DIRECTORY INFORMATION

BlueCare Plus (HMO SNP) – Provider Directory Information


This directory provides a list of BlueCare Plus’ network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).
For the 2019 plan year, you are not required to get a referral from your Primary Care Provider in order to go to a network specialist.
You will have to choose one of our network providers who are listed in this directory to be your Primary Care Provider (PCP). Generally, you must get your health care services from your PCP. Your PCP is your partner in health care and can help you stay healthy. You must choose a PCP at the time you enroll in BlueCare Plus. If you wish to change your PCP, please contact Member Service at 1-800-332-5762 (TTY: 711).
The network providers listed in this directory have agreed to provide you with your health care, vision, and dental services. You may go to any of our network providers listed in this directory. Other providers are available in our network.
The selection of providers for your care and treatment is yours. This provider directory is not a recommendation for any provider or type of health care. BlueCare Plus is not a provider of healthcare. BlueCare Plus does not control or interfere with the care and treatment recommendations made by providers in this directory.
Some providers may have more than one office. Not all of a provider’s offices may be in-network. Please call Member Service at the number on your ID card for details.

Using Out-Of-Network Providers To Get Your Medical Care
Out-of-network providers are providers that are not part of the BlueCare Plus provider network. You must use network 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 BlueCare Plus will be responsible for the costs.
If the circumstances are unusual or extraordinary, and network providers are temporarily unavailable or inaccessible, our plan will allow you to get covered services from an out-of-network provider at the in-network cost sharing amount. Please contact us for more information about what you should do if you need to get care from an out-of-network provider.

If You Get a Bill From an Out-of-Network Provider
As a member of BlueCare Plus, you have no cost-sharing for most services covered by our plan. Providers are not allowed to bill you for more than your share of the cost or “balance bill.” This includes instances when our payment plus TennCare’s payment are less than the provider charges for a service. Providers are also not allowed to add additional separate charges.
If you get a bill from an out-of-network provider for services covered by your plan, you should not pay the bill and should instead send us the bill along with documentation of any payments you may have already made. We will process the bill and determine your liability for the cost. Please refer to your Evidence of Coverage (EOC) for more information on how to submit the bill to us.
If you believe a provider has “balance billed” you, please call Member Service at 1-800-332-5762. TTY users should call 711.

Emergency Coverage
If you have a medical emergency:

  • Get help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. Call for an ambulance if you need it. You do not need to get approval or a referral first from your primary care provider.
  • As soon as possible, make sure that our plan has been told about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, if possible within the first 48 hours. Contact Member Service at 1-800-332-5762.

You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories. For example, you can get emergency medical care and post-stabilization care at a hospital or emergency room.
If you have an emergency, we will talk with the doctors who are giving you emergency care to help manage and follow up on your care. The doctors who are giving you emergency care will decide when your condition is stable and the medical emergency is over. Prior authorization may be required for follow-up care after the emergency is over. If your emergency care is provided by out-of-network providers, we will try to assist you with finding network providers to take over your care as soon as your medical condition and the circumstances allow.

Pharmacy Directory Information
This tool provides a list of the BlueCare Plus network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and BlueCare Plus formulary.
We call the pharmacies on this list our “network pharmacies” because we have made arrangements with them to provide prescription drugs to Plan members. In most cases, your prescriptions are covered under our plan only if they are filled at a network pharmacy or through our mail order pharmacy service. Once you go to one pharmacy, you are not required to continue going to the same pharmacy to fill your prescription but can switch to any other of our network pharmacies. We will fill prescriptions at non-network pharmacies under certain circumstances as described in your Evidence of Coverage.



This page was updated on October 1, 2018