excellus bcbs customer service

Members or providers can initiate a dispute request via the IDRE portal. Links marked with an (external site) icon indicate you're leaving ExcellusBCBS.com. 333 Butternut Drive If you need an immediate response, please call by telephone. Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Call 1-800-920-8889 Website - www.samhsa.gov. Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. This is a dedicated line staffed by individuals to handle all your questions, including prescription-related questions. If you are in an ongoing course of treatment when your doctor leaves your insurance plan, then you may be able to continue to receive covered services for the ongoing treatment from your doctor for up to 90 days from the date your doctors contractual obligation to provide services to you terminates. The website includes Frequently Asked Questions and search capabilities. Can I submit a Surprise Bill Certification Form via the member Web? All rights reserved. Visit the Federal No Surprise Bill website for more information about submitting an IDR request. Other plans may not have this requirement, but you may need to get a referral or pay a higher copay for out of area treatment. Carrie.Clifford@excellus.com, COVERAGE AREA: The best way to stay informed and have access to your coverage is online. Binghamton, NY 13902-5266, In the Central New York and Southern Tier Regions: Whats changing: After May 11, 2023, the health plan will resume reviewing requests for early prescription refills. All rights reserved. See states serviced LAST UPDATED: December 27th, 2022 Headquartered in Rochester, New York, Excellus BlueCross BlueShield is a BCBS subsidiary. Alicia.Chase@Excellus.com, COVERAGE AREA: Your PCP is your partner in managing and coordinating your health care services. This page last updated 10-01-2022. St. Joseph's Syracuse, Carthage, Samaritan, River and Lewis County General, Bianca Coe View our online pharmacy directory to find a FLRx participating pharmacy. If you have our prescription drug coverage and need to fill a prescription while traveling, you can use FLRx, our National Pharmacy Network. Don't have your card? There is no cost to you if you have Silver&Fit included in your plan. You may also visit Fair Healths website (www.fairhealthconsumer.org) to estimate potential out-of-network out-of-pocket expenses. In these cases, we will not release more information than necessary. Syracuse, NY 13214-1803 Rochester, New York 14647, In the Utica Region: 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. For unresolved negotiations, the provider can submit an Independent Dispute Resolution (IDR) via the IDRE portal. There typically are a limited number of days available for inpatient treatment in a calendar year. Contract changes may be made at any time due to a qualifying event such as a birth, death, marriage, divorce or loss of employment. If you need an immediate response, please call by telephone. The information you're accessing may not be Medicare-specific and/or provided by Excellus BCBS. Coverage is limited to the terms of your health care program. Help When You Need It Excellus BCBS Members: For personalized care and questions, call the number on your member card. If your doctor agrees to these conditions, you will receive the covered services as if they were being provided by a participating provider. ET Friday: 9 a.m. - 5 p.m. Register or create an account or request access today ! This information is optional and can be used to track patient access, quality of care and other provider trends. Dione.Ashman@excellus.com, COVERAGE AREA: 215 Washington Street To submit a claim electronically, please login and go to Submit Claims page. Our online Find a Doctor feature includes participating health care professionals names, addresses and driving directions, specialties, office hours, and much more. Opportunities - Excellus BCBS. Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. Pay all co-payments required under your program. Optometry, Ophthalmology, Optical, Carrie Clifford Check Out Our Process for Enrollment Inquiry & SupportOpen a PDF. For more information, view our privacy policy. Do plan health care providers receive financial incentives for my care? You can also call the Resource Center at (585) 225-0221 if you have additional questions before you visit. If youre losing your employer-sponsored health insurance, there are affordable, high-quality options available to you. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. (585) 339-7691 .pt-3 { Walk-ins welcome! Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will continue to cover all COVID-19 lab tests at no cost through Sept. 30, 2024. Box 5266 If youre losing your employer-sponsored health insurance, there are affordable, high-quality options available to you. 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. You can still order free over-the-counter tests through. In this article, we cover 20 productivity tips for working from home that you can use to stay productive, boost your remote performance and keep yourself motivated throughout your workday. Box 21146 Programs that provide this benefit often have a limited number of sessions. Visit our Member Bill Pay Options page for more information. What can I do if my benefits are exhausted for medical services? Follow this link to learn more about how our coverage travels with you. Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will continue to cover all COVID-19 lab tests at no cost through Sept. 30, 2024. The Patient Protection and Affordable Care Act (PPACA) signed into law in March 2010 requires private insurers that offer dependent coverage for children to allow young adults up to age 26 to remain on their parents insurance plan. All rights reserved. Other changes include: Links marked with an (external site) icon indicate you're leaving ExcellusBCBS.com. This lookup tool is for medical services and provider administered drugs only. We get it. Adirondack Medical Center, Alice Hyde Medical Center, Champlain Valley Physician, Elizabethtown Community, Moses Ludington, University of Vermont Medical Center, COVERAGE AREA: Use the link below to find your local BCBS company's website. Phone - 1-877-726-4727 We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. The protection of your privacy will be governed by the privacy policy of that site. 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. What if I disagree with the denial of my claim? This is also known as your protected health information (PHI). Our Lady of Lourdes hospital and physician practices (regardless of zip code), SOUTHERN TIER SPECIALTY PROVIDERS: For a listing of prescription drugs medications, see Prescription Drugs. Our registered Nurses can provide you with education on health care questions. 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. We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. Medicare does not cover over-the-counter tests. What happens after I submit a Surprise Bill Certification Form? Phone - 1-800-342-9871 From free or low-cost New York state sponsored plans to individual and family plans, you can still have the peace of mind that comes with having coverage you know and trust. Terms of Use | Web Privacy Policy | Accessibility Statement. Learn more about the transition of the pharmacy benefit from Blue Choice Option, HMO Blue Option, and Blue Option Plus to NYRx, the Medicaid Pharmacy Program. 2023 Blue Cross Blue Shield Association. Once the federal government runs out of its supply of treatments, however, what you pay will be based on the terms of your health insurance plan. Outpatient mental health benefits are for counseling for mental health problems. Renewals will begin in June of 2023, on a rolling monthly basis. See our Privacy Policy for how we use information. Select a category below to view a filtered search of open positions in that area. Surprise Bills subject to the New York State Mandate. 12 Rhoads Drive Closed Weekdays: Noon - 1p.m. ET Broome County, Chemung County, Schuyler County, Steuben County, Tioga County, Pennsylvania (Bradford and Susquehanna Counties), Alicia Chase 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. Brian.Fetterly@excellus.com, COVERAGE AREA - CNY: The Surprise Bill Certification Form is reviewed by Customer Care. Utica, NY 13502 For our records, we may ask that you give a reason for changing your PCP. Terms of Use | Web Privacy Policy | Accessibility Statement. Our representatives will respond within four business days. Copyright 2023, Excellus BlueCross BlueShield, a nonprofit independent licensee of the Blue Cross Blue Shield Association. Some health programs provide a limited number of inpatient chemical dependency rehabilitation days. Whether or not your program requires a referral, it is a good idea to discuss your concerns with your primary care physician who may be able to assist in selecting a mental health specialist. The information provided is intended to help educate members, not to replace the advice of a medical professional. Please allow up to 72 hours for a reply. Oneida County: Entire county, except Rome, UTICA REGION SPECIALTY PROVIDERS: If it is an emergency situation, there is no referral required before seeking care. Once you have submitted the form to the Health Plan, no other action is required on your part. Y0028_8830_C. If we are unable to agree on a payment, we will pay what we deem to be a reasonable amount. You will be prompted to log in. Learn more about your rights and protections against surprise medical bills in this NoticeOpen a pdf. Whats changing:Many health plans do not include coverage for over-the-counter (OTC) products. If your benefits have exhausted for medical or behavioral health services, you may contact one of the agencies below for assistance in obtaining necessary care. The 24/7 Nurse Call Line is a service provided to our members to support their relationship with their health care providers. 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. Chenango County physicians, SOUTHERN TIER SPECIALTY PROVIDERS: "Customer Service Manager""Customer Service Supervisor" retrieves an opportunity for a Customer Service Manager or a Customer Service Supervisor. Customer Care Speak with one of our Medicare Customer Care Advocates toll-free. You may still submit bills to Excellus BCBSfor reimbursement for OTC tests purchased through May 11, 2023. (315) 671-7176 Genesee, Livingston, Monroe, Ontario, Orleans, Seneca, Wayne, Yates, Carrie Gallagher Exclude terms Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Whats changing: Youll likely receive COVID-19 antiviral medication and treatment at no cost for now. 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. 