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(HMO) Provider Directory

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  • New Mexico Retiree Health Care Authority (NMRHCA)

    2016 Provider DirectoryBlue Cross Medicare Advantage (HMO)SM

    MRK_NM_NMRTDir16_NR

    Last updated 10/15475855.0915

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    HMO plans are provided by Blue Cross and Blue Shield of New Mexico, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an Independent Licensee of the Blue Cross and Blue Shield Association. HCSC is a Medicare Advantage organization with a Medicare contract. Enrollment in HCSCs plans depends on contract renewal.

    This information is available for free in other languages. Please call our Customer Service number at 1-877-299-1008 (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

    Esta informacin est disponible en otros idiomas de forma gratuita. Comunquese a nuestro nmero de Servicio al cliente al 1-877-299-1008 (los usuarios de TTY/TDD deben llamar al 711). Nuestro horario es de 8 a.m. a 8 p.m., hora local, los 7 das de la semana. Si usted llama del 15 de febrero al 30 de septiembre, durante los fines de semana y feriados, se usarn tecnologas alternas (por ejemplo, correo de voz).

    This document is available in other formats such as Braille and large print. For additional information, call us at 1-877-299-1008. (TTY/TDD users should call 711).

    This directory provides a list of Blue Cross Medicare AdvantagesSM network providers.

    This directory is for the entire Blue Cross Medicare Advantage provider network offered to people that are Medicare eligibles and residing in New Mexico.

    This directory is current as of October 2015. Some network providers may have been added or removed from our network after this directory was printed. We do not guarantee that each provider is still accepting new members. To get the most up-to-date information about Blue Cross Medicare Advantages network providers in your area, you can visit getbluenm.com/mapd/providers or call our Customer Service Department at 1-877-299-1008. We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays. TTY/TDD users should call: 711.

    Blue Cross Medicare Advantage

    2016 Provider Directory

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    Section 1 IntroductionThis directory provides a list of Blue Cross Medicare Advantage network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

    If you join the Blue Cross Medicare Advantage, 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 coverage from your PCP.

    A PCP is a doctor who is a family practitioner, internist or geriatric physician. The PCP is trained to provide general medical care. The PCP you select provides or manages your health care. The PCP also helps you make informed decisions about your care. When necessary the PCP makes referrals to specialists, generally within your medical group network.

    The network providers listed in this directory have agreed to provide you with your health care coverage. You may go to any of our network providers listed in this directory; however, some services may require a referral. 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. If you require medical care beyond the scope of your PCP, the PCP will coordinate with providers most appropriate to render the medical treatment. It is important to note that the PCP belongs to a network. The PCP has certain network specialists and hospitals that they use for coordinated specialty, diagnostic and hospital medical care. The specialist and hospitals that the PCP may refer you to will be within the PCP network affiliation.

    You may be financially responsible to pay for some or possibly all services if you choose to go to a doctor outside of your affiliated medical group without authorization from your PCP. Your PCP will coordinate the authorization process.

    If you are traveling and are out of the Blue Cross Medicare Advantage Plan service area and need urgent care or emergency care, you should go to the nearest provider to seek care.

    You do not need prior authorization to seek medical help in an urgent or emergency situation. The physician treating your emergency needs will discuss your condition with your Primary Care Physician. When your condition is stable the physicians will coordinate the transfer of your care back to your Primary Care Physician network.

    If an out-of-network provider asks you to pay for covered services you receive, please call Customer Service at 1-877-299-1008 (TTY/TDD 711) or send the bill(s) with a note explaining the situation to:

    Blue Cross Medicare Advantage

    P.O. Box 11968

    Albuquerque, NM 87192

    You may receive covered urgent or emergency medical care whenever you need it. You are covered for emergency care worldwide. Our plan covers ambulance services in situations where getting to the emergency room in any other way could endanger your health after your co-pay.

    If your emergency care is provided by out-of-network providers, we will try to arrange for network providers to take over your care as soon as your medical condition and the circumstances allow.

    You must use plan providers except in emergency or urgent care situations or for out-of-area renal dialysis

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    or other services. If you obtain routine care from out-of-network providers neither Medicare nor Blue Cross Medicare Advantage will be responsible for the costs.

    What is the service area for Blue Cross Medicare Advantage?HMO plans available statewide in New Mexico.

    How do you find Blue Cross Medicare Advantage providers in your area? The directory includes hospitals, physicians and other providers participating in the Blue Cross Medicare Advantage Plan. Please refer to the Index for section names. Each section is organized alphabetically by city.

    Within each city, the city and/or physician names are listed in alphabetical order along with the address and phone number. For the most updated Blue Cross Medicare Advantage provider information, please call our Customer Service Department (see below). While every provider listed in this directory is affiliated with or employed by a contracting medical group, not every provider listed will be accepting new patients. Although Blue Cross Medicare Advantage has identified those providers who were not accepting patients at the time this directory was created, the status of any physicians practice may have changed. For the most current information regarding the status of any physicians practice, please contact either the physician or the medical group you have selected at the phone number listed in this directory.

    To ensure that you are comfortable with your choice of doctors, you may change your medical group or PCP for any reason. To change to another PCP, simply call the Blue Cross Medicare Advantage Plan at 1-877-299-1008 (TTY/TDD 711). You can begin to see your new PCP the first of the following month of your request. A change of PCP cannot be retroactive.

    If you have questions about Blue Cross Medicare Advantage or require assistance in selecting a PCP, please call our Customer Service Department at 1-877-299-1008, 8 a.m. - 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on weekends and holidays. TTY/TDD users should call 711.

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    HOW TO READ THE PHYSICIAN LISTINGExample:

    ALBUQUERQUE (Alphabetical listing of towns and cities)

    FAMILY PRACTICE (Specialty)

    Smith, John, MD (Physicians name)

    (555)123-4567 (Phone number)

    This information changes on a frequent basis. Please refer to the online directory or call Customer Service below for current updates.

    Participation by providers in this directory is not guaranteed and may be subject to change. Please ask your provider whether he/she is still participating in the network. If you have questions about Blue Cross Medicare Advantage, please call our Customer Service number at 1-877-299-1008 (TTY/TDD users should call 711). We are open between 8 a.m. and 8 p.m., local time, 7 days a week. If you are calling from February 15 through September 30, alternate technologies (for example, voicemail) will be used on the weekends and holidays.

    This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. The provider network may change at any time. You will receive notice when necessary.

  • ALBUQUERQUEBERNALILLOCOUNTY

    GENERAL ACUTE CAREHOSPITALLovelace Med Ctr Downtown504 Elm St NEAlbuquerque, NM 87102(505) 727-8000Lovelace Westside Hospital10501 Golf Course Rd NWAlbuquerque, NM 87114(505) 727-2000Lovelace Womens Hospital4701 Montgomery Blvd NEAlbuquerque, NM 87109(505) 727-7800UNM Hospital2211 Lomas Blvd NEAlbuquerque, NM 87106(505) 272-2111

    LONG-TERM ACUTECARE HOSPITAL(LTACH)Albuquerque Amg SpecialityHospit235 Elm St NEAlbuquerque, NM 87102(505) 842-5550Kindred Hospital Albuquerque700 High St NEAlbuquerque, NM 87102(505) 242-4444

    PSYCHIATRICHOSPITALHaven Behavioral Services of Alb5400 Gibson Bl