Check your coverage information or call Customer Services to see what benefits are available to you and if prior authorization is required. Excellus BlueCross BlueShield Explore our internship program Why Excellus BCBS You'll find phone numbers and email links on our Contact Us page. You are not responsible for any charges from a Health Plan participating provider beyond your applicable deductible, copayment, or coinsurance, including any fees charged for PPE. Most often these services are provided in facilities that are licensed by the Office of Alcohol and Substance Use and provide individual, group and family counseling. Website - www.samhsa.gov. Website - www.samhsa.gov. We know that having any health symptoms can be scary. We are working to resolve this issue and apologize for the inconvenience. Heather.Ducot@excellus.com, COVERAGE AREA: Contact your physician before you enter treatment, unless it is an emergency. Because were focused on your health and well-being, our team of nurses, social workers, respiratory therapists and mental health coaches are here to support you. Oneida County: Entire county, except Rome, UTICA REGION SPECIALTY PROVIDERS: The information you're accessing may not be provided by Excellus BCBS. The law does allow us to discuss your PHI with your health care providers, but only within the scope of services that they themselves are providing to you. See our Contact Us page for the address of your local office. View and order your member card. Your PCP is your partner in managing and coordinating your health care services. What do the fields on my Explanation of Benefits (EOB) mean? If you are unable to submit your documentation electronically, you may continue to submit your documentation via mail to the address on the back of your member card. P.O. We know that having any health symptoms can be scary. ET If the provider is not satisfied with our payment, he/she may submit the claim to an independent dispute resolution entity who will determine whether our payment or the providers charge is most reasonable. Copyright 2023 Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Clinton, Essex, Franklin, Hamilton, Warren, Washington, Vermont, all Planned Parenthood locations regardless of ZIP code, HOSPITALS: Heres everything you need to know about it. All rights reserved. Fax 1-800-956-2397, EDI Solutions can help with electronic transactions such as claim submissions, eligibility and claim status. Links marked with an (external site) icon indicate you're leaving ExcellusBCBS.com. Don't have your member card handy? Website - www.aging.ny.gov, The New York State Department of Health can be a useful source of consumer information. You may also submit your grievance or request for appeal in writing. kristin.korniat@excellus.com, HOSPITALS: Our local offices are staffed with a team of friendly, knowledgeable advisors ready to help. Alaura.Daniels@excellus.com, Children's Behavioral Health Services: Reminder: Personal Protective Equipment ("PPE") Used by Providers, Commercial Group, Medicare, and Qualified Health Plan members, call 1-800-499-1275, Medicaid and Child Health Plus members, call 1-800-650-4359, Essential Plan members, call 1-877-626-9298. Download Statements & Forms. You can also call the Resource Center at (585) 225-0221 if you have additional questions before you visit. All calls are toll-free, anonymous and confidential. This means less out-of-pocket cost to you, and less hassle because there's no need to fill out paperwork. This is a dedicated line staffed by individuals to handle all your questions, including prescription-related questions. Carrie.Gallagher@excellus.com, COVERAGE AREA: Some health programs provide a limited number of inpatient chemical dependency rehabilitation days. 215 Washington Street If you are experiencing severe symptoms such as sharp pains, fever, loss of bodily function control, vomiting or any other immediate medical concern, dial 911 or contact a physician directly. You will need to attach an itemized bill from the provider who rendered services to you. Ask a Nurse Today! 1-888-576-6542. The Blue Cross Blue Shield Association has two office locations. See our Privacy Policy for how we use information. If the denial was based on your contract, you may file a grievance. Check out the changes and updates to our plan in 2023. At this time, electronic methods are preferred over mail. (585) 339-3839 Our plans have a process for reviewing health care services to ensure that they are evidence based, medically necessary, and being performed at the right level of care by qualified professionals. Hospital or physicians: file claims with local BlueCross and/or BlueShield Plan. Follow this link to Order a Member Card Online. Lets get you set up online today. If you would like to submit a complaint to us about charges for PPE from a participating provider, please contact us toll-free: Language AssistanceandNon-Discrimination Notice, English|Espaol||P|Kreyl Ayisyen||Italiano|||Polski||Franais||Tagalog||shqiptar. DME Vendors (Local and National), Lab Vendors (Local and National), Oral Surgery, Physical/Speech/Occupational Therapy, Skilled Nursing Facilities, Lauren Thayer Lets get you set up online today. Almost all health plans already include full coverage for vaccines (including COVID-19 vaccines and boosters) that are recommended by the federal Advisory Committee on Immunization Practices (ACIP) and given by an in-network provider. Chiropractic, HOSPITALS: Visit our Join Our Network page for more information. 