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. If we determine that the form is for a claim that does not meet the definition of a surprise bill, we will notify you of the denial and you will be responsible for any costs not covered under your contract. Please log in to your member account at ExcellusBCBS.comto view your benefits. View customer complaints of Excellus Blue Cross Blue Shield, BBB helps resolve disputes with the services or products a business provides. Find a plan that works in your service area. Here is more information on what will (or wont) change once the public health emergency ends: Whats changing: Most members will continue to receive FDA-authorized COVID-19 vaccines and boosters at no cost once the federal emergency ends. Our Find A Doctor online tool is designed to help you connect with any doctor participating in our network, including Primary Care Physicians. Members have the. Because of HIPAA, we cannot release any information regarding your policy, claims or benefits without your express permission. If your mental health or chemical dependency benefits have exhausted, you may call one of the agencies below for assistance in obtaining necessary care. Youll likely have to pay the full cost for COVID tests that are purchased at a pharmacy or online after May 11. Whats changing: What you pay for telehealth COVID-19 services after May 11, 2023 will depend on the details of your health plan. Onondaga County: Baldwinsville (13027), Liverpool (13090, 13088), Crouse physicians (regardless of ZIP code);Oswego County, St. Lawrence County, HOSPITALS: Watertown, NY 13601 Rushville, Farmington, Ontario, Geneseo, Lakeville, Livonia, Dansville, Avon, Canandaigua, Victor, Williamson, Sodus, Penn Yan, Nicole Trombley How do I obtain a duplicate Explanation of Benefits or Monthly Health Summary statement showing how my claims have been processed? Suite 250 At your local Excellus BCBS office, you can: Rochester Office Auburn Community, SUNY Upstate, Kristin Korniat Beginning April 1, 2023, all Medicaid members enrolled in Blue Choice Option, HMO Blue Option, and Blue Option Plus will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. You will be asked by your provider to sign a release of information. Help When You Need It Excellus BCBS Members: For personalized care and questions, call the number on your Member Card. *Members of a select number of grandfathered employer groups may need to pay a cost share for the administration of the vaccine. This process is called utilization management (UM) and it is conducted by licensed health care professionals and practitioners. Website - https://nyspltc.health.ny.gov/, The Centers for Medicare & Medicaid Services (CMS) provides Medicare and Medicaid information for each state. If I do need to file my own medical, dental or vision claim, what do I need to include with my claim form? Syracuse Office If you are enrolled in a grandfathered group, please consult with your employers human resources or health benefits representative for COVID-19 vaccine-related benefits. Whats changing: After May 11, 2023, the health plan will resume reviewing requests for early prescription refills. Excellus BlueCross BlueShield Updates on COVID-19 (Coronavirus). You may still submit bills to Excellus BCBSfor reimbursement for OTC tests purchased through May 11, 2023. Please utilize the appropriate form and attach to ensure proper handling. See our Privacy Policy for how we use information. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Customer Care Advocate IA De Witt, Town of, NY Customer Service, Claims & Operations The Customer Care (CC) Advocate resolves customer inquiries via telephone, walk in, mail, fax, web chat, off-phone work, and email concerning, but not limited to, contract benefits, claim payments, and. How do I obtain a duplicate Explanation of Benefits or Monthly Health Summary statement showing how my claims have been processed? Chiropractic, Jason Lutz (315) 671-7174 165 Court Street ET, Contact Dental Customer Care for eligibility/benefits and claims inquiries, Contact By: Give our Customer Care team a call at 1-800-234-4781 and we will help connect you to the support you need. An adjustment amount may appear on your next Monthly Health Statement or Explanation of Benefits. All rights reserved. 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. Monday - Friday: 9 a.m. - 4:30 p.m. Y0028_8830_C. Community Memorial, Oneida Healthcare, Rome Hospital, Contact Customer Care for eligibility/benefits and claims inquiries, Contact By: Monroe County (14020, 14423, 14428, 14464, 14468, 14470, 14514, 14546, 14559, 14605, 14606, 14612, 14613, 14615, 14616, 14617, 14621, 14622, 14624, 14626), PHYSICAN PRACTICES: (518) 561-2243 (option 5, then option 3) Inpatient mental health is hospital-based treatment. CR-02A - Non-Physician Health Care Practitioner Recredentialing. All rights reserved. You can view this report online at www.dfs.ny.gov/consumers/health_insurance/health_insurance_complaint_rankings or use the addresses below to request a printed copy: * If requesting by email or mail, please provide Your Name, Address, City/State/ZIP. See our Privacy Policy for how we use information. Once the federal government runs out of its supply of treatments, however, what you pay will be based on the terms of your health insurance plan. If you are currently in treatment with your PCP, we can make the change effective on the date of your request. Please note: Medicare cost information may be found at CMS.gov fee schedule search tool. If you would like to appoint a representative to act on your behalf, give Customer Service that person's name. What policies do you offer for people who don't receive health insurance coverage through an employer? How can I file a claim? Refer to the, Membership/Enrollment Application or Documentation. View and order your member card. Excellus BlueCross BlueShield Eagan, MN 55121, Excellus BlueCross BlueShield - Group The IDREs determination is binding on us and the provider. 