2011 Provider/Pharmacy Directory - Blue Cross and Blue Shield of ...

Section 1 – Introduction
This directory provides a list of Medicare Blue and Medicare Blue Plus’ network providers. To
get detailed information about your health care coverage, please see your Evidence of Coverage.
The “network providers” listed in this directory have agreed to provide you with your health care
and vision 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 going to that same
provider. In some cases, you may get covered services from non-network providers.
Emergency care can always be obtained in or out of the service area from the nearest available
provider. When in the service area, you must use plan providers for urgent care. When out of the
service area urgent care may be obtained from the first available provider. In addition, when out
of the service area, you can obtain dialysis treatment from any qualified dialysis provider. If you
obtain routine care from out-of-network providers, neither Medicare nor Medicare Blue or
Medicare Blue Plus will be responsible for the costs.
A “medical emergency”—when you believe that your health is in serious danger—includes
severe pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much
worse. If you have a medical emergency, get medical help as quickly as possible. Call 911 for
help or go to the nearest emergency room, hospital, or urgent care center. You do not need to get
approval or a referral first from your doctor or other network provider. You may get covered
emergency medical care whenever you need it, anywhere in the United States. As soon as
possible, make sure that we know about your emergency; call your doctor’s regular office
number.
While you are a member of our Plan, you may use either network providers or out-of-network
providers. However, your out-of-pocket costs may be higher if you use out-of-network providers,
except for emergency care or out-of-area dialysis services. You don’t need to get a referral or
prior authorization when you get care from out-of-network providers; however, before getting
services from out-of-network providers, you may want to confirm with us that the services you
are getting are covered by us and are medically necessary.
If an out-of-network provider sends you a bill that you think we should pay, please contact
Customer Service or send the bill to us for payment. We will pay your doctor our share of the bill
and will let you know what, if anything, you must pay. You won’t have to pay an out-ofnetwork
provider any more than what he or she would have gotten if you had been covered under
the Original Medicare Plan. It is best to ask an out-of-network provider to bill us first; but if you
have already paid for the covered services, we will reimburse you for our share of the cost.
(Please note that we cannot pay a provider who has opted out of the Medicare program. Check
with your provider before receiving services to confirm that they have not opted out of
Medicare.) If we later determine that the services are not covered or were not medically
necessary, we may deny coverage and you will be responsible for the entire cost.
What is the service area for Medicare Blue and Medicare Blue Plus
Our service area is the state of South Carolina.