer Service Department at 1-888-310- 4110, 7 days a week from 8:00 a.m. to 8:00 p.m. TTY users should call 1-888-451-9957. H3449_3777, 9/6/07 2008 Blue Medicare HMO Plan Provider Directory Page 1 Table of Contents TABLE OF CONTENTS Section 1 – Introduction ..........................................................................................3 What is the service area for Blue Medicare HMO?.................................................................... 3 How do you find Blue Medicare HMO providers in your area? ................................................ 4 What if you use non-plan providers to get my covered services? .............................................. 4 What should you do if you have bills from non-plan providers that you think should be paid by Blue Medicare HMO?................................................................................................................. 4 Getting care when traveling or away from the plan’s service area............................................. 5 Can the list of plan providers change?........................................................................................ 5 Your rights to access and participate in medical care................................................................. 5 Section 2 - Choosing your Primary Care Provider (PCP) ...................................6 What is a “PCP”?........................................................................................................................ 6 How do you choose a PCP?........................................................................................................ 6 Getting care from your PCP........................................................................................................ 6 How to change your PCP............................................................................................................ 6 What if your doctor or provider leaves Blue Medicare HMO? .................................................. 7 Section 3 – Getting care from specialists ...............................................................8 Section 4 – Self-referrals .........................................................................................9 Section 5 – What if you need medical care when your PCP’s office is closed?10 What to do if you have a medical emergency or urgent need for care and your PCP’s office is closed ........................................................................................................................................ 10 What to do if it is not a medical emergency and your PCP’s office is closed.......................... 10 Section 6 – Getting care if you have a medical emergency or an urgent need for care ....................................................................................................................11 What is a medical emergency? ................................................................................................. 11 What should I do if I have a medical emergency?.................................................................... 11 Your PCP will help manage and follow-up on your emergency care....................................... 11 What is covered if I have a medical emergency? ..................................................................... 12 What if it wasn’t really a medical emergency?......................................................................... 12 What is “urgently needed care”? (This is different from a medical emergency.)..................... 12 What is the difference between a “medical emergency” and “urgently needed care”?............ 12 Getting urgently needed care when you are in the plan’s service area..................................... 13 Getting urgently needed care when you are outside the plan’s service area ............................ 13 Section 7 – For more information.........................................................................14 Section 8 – List of Plan Providers.........................................................................15 2008 Blue Medicare HMO Plan Provider Directory Page 2 Section 1 - Introduction Section 1 – Introduction This directory provides a list of Blue Medicare HMO’s plan providers. It also includes basic information about how to get your covered services with Blue Medicare HMO. To get more detail about your health care coverage, please see your Evidence of Coverage. You will have to choose one of our plan providers that is 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 coverage from your PCP. The “plan providers” listed in this directory have agreed to provide you with your health care coverage. In most cases, your health care coverage is covered under Blue Medicare HMO. You may go to any of our plan providers listed in this directory. If you have been going to one plan provider, you are not required to continue going to that same provider. In some cases, you may get covered services from non-plan providers. What is the service area for Blue Medicare HMO? The counties in our service area are listed below. Alamance Catawba Guilford Orange Surry Alexander Chatham Halifax Person Wake Alleghany Cumberland Hoke Randolph Watauga Ashe Davidson Iredell Richmond Wilkes Avery Davie Johnston Rockingham Yadkin Cabarrus Durham Mecklenburg Rowan Caldwell Forsyth Nash Stanly Caswell Gaston Northampton Stokes 2008 Blue Medicare HMO Plan Provider Directory Page 3 Section 1 - Introduction How do you find Blue Medicare HMO providers in your area? It is easy to find a Plan Provider in this directory. First, you should identify the type of provider you are trying to find. Then, you would search alphabetically for the preferred county and then the city of your choice. Within each city, we provide a further breakdown of providers by sub- specialty such as Family Practice or Surgery, or Optometry. And, finally, within each sub- specialty listing, you would search alphabetically for a provider by practice name and then physician name. For example, to find a PCP, look at the top of the pages for the section labeled Primary Care Physicians. If you want to find a PCP in the town of Clemmons in Forsyth County, you would then search alphabetically for Forsyth County and then alphabetically within Forsyth County for Clemmons. Under Clemmons, you will find subsections labeled Family Practice, Geriatrics, and Internal Medicine. If you want a Geriatric PCP, then go that subsection, and you will find an alphabetical listing by practice name followed by physician name, address and phone number. You can also visit www.bcbsnc.com/member/medicare or call our Customer Service Department at 1-888-310-4110, 7 days a week from 8:00 a.m. to 8:00 p.m. TTY users should call 1-888-451- 9957. What if you use non-plan providers to get my covered services? “Non-plan providers” are providers that are not part of Blue Medicare HMO. If you use non-plan providers, you may have to pay more. Care or services you get from non-plan providers will not be covered, except for ambulance services, emergency care, including post-stabilization care, urgently needed care, renal dialysis (kidney), and any services which were ordered covered through an appeals process. What should you do if you have bills from non-plan providers that you think should be paid by Blue Medicare HMO? We cover certain health care services that you get from non-plan 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

Load more