215 Washington Street, Suite 112 Email Provider Enrollment to submit your application and follow up on enrollment status. Call our Customer Care team at 1-800-234-4781 to schedule an appointment. Include terms word1 + word2 Manager + Accounting returns opportunities for Manager and Accounting. Under the federal Health Insurance Portability and Accountability Act (known by its acronym, HIPAA), we are required to protect any and all information that could lead anyone to identify you by your past, present and/or future medical or mental health treatment or conditions. Phone - 1-866-950-7526 If you still have questions, you should contact the Customer Service department at the telephone number on your member card. Faxton St. Luke's Healthcare, St. Elizabeth Medical Center, COVERAGE AREA: For general press inquiries, please visit News to contact our media relations team. Our Find A Doctor online tool is designed to help you connect with any doctor participating in our network, including Primary Care Physicians. Use this tool to determine whether a procedure requires prior authorization for this specific member. Yes, these regulations require that any protected health information about members or their dependents age 18 or older cannot be released, even to family members, without the members authorization. What if I disagree with the denial of my claim? Will the privacy laws prohibit me from getting member-specific information for my dependent who is over 18, my elderly parents or even my spouses claims if Im also on the policy? Medicare does not cover over-the-counter tests. Call 1-800-920-8889 Weekdays from 9 a.m. to 8 p.m. local time (excluding holidays). Please note that if your doctor was terminated by us due to fraud, imminent harm to patients or final disciplinary action by a state board or agency that impairs the doctors ability to practice, continued treatment with that doctor is not available. Utica Office If my life or my dependents life is in jeopardy, are you allowed by law to give PHI to anyone else? If you receive a call that appears to originate from this number, the call is likely fraudulent or malicious and you should not answer it, or hang up immediately after receiving it if you do answer the call initially. Follow these links to send a private, secure message to us. He or she works with a team of health care professionals, which may include physician assistants (PAs) and nurse practitioners (NPs), to provide your treatment. Whats changing: Youll likely receive COVID-19 antiviral medication and treatment at no cost for now. Whats changing:Many health plans do not include coverage for over-the-counter (OTC) products. Submit an inquiry online, For medication prior authorization, benefit questions, or to reach a pharmacist, Contact By: For more information, view our privacy policy. Whats changing: Youll likely receive COVID-19 antiviral medication and treatment at no cost for now. Membership inquiries using the 'Enrollment & Billing Support' form are delivered into a secure database in which inquiries are tracked and monitored. If you disagree with a decision made by us to deny a requested service, you may contact Customer Service and a representative will be glad to assist you. Strong Memorial, Highland, FF Thompson, Noyes, Aleisa Bevilacqua Coverage is limited to the terms of your health care program. Whats changing:Many health plans do not include coverage for over-the-counter (OTC) products. If you need to file a claim choose from one of the following options: Excellus BlueCross BlueShield provides a process to follow if you and/or your health care provider disagree with our decision to deny services. You can also call the Resource Center at (607) 304-9800 if you have additional questions before you visit. Links marked with an (external site) icon indicate you're leaving the Medicare portion of ExcellusBCBS.com. If you have Medicaid, Essential Plan or Child Health Plus, you may have to start renewing your coverage once a year, for the first time since early 2020. Guthrie Hospitals and physician groups (regardless of zip code) Check your contract or benefit booklet, talk to your employer group representative or contact us if you are unsure whether or not you need to obtain a referral from your PCP. Please review the terms of use and privacy policies of the new site you will be visiting. Walk-ins welcome! Box 21146 Plattsburgh, NY 12901. accepting responsibility for the outcomes of your decisions. (518) 561-2243 (option 5, then option 3) For help or questions with your insurance plan, call the number on your Member Card for personalized care, or contact us. Call Customer Service at the phone number listed on your Member Card, or view our Contact Us page for a listing of phone numbers. For unresolved negotiations, the provider can submit an Independent Dispute Resolution (IDR) via the IDRE portal. The information you're accessing may not be provided by Excellus BCBS. Eagan, MN 55121, Excellus BlueCross BlueShield - Group You can submit completed Surprise Bill Certification Forms from the member web via secure email. BY APPOINTMENT ONLY Call 1-800-724-1675 A completed form directs the provider to seek payment for the service from the Health Plan (your assignment). After May 11, your cost for COVID-related services will now be based on the details of your current health plan benefits. *Members of a select number of grandfathered employer groups may need to pay a cost share for the administration of the vaccine. (315) 404-9933 AO Fox Healthcare, MIBassett Healthcare, Cobleskill Regional Hospital, Delaware Valley, Little Falls, Margaretville Memorial, O'Connor, Tri-Town Regional Healthcare, Nathan Littauer, St. Mary's Amsterdam, SPECIALTY GROUPS: This is when you or a family member requires medically necessary treatment in a facility that provides 24-hour care. 150 N. Main Street, Suite 1 right to confirm if a service requires prior authorization. Whats changing: You will likely have to pay some costs for FDA-authorized COVID-19 lab tests and related visits after May 11, 2023, depending on the type of test and reason for the visit, as explained in your health plan benefits. