DIRECTORY INFORMATION

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.

For the 2017 plan year, you are not required to get a referral from your Primary Care Physician in order to go to a specialist.

You will have to choose one of our network providers who are listed in this directory to be your Primary Care Physician (PCP). The term “PCP” will be used throughout this directory. Generally, you must get your health care services from your PCP.

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. 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. Other providers are available in our network.

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 will be responsible for paying the entire costs if you use out-of-network providers, except for emergency, urgent care or out-of-area dialysis services.

In most situations, if you are in the plan’s service area and you use an out-of-network provider, you will pay the entire cost for your care. 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.

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 charge more than your share of the cost or “balance bill.” This includes instances when our payment and/or TennCare’s payment is 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, 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, if any. Please refer to your Evidence of Coverage for more information on how to submit the bill to us.

If you believe a provider has “balance billed” you, please contact us.

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 physician.
  • 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, usually within 48 hours.

You may get covered emergency medical care whenever you need it, anywhere in the United States or its territories.

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. After the emergency is over you are entitled to follow-up care to be sure your condition continues to be stable. Your follow-up care will be covered by our plan. 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.

What is the service area for BlueCare Plus?
The counties in our service area are listed below.
Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett, Cumberland, Davidson, Decatur, DeKalb, Dickson, Dyer, Fayette, Fentress, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Loudon, Macon, Madison, Marion, Marshall, Maury, McMinn, McNairy, Meigs, Monroe, Montgomery, Moore, Morgan, Obion, Overton, Perry, Pickett, Polk, Putnam, Rhea, Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson and Wilson counties, TN

Pharmacy Directory Information

This tool provides a list of network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and your plan’s 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, 2017