165 Court Street 214 South Warren St., 1st Floor, Phone - 1-877-726-4727 This rating has decreased by -2% over the last 12 months. 333 Butternut Drive 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. 14 Durkee Street, Suite 250 Medicaid Managed Care, Essential Plan, Health and Recovery Plans (HARP) and Child Health Plus will cover certain brands of over-the-counter tests at no cost until further notice. What you pay for COVID-19 related medical and pharmacy care may change once the public health emergency ends on May 11, 2023. Website - www.samhsa.gov. Because we're focused on your health and well-being, our team of nurses, social workers, respiratory therapists and mental health coaches are here to support you. 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. The negotiation period must be open for 30 days. Eagan, MN 55121. Find a doctor, estimate medical cost and track your deductible and spending. Phone - 1-877-846-7369 Links marked with an (external site) icon indicate you're leaving the Medicare portion of ExcellusBCBS.com. To access your member services, please visit your BCBS company. 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. What if I disagree with the denial of my claim? Excellus BlueCross BlueShield If you are deaf, hard of hearing, or have a speech disability, dial 711 for TTY relay services. Health Insurance Plans for Excellus BCBS Providers. We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. You may also submit your grievance or request for appeal in writing. Heather.Ducot@excellus.com, COVERAGE AREA: If you would rather speak to us directly, please contact our Customer Service department at the number listed on the back of your Member card. P.O. Stop by our walk-in customer service units if you'd like to visit us in-person. Take a Tour | Download App We're Here For You Select a method below to get started: Email Call Mail Visit Quick Links Print Forms Give permission to access your health information Crisis Services Find a Doctor or Find a Dentist Telehealth / Telemedicine We use cookies and other technologies to optimize site functionality, analyze website traffic, and share information with social media, advertising, and analytics partners. Your doctor must also agree to provide us necessary medical information related to your care and adhere to our policies and procedures, including those for assuring quality of care, obtaining preauthorization, authorizations, and a treatment plan approved by us. Chiropractic, HOSPITALS: Follow this link to Order a Member Card Online. Utica Business Park If you have paid PPE charges to a Health Plan participating provider, you should contact the provider and obtain a refund. The information you're accessing may not be provided by Excellus BCBS. DME Vendors (Local and National), Lab Vendors (Local and National), Oral Surgery, Skilled Nursing Facilities; Physical/Speech/Occupational Therapy, Kristin Korniat Give permission to access your health information. Box 21146 Register for an Online Account View your member card View benefits and coverage, including copays and coinsurance costs Estimate medical costs and check drug prices View claims and track your spending (deductible and out-of-pocket costs) Choose to go paperless for available documents Almost all of the physicians in the area participate with us, so you have a large network from which to choose. Quality Care Thats Right for YouWhether you need a routine check-up or a specialty procedure, you want the best care you can find. Insights, information and powerful stories on how Blue Cross Blue Shield companies are leading the way to better healthcare and health for America. Tips & Tricks. Rochester Regional Health System (Hospitals and all physicians, regardless of ZIP code), Dione Ashman Connect at a Resource Center Our Resource Centers offer personalized assistance in a friendly, welcoming atmosphere. The website includes a Directory of Services and links to New York state government resources. Do not pay any bills received from your provider while a surprise bill is being evaluated. We use cookies on this website to give you the best experience and measure website usage. ET Utica Business Park, 12 Rhoads Drive Member Discounts Take advantage of member-only discounts on health-related products and services. Certain plans may also ask members to pay some costs for the administration of the vaccine. Links marked with an (external site) icon indicate you're leaving ExcellusBCBS.com. How may I estimate potential out-of-pocket expenses for an out-of-network service? The information provided is intended to help educate members, not to replace the advice of a medical professional. Do you need to send us documentation, including membership forms or correspondence? Call 1-800-920-8889 accepting responsibility for the outcomes of your decisions. Log in and use the Enrollment & Inquiry Support tool to send all inquiries to our Enrollment team. Your physician may want to meet with you to evaluate and discuss the appropriate care for you. Call our Customer Care team at 1-800-234-4781 to schedule an appointment. Learn more about the. Optometry, Ophthalmology, Optical, SOUTHERN TIER SPECIALTY PROVIDERS: Website - www.oasas.ny.gov/hopeline, SAMHSA - an Agency of the U.S. Department of Health & Human Services Excellus BlueCross BlueShield is an HMO plan and PPO plan with a Medicare contract. BY APPOINTMENT ONLY The 24/7 Nurse Call Line is a service provided to our members to support their relationship with their health care providers. Our representatives will respond within four business days.

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