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Complete Blue PPO Plan 2022 Provider Directory

Complete blue PPO Plan 2022 Provider Directory This Directory provides a list of Complete about the information contained in this blue PPO's network providers. Directory (hardcopy or online), please call our Customer Service Department at This Directory is for the following counties 1-833-227-9375, Monday through Sunday, in Pennsylvania: Allegheny, Armstrong, 8:00 to 8:00 TTY users should call Beaver, Bedford, Blair, Butler, Cambria, 711. Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, This document may be available in Huntingdon, Indiana, Jefferson, Lawrence, alternate formats. Please call our Customer McKean, Mercer, Potter, Somerset, Service Department at the numbers listed Venango, Warren, Washington, and above. Westmoreland. highmark Senior Health Company is a PPO.

Mar 08, 2022 · Highmark Senior Health Company is a PPO plan with a Medicare contract. Enrollment in Highmark Senior Health Company depends on contract renewal. Health benefits or health benefit administration may be provided by or through Highmark Senior Health Company. Highmark Blue Cross Blue Shield provides certain administrative communications for this ...

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Transcription of Complete Blue PPO Plan 2022 Provider Directory

1 Complete blue PPO Plan 2022 Provider Directory This Directory provides a list of Complete about the information contained in this blue PPO's network providers. Directory (hardcopy or online), please call our Customer Service Department at This Directory is for the following counties 1-833-227-9375, Monday through Sunday, in Pennsylvania: Allegheny, Armstrong, 8:00 to 8:00 TTY users should call Beaver, Bedford, Blair, Butler, Cambria, 711. Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, This document may be available in Huntingdon, Indiana, Jefferson, Lawrence, alternate formats. Please call our Customer McKean, Mercer, Potter, Somerset, Service Department at the numbers listed Venango, Warren, Washington, and above. Westmoreland. highmark Senior Health Company is a PPO.

2 Some network providers may have been plan with a Medicare contract. Enrollment added or removed from our network in highmark Senior Health Company after this Directory was printed. We do depends on contract renewal. not guarantee that each Provider is still accepting new members. To get Health benefits or health benefit the most up-to-date information about administration may be provided by or Complete blue PPO's network providers through highmark Senior Health Company. in your area, you can visit medicare. highmark blue cross blue shield provides or call our Customer Service certain administrative communications Department at 1-833-227-9375, Monday for this company. highmark blue cross through Sunday, 8:00 to 8:00 TTY blue shield and highmark Senior Health users should call 711. Company are independent licensees of the blue cross blue shield Association.

3 All To access Complete blue PPO's online references to highmark in this document Provider Directory , you can visit are references to the highmark company For any questions that is providing the member's health benefits or health benefit administration. This Directory is current as of March 8, 2022. 1. H3916_21_6933_C. Table of Contents Please click the link on each section to go to that page. Section 1 - Introduction .. 3. What is the service area for Complete blue PPO?..6. How do you find Complete blue PPO providers that serve your area?..7. Section 2 List of Network Providers .. 8. Primary Care Providers Index ..11. Primary Care Providers ..35. Language Index for Providers ..131. Specialist Physicians Index ..139. Specialist Physicians ..177. Routine Hearing Care Providers ..529. Routine Vision Care Providers.

4 541. Hospitals, Home Health, SNFs and Ambulatory Surgical Durable Medical Equipment Providers ..675. Dental Providers ..691. Outpatient Mental Health Providers ..771. Chain Pharmacies ..859. Pharmacies ..863. Out-of-State Pharmacies ..887. Section 3 Auxiliary Provider 901. Cleveland Clinic Section 1 Introduction This Directory provides a list of Complete blue PPO's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC). 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, Complete blue PPO. will notify you in writing regarding your options 30 calendar days before the effective date of the termination.

5 The network providers listed in this Directory have agreed to provide you with your health care/. vision/dental coverage. 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. Complete blue PPO members may go to any health care Provider of their choice either in or out of the highmark Medicare Advantage PPO Network as long as the Provider has not opted out of the Medicare program. If you get a health care service from a network Provider , this is known as an in-network service. Eligible in-network services are covered in full except for small copayments or coinsurance for certain services. A health care service you get from a non-network Provider is known as an out-of-network service.

6 You may use non-network providers to get your covered services, but your out-of-pocket costs may be higher than if you use our network providers. There are special rules for out-of-network services. Certain services that we offer are not covered out-of-network. Also, you do not need to get a referral or prior authorization when you get out-of-network services from non-network providers. However, before getting an out-of-network service, you may want to check with your plan to see if the services you are getting are covered by your plan and are medically necessary. Out-of-network/non-contracted providers are under no obligation to treat Complete blue PPO. members, except in emergency situations. 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.

7 Please call our customer service number or see your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services. 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 and 8:00 at 1-833-227-9375. TTY users should call 711. Eligible services will be paid by Complete blue PPO. 3. 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.

8 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 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 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 (EOC). Complete blue PPO 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 agree to another arrangement.

9 Complete blue PPO 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. While out of the area, get the care you need from any Provider of your choice. 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 . Complete blue PPO 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.

10 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 for authorization. However, as soon as possible, you or someone else should contact your preferred Provider or PCP, if you have one, so that he/she may provide follow-up care. Complete blue PPO members are encouraged to choose a preferred Provider /primary care Provider (PCP), but it is not required. You may select any Provider from the Preferred Providers/. Primary Care Provider section of this Directory as your preferred Provider . 4. 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 (EOC) for detailed information about your specific plan's benefits, limitations, copayments and coinsurance, and how to receive care.


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