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Network Providers

Medicare Advantage plans have network providers. These are the doctors and other healthcare professionals, medical groups, hospitals and other healthcare facilities that have an agreement with us to accept payment and any plan cost-sharing as payment in full. We have arranged with these providers to deliver covered services to members in our plan.

Excellus BlueCross BlueShield provides reimbursement for all covered benefits regardless of whether they are received In-Network, as long as they are medically necessary. However, your out-of-pocket costs may be higher when you use an Out-of-Network provider, except in cases such as emergency care, urgently needed care, or out-of-area renal dialysis.


Network Pharmacies

Generally, you must use network pharmacies to get your prescription drugs covered, except under non-routine circumstances, and quantity limitations and restrictions may apply.

We have network pharmacies outside of our service area where you can get your prescriptions filled as a member of our plan. Generally, we cover drugs filled at an out-of-network pharmacy only when you are not able to use a network pharmacy. Here are the circumstances when we would cover prescriptions filled at an out-of-network pharmacy:

  • If the prescriptions are related to care for a medical emergency or urgently needed care.
  • If you are unable to get a covered prescription drug in a timely manner within our service area because there are no network pharmacies within a reasonable driving distance that provide 24-hour service.
  • If you are trying to fill a covered prescription drug that is not regularly stocked at an eligible network retail or mail order pharmacy (these drugs include orphan drugs or other specialty pharmaceuticals).

In these situations, please check first with our Customer Service Department to see if there is a network pharmacy nearby.

A network pharmacy is a pharmacy that has contracted to participate in our network to provide your covered prescription drugs. Our pharmacy network includes retail, mail order, long-term care, home infusion and Indian/Tribal/Urban pharmacies. The same quantity limitations apply to both mail order and retail pharmacies. To obtain a list of network pharmacies, to find out if your pharmacy is in our network, or to get order forms and information about filling your prescriptions by mail, call our Pharmacy Help Desk toll-free at 1-800-499-2838, (TTY/TDD 1-800-421-1220) 8 a.m. to 8 p.m. Monday - Friday. From Oct. 1 to Feb. 14, representatives also are available weekends from 8 a.m. to 8 p.m. To contact us by mail: Excellus BlueCross BlueShield, PO Box 546, Buffalo, NY 14201.

 

Excellus BlueCross BlueShield contracts with the federal government and is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. .
This page last updated .

Need Help?

Speak with one of our dedicated Medicare Sales Representatives.

Call: 1-800-671-6081
TTY/TDD: 1-800-421-1220
Monday - Friday 8 a.m. - 8 p.m.

From Oct. 1 - Feb. 14, representatives are also available weekends from 8 a.m. – 8:00 p.m.
Need information in a different format?

Call Customer Service toll-free at 1-877-883-9577 (TTY/TDD 1-800-421-1220) 8 a.m. to 8 p.m. Monday - Friday. From Oct. 1 to Feb. 14, representatives also are available weekends from 8 a.m. - 8 p.m.

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