BLUE ADVANTAGE (HMO/PPO) PLANS

1 CONTACT CUSTOMER SERVICE1-866-508-7145 TTY 711 PROVIDER AND PHARMACY DIRECTORYLOUISIANA AREABlue ADVANTAGE (HMO) | Blue ADVANTAGE (PPO)CaddoBossierWebsterClaiborneUnionMo rehouseBienvilleLincolnJacksonOuachitaMa disonTensasFranklinRichlandCaldwellWinnN atchitochesRedRiverDe SotoSabineGrantLa MartinIberiaIbervilleEastBatonRougeWestB atonRougeLivingstonSt. Johnthe BaptistJeffersonOrleansSt. AreaNortheast AreaAcadiana AreaBaton Rouge AreaNorth Shore AreaNew Orleans AreaY0132_22-255_ENLA_C01MA2042 R05/22 This Provider/Pharmacy Directory was updated on 5/1/2022. For more recent information or other questions, please contact the Blue ADVANTAGE Customer Service department toll-free at 1 (866) 508- 7145. TTY users should call 711. Customer Service will operate seven (7) days a week from 8 to 8 CST, from October March. After March, Customer Service will operate five (5) days a week, Monday - Friday from 8 to 8 CST.

2 April September. You may also visit us on the web at to our provider and pharmacy networks may occur during the benefit year. An updated Provider/Pharmacy Directory is located on our website at You may also call Customer Service for updated information. Blue Cross and Blue Shield of Louisiana HMO offers Blue ADVANTAGE (HMO). Blue Cross and BlueShield of Louisiana, an independent licensee of the Blue Cross and Blue Shield Association, offers Blue ADVANTAGE (PPO).2022 BLUE ADVANTAGE (HMO/PPO) PLANS Provider/Pharmacy Directory This directory is current as of May 1, 2022. This directory provides a list of Blue ADVANTAGE s current network providers and pharmacies. This directory is for the state of Louisiana service area. It includes all parishes in Louisiana. To access Blue ADVANTAGE s online provider/pharmacy directory, you can visit our website at For any questions about the information contained in this directory, please call the Blue ADVANTAGE Customer Service department toll-free at 1 (866) 508-7145.

3 TTY users should call 711. Customer Service will operate seven (7) days a week from 8 to 8 CST, from October March. After March, Customer Service will operate five (5) days a week, Monday - Friday from 8 to 8 CST. To obtain this document in an alternate format or language, please contact Customer Service at the number listed above. Blue Cross and Blue Shield of Louisiana HMO offers Blue ADVANTAGE (HMO). Blue Cross and Blue Shield of Louisiana, an independent licensee of the Blue Cross and Blue Shield Association, offers Blue ADVANTAGE (PPO). Blue ADVANTAGE from Blue Cross and Blue Shield of Louisiana HMO is an HMO plan with a medicare contract. Blue ADVANTAGE from Blue Cross and Blue Shield of Louisiana is a PPO plan with a medicare contract. Enrollment in either Blue ADVANTAGE plan depends on contract renewal. Table of Contents Section 1 Introduction to 2022 Blue ADVANTAGE Provider What is the service area for Blue ADVANTAGE ?

4 2 How do you find Blue ADVANTAGE providers that serve your area?..2 Nondiscrimination Language Section 2 List of Network Providers Hospitals (123)..5 Primary Care Providers (5,544)..9 Specialists (10,048)..123 Ancillary Services (3,884)..340 Skilled Nursing Facilities (136)..429 Outpatient Mental Health (1,672)..434 Section 3 Introduction to 2022 Blue ADVANTAGE Pharmacy Section 4 List of Network Pharmacies Retail (777)..474 Home Infusion (21)..491 Long Term Care (LTC) (138)..492 Mail Order (1)..496 Section 1 2022 Blue ADVANTAGE Provider Sections Introduction This directory provides a list of Blue ADVANTAGE s network providers. 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.