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Don't have your Member Card handy? Search for Doctors, Hospitals and Dentists Blue Cross Blue Shield members can search for doctors, hospitals and dentists: In the United States, Puerto Rico and U.S. Virgin Islands. Members should call thenumber on their Member ID Card. Monday Friday: 9 a.m. 4:30 p.m. Our registered Nurses can provide you with education on health care questions. If you do not have online account or need access to additional online features, it's easy! Submit an inquiry online MEDICARE FOR BUSINESSES. For a listing of prescription drugs medications, see Prescription Drugs. The protection of your privacy will be governed by the privacy policy of that site. Can you help me decide which PCP to select? 1-844-730-0088 We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. Do plan health care providers receive financial incentives for my care? Create a personal representative account Monday - Friday: 9 a.m. - 4:30 p.m. Youll likely have to pay the full cost for COVID tests that are purchased at a pharmacy or online after May 11. All rights reserved. Please log in to your member account at ExcellusBCBS.comto view your benefits. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Contact our Dedicated Customer Care Team at Excellus BCBS at 800.493.0318 (TTY: 800.662.1220) , Monday-Thursday: 8 a.m.-8 p.m. EST; Friday: 9 a.m.-8 p.m. EST. A PCP is a physician whose principal medical specialty is in family practice, internal medicine, OB/GYN, general practice or pediatrics. If you have paid PPE charges to a Health Plan participating provider, you should contact the provider and obtain a refund. We encourage our female members to select a provider specializing in obstetrics/gynecology as well as a PCP. Exercise at Home Exercise at home with a wide range of Home Fitness Kits such as yoga, strength, and more. How can I file a claim? An adjustment amount may appear on your next Monthly Health Statement or Explanation of Benefits. Y0028_8830_C. Help When You Need It Excellus BCBS Members: For personalized care and questions, call the number on your Member Card. ET Closed Weekdays: Noon - 1 p.m. Syracuse, NY 13214 Optometry, Ophthalmology, Optical, Carrie Clifford All rights reserved. Box 21146 53 Chenango Street How does the Surprise Bill dispute process work? To access your member services, please visit your BCBS company. View customer complaints of Excellus Blue Cross Blue Shield, BBB helps resolve disputes with the services or products a business provides. There typically are a limited number of days available for inpatient treatment in a calendar year. Keep scheduled appointments. BY APPOINTMENT ONLY Youll likely have to pay the full cost for COVID tests that are purchased at a pharmacy or online after May 11. St. Joseph's Syracuse, Carthage, Samaritan, River and Lewis County General, Bianca Coe As our member, there's no need to worry about your coverage if you get sick or injured while traveling. Renewals will begin in June of 2023, on a rolling monthly basis. You wont need a referral from your PCP to see a participating OB/GYN for covered OB/GYN care, including routine annual exams, prenatal care, or mammograms. Suite 112 CR-01 - PCP and Specialty Care Physician Initial Credentialing. (315) 671-7176 If you are experiencing severe symptoms such as sharp pains, fever, loss of bodily function control, vomiting or any other immediate medical concern, dial 911 or contact a physician directly. Find a plan that works in your service area. Phone - 1-877-846-7369 Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. CR-03 - Clean Practitioner Files. Call 1-800-278-1247 Outpatient mental health benefits are for counseling for mental health problems. No problem! To live free of worry, free of fear, because you have the strength of Blue Cross Blue Shield companies behind you. This will allow your Mental Health or Chemical Dependency specialist to share information with your Primary Care Physician concerning your treatment plan and medical condition. 165 Court Street At a Resource Center, you can: Need to pay a bill? Office of Addiction Services and Supports (OASAS) Refer to the, Membership/Enrollment Application or Documentation. Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. See states serviced LAST UPDATED: December 27th, 2022 Headquartered in Rochester, New York, Excellus BlueCross BlueShield is a BCBS subsidiary. (585) 485-6064 Greece Resource Center If you have Medicaid, Essential Plan or Child Health Plus, you may have to start renewing your coverage once a year, for the first time since early 2020. If you are experiencing severe symptoms such as sharp pains, fever, loss of bodily function control, vomiting or any other immediate medical concern, dial 911 or contact a physician directly. The website includes Frequently Asked Questions and search capabilities. How may I estimate potential out-of-pocket expenses for an out-of-network service? Information about services, staff, hours of operation and your benefits, including access to routine services as well as after-hours and emergency services, and members' rights and responsibilities; Participate in decision-making with your physician about your health care; Obtain complete, current information concerning a diagnosis, treatment and prognosis from a provider in terms that you can reasonably be expected to understand; Refuse treatment as allowed by law, and be informed by your physician of the medical consequences; Confidentiality of medical records and information, with