This directory provides a list of BlueAdvantage’s network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage (EOC).
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. You do not need a referral to see a network provider.
Out-of-network providers are under no obligation to treat BlueAdvantage 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 Member Service Department at 1-800-831-BLUE (2583), from 8 a.m. to 9 p.m., ET, Monday through Friday. TTY users should call 711. You may also refer to your Evidence of Coverage (EOC) for more information, including the cost sharing that applies to out-of-network services.
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. BlueAdvantage is not a provider of health care. BlueAdvantage 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 BlueAdvantage provider network. Your out-of-pocket costs may be higher if you use out-of-network providers, except for emergency, urgent care or out-of-area renal dialysis services. If you receive covered services from an out-of-network provider, you are only responsible for paying your share of the cost.
Please note: While you can get your care from an out-of-network provider, it must be from a provider who is eligible to participate in Medicare and has not “opted out” of Medicare. We cannot pay a provider that has opted out of Medicare, with some exceptions. You will be responsible for the full cost of the services if the provider has “opted out” of Medicare.
If the circumstances are unusual or extraordinary, and network providers are temporarily unavailable or inaccessible, our plan may allow you to get covered services from an out-of-network provider at the lower in-network cost sharing amount.
If You Get a Bill From an Out-of-Network Provider
As a member of BlueAdvantage, you only have to pay our plan’s cost-sharing amounts when you get 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 your share of the cost 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 more than your share of the cost, 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 or you are not sure what your share of the cost is for a service, please callMember Service at 1-800-831-BLUE (2583). TTY users should call 711.
What is the service area for BlueAdvantage?
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.
If you have a medical emergency:
You may get covered emergency medical care whenever you need it, anywhere in the world. You can get emergency medical care and post-stabilization care in different settings, such as 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. Follow-up care must be provided by network providers or Medicare providers in the U.S. or its territories. If you get your follow-up care from out-of-network providers, you will pay the out-of-network cost sharing amount, which is usually higher.
This tool provides a list of BlueAdvantage’s network pharmacies. To get a complete description of your prescription coverage, including how to fill your prescriptions, please review the Evidence of Coverage and BlueAdvantage’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.
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