5 The PCP may be a provider who specializes in Family or General Practice, or Internal Medicine. The PCP will be the provider who will provide, arrange or authorize all routine medical care that you may need while you are a member of our plan. If you have questions about selecting or changing your PCP, please call Blue ADVANTAGE s Customer Service Department at 1 (866) 508-7145. The network providers listed in this directory have agreed to provide you with your health care services. Other providers are available in our network. However, HMO and PPO plan networks differ: HMO members may go to any of our network providers listed in this directory. PPO members may go to any of our network providers listed in this directory. However, providers marked with an will be treated as out-of-network for PPO members and the out-of-network cost share will apply. In cases where out-of-network providers submit a bill directly to you, you should not pay the bill but should submit it to the plan for processing and determination of your liability, if any.

6 Contact Blue ADVANTAGE Customer Service for more information. HMO plan members must use network providers except in emergency or urgent care situations or for out-of-area renal dialysis services or other services. If you obtain routine care from out-of-network providers, neither medicare nor Blue ADVANTAGE will be responsible for the costs. PPO plan members may get covered services from out-of-network providers. With the exception of emergencies, it may cost more to get care from out-of-network providers. Out-of-network providers are under no obligation to treat Blue ADVANTAGE (PPO) enrollees, except in emergencies. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our Customer Service department toll-free at 1 (866) 508-7145.

7 TTY users should call 711. Customer Service will operate seven (7) days a week from 8 to 8 CST, from October March. After March, Customer Service will operate five (5) days a week, Monday - Friday from 8 to 8 CST. You may also refer to your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services. Page 1 What is the service area for Blue ADVANTAGE ? Employer group and individual PLANS are available in all Louisiana parishes. Individual HMO and PPO plan offerings are grouped into the service areas below: Baton Rouge Region: Ascension, East Baton Rouge, East Feliciana, Iberville, Livingston, Pointe Coupee, St. Helena, West Baton Rouge, West Feliciana. Greater New Orleans Region: Assumption, Jefferson, Lafourche, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John the Baptist and Terrebonne. North Shore Region: St.

8 Tammany, Tangipahoa and Washington. Acadiana Region: Acadia, Allen, Avoyelles, Beauregard, Calcasieu, Cameron, Evangeline, Grant, Iberia, Jefferson Davis, Lafayette, Rapides, St. Landry, St. Martin, St. Mary, Vermilion and Vernon. Northeast Region: Caldwell, Catahoula, Concordia, East Carroll, Franklin, Jackson, LaSalle, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll and Winn. Northwest Region: Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine and Webster. How do you find Blue ADVANTAGE providers that serve your area? This directory is sorted by Hospitals, Primary Care Providers, Specialists, Ancillary Services, Skilled Nursing Facilities, Outpatient Mental Health Providers and Pharmacies. It is further sorted by state, parish, specialty, and provider s name alphabetically. If you have questions about Blue ADVANTAGE or require assistance in selecting a PCP, please call our Customer Service department toll-free at 1 (866) 508-7145.

9 TTY users should call 711. Customer Service will operate seven (7) days a week from 8 to 8 CST, from October March. After March, Customer Service will operate five (5) days a week, Monday - Friday from 8 to 8 CST. You can also visit Page 2 Notice of Non-Discriminatory PracticesBlue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc., comply with applicable federal civil rights laws and do not exclude people or treat them differently on the basis of race, color, national origin, age, disability or sex. Blue Cross and Blue Shield of Louisiana and its subsidiary: Provide free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters Written information in other formats (large print, audio, accessible electronic formats, other formats) Provide free language services to people whose primary language is not English, such as: Qualified interpreters Information written in other languagesIf you need these services, call Customer Service at 1-866-508-7145 (TTY 711).

10 Our phone lines are open 8 to 8 , 7 days a week from October March and 8 to 8 , Monday Friday from April you believe that Blue Cross or its subsidiary has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance in person or by mail, fax or email. In person: 5525 Reitz Avenue Baton Rouge, LA 70809 By mail: Section 1557 Coordinator P. O. Box 98012 Baton Rouge, LA 70898-9012 225-295-2300 1-800-711-5519 (TTY 711) Fax: 225-298-7240 (Attention: Government Programs) Email: you need help filing a grievance, our Section 1557 Coordinator is available to help you. You can also file a civil rights complaint with the Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at , or by mail or phone at: Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, 20201 1-800-368-1019, 800-537-7697 (TDD)Complaint forms are available at Blue Cross and Blue Shield of Louisiana HMO offers Blue ADVANTAGE (HMO).