the authority to approve or refuse the re-disclosure by us of such information, to the extent protected by law; Receive all information needed to give informed consent for any procedure or treatment; Access to your medical records as permitted by New York State law; Express concerns and complaints about the care and services provided by physicians and other providers, and have us investigate and respond to these concerns and complaints; Candid discussion of appropriate or medically necessary treatment options for your condition, regardless of cost or benefit coverage; Care and treatment without regard to age, race, color, sex or sexual orientation, religion, marital status, national origin, economic status or source of payment; Voice complaints or appeals and recommend changes in benefits and services to staff, administration and/or the New York State Insurance Department or Department of Health, without fear of reprisal; Formulate advance directives regarding your care. Chiropractic, Heather Ducot ET Friday: 9 a.m. - 5 p.m. We cant tell you whom to select, but we do offer tools to help you decide which practitioner is right for you. Madison County, Oneida County: Rome, UTICA REGION SPECIALTY PROVIDERS: If the form is for a claim that meets the definition of a surprise bill, the Health Plan will work with the provider to resolve the bill. (315) 404-9933 Healthfirst Customer Service-Health First Provider Phone Number-Address and Timely Filing Limit; Kaiser Permanente Phone Number - Claims address and Timely Filing Limit . Utica, NY 13502, In the Watertown Region: At a Resource Center, you can: Meet 1-on-1 with a licensed advisor to discuss your health insurance options Use the link below to find your local BCBS company's website. Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will continue to cover oral antivirals and therapeutics at no cost through Sept. 30, 2024. Binghamton Whether it's for a grievance or a medical appeal, the first step in the process is to file your concern with our Customer Service Department. What if I disagree with the denial of my claim? Can I fill prescriptions at an out-of-town pharmacy? We want to help 24/7 Nurse Call Line We know that having any health symptoms can be scary. Contact Customer Care for eligibility/benefits and claims inquiries Contact By: Call 1-800-920-8889 Submit an inquiry online Monday - Thursday: 8 a.m. - 5 p.m. We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. Mail Visit Us In-Person Follow these links to send a private, secure message to us. Cortland Regional If you have an emergency medical condition, you should go directly to the nearest emergency room. Excellus BCBS offers affordable health insurance for Individuals, Employers and Medicare Individuals with the name trusted for over 85 years. Enrollment Inquiry & Support Tool Log in and use the Enrollment & Inquiry Support tool to send all inquiries to our Enrollment team. Do not pay any bills received from your provider while a surprise bill is being evaluated. Register & Create Account. If the denial was based on medical necessity and/or the experimental or investigational nature of the treatment, you and/or your health care provider may request a medical appeal. Arnot hospitals and physician groups (regardless of zip code) Where can I get a Surprise Bill Certification Form? BCBS Customer Service Call the toll-free number on the back of your member ID card for BCBS customer service. Visit the Federal No Surprise Bill website for more information about submitting an IDR request. Clinton, Delaware, Essex, Franklin, Fulton, Hamilton, Herkimer, Madison, Montgomery, Oneida, Otsego, Laura LePage Jefferson County, Lewis County, Onondaga County:Brittonfield Parkway,Cicero (13039), Clay (13041), St. Joseph's Medical PC and St. Joseph's Health PC, Syracuse (13210, 13211, 13212, 13217, 13220, 13244, 13290), HOSPITALS: Requests are typically completed within 3-5 business days. If I do need to file my own medical, dental or vision claim, what do I need to include with my claim form? CR-02A - Non-Physician Health Care Practitioner Recredentialing. Access general information about NYRx, the Medicaid Pharmacy Program, along with additional information for Members and Providers. Managed care and point of service (POS) plans require you to select a PCP to provide, manage, arrange or authorize almost all the medical care you receive. To search for a list of covered tests, visit the. Providers can submit an open negotiation form. To submit a claim electronically, please login and go to Submit Claims page. If you believe you have received a surprise bill, please complete a Surprise Bill Certification Form and submit a copy to your provider and to the Health Plan. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Submit an inquiry online, Monday - Thursday:8a.m. - 4:30p.m. What you pay for COVID-19 related medical and pharmacy care may change once the public health emergency ends on May 11, 2023. This is the customer service number for questions about your health insurance coverage, benefits or treatment. The guide provides important consumer information on the performance of health maintenance organizations (HMOs) and other insurers. The New York State Partnership for Long Term Care is a unique program that combines private long term care insurance and Medicaid to help New Yorkers prepare financially for the possibility of needing nursing home or home care. Almost all health plans already include full coverage for vaccines (including COVID-19 vaccines and boosters) that are recommended by the federal Advisory Committee on Immunization Practices (ACIP) and given by an in-network provider. Phone - 1-800-342-9871 Terms of Use | Web Privacy Policy | Accessibility Statement.