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BCN Advantage Provider Directory information

These online directories provide a list of BCN Advantage's network providers. To get detailed information about your health care coverage, please see your Evidence of Coverage.

You will have to choose one of our network providers that are listed in these online directories to be your Primary Care Physician (PCP). The term "PCP" will be used throughout these directories. Generally, you must get your health care coverage from your PCP. Your PCP is a physician who meets state requirements and is trained to give you basic medical care. You will get your routine or basic care from your PCP. Your PCP can also coordinate the rest of the covered services you need. In most cases, you must see your PCP to get a referral before you see any other health care provider. For some types of referrals to plan specialists, your PCP may need to get approval ahead of time from BCN. This is called prior authorization.

The "network providers" listed in these directories have agreed to provide you with your health care coverage. You may go to any of our network providers listed in these directories; 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 as long as your care is coordinated through your PCP. Your PCP will provide most of your care and, when needed, refer you to a specialist who will provide care for the duration of the referral. Individual referrals are not needed for each visit to the specialist. In most instances, you need to coordinate your care through your PCP; however, there are limited circumstances in which you do not:

  • In the event of an emergency, call 911 or go directly to an emergency room.
  • For mental health or substance abuse treatment, call the BCN Advantage behavioral health unit at 1-800-431-1059. TTY users should call 1-800-430-3211.
  • For routine gynecological services, women may see any participating physician or OB/GYN.

Before selecting a physician, check the directory or call the provider to see if he or she is accepting new patients. If there is a particular BCN Advantage specialist or hospital that you want to use, check first to make sure your PCP makes referrals to that specialist, or uses that hospital. Those physicians that speak another language besides English will have that other language noted in their online profile.

If you get a bill from a non-plan provider

We cover certain health care services you may get from non-plan providers, including:

  • Care for medical emergencies
  • Urgently needed care
  • Renal dialysis that you get outside the BCN Advantage service area
  • Care that has been approved in advance by Blue Care Network
  • Any services that were ordered covered through an appeals process

If a non-plan provider asks you to pay for covered services you get in these situations, please contact us at:

BCN Advantage HMO-POS
P.O. Box 68753
Grand Rapids, MI 49516-8753

You should never pay a non-plan provider more than what the plan is allowed by Medicare. The provider has a right to get his or her fees, but does not have the right to get them from you. Ask the non-plan provider to bill us first. If you have already paid for the covered services, we will reimburse you for our share of the cost. If you get a bill for the services, you can send the bill to us for payment. We will pay your non-plan provider for our share of the bill and will let you know what, if anything, you must pay.

Emergency medical care can always be obtained in or out of the service area from the nearest available provider. When in the service area you must use plan providers for urgent care. When out of the service area urgent care may be obtained from the first available provider. In addition, when out of the service area you can obtain dialysis treatment from any qualified dialysis provider. If you obtain routine care from out-of-network providers neither Medicare nor BCN Advantage will be responsible for the costs.

What is the service area for BCN Advantage?

The counties in our service area are listed below: Alcona, Allegan, Antrim, Arenac, Barry, Bay, Branch, Calhoun, Cheboygan, Clare, Clinton, Crawford, Eaton, Genesee, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ingham, Ionia, Iosco, Isabella, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Lapeer, Livingston, Macomb, Manistee, Mason, Mecosta, Midland, Missaukee, Monroe, Montcalm, Montmorency, Muskegon, Newaygo, Oakland, Oceana, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, Sanilac, Shiawassee, St. Clair, Tuscola, Van Buren, Washtenaw, Wayne and Wexford.

How do you find BCN Advantage providers in your area?

These directories list BCN Advantage providers nearest to the address that you provide in the search so you can find primary care physicians and specialists in your community.

If you have questions about BCN Advantage or require assistance in selecting a PCP, please call Customer Service at 1-800-450-3680, 8 a.m. to 8 p.m. seven days a week. TTY\TDD users should call 1-800-430-3211. Click the button at the top of this page to go to our online provider search.

You may also call BCN Advantage customer service to obtain a printed directory for any area that you request.

Ancillary Providers

Behavioral health and substance abuse
Your BCN Advantage behavioral health and substance abuse benefits are available without a referral. BCN care managers are available 8 a.m. to 5 p.m. Monday through Friday for routine care issues and 24 hours a day, seven days a week for behavioral health emergencies. When you call, you'll speak to a care manager who will evaluate your needs and arrange for the appropriate services. You can call 1-800-431-1059 (TTY 1-800-430-3211) to:

  • Obtain information about your behavioral health or substance abuse benefits
  • Get help in an emergency
  • Obtain a referral for mental health or substance abuse services
  • Request a different therapist

Dental care
Your dental care is provided by Blue Cross Blue Shield of Michigan. To find a provider near you, call the Customer Service number on the back of your ID card 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Certain services are available 24/7 through our automated telephone response system. You may also use our online provider search tool by visiting www.mibluedentist.com. Search for PPO dentists in the BCN Advantage network.

Hearing care
Your hearing services are provided through our expanded BCN Advantage audiology network. To find a provider near you, check the specialist listings in this directory under Audiology, call BCN Advantage Customer Service or click the button at the top or bottom of this page to go to our online provider search.

Vision care
If your plan includes vision coverage, VSP is your vision care provider. VSP doctors are conveniently located in retail, neighborhood, medical and professional settings, and many offer early morning, evening and weekend hours. To find a VSP provider near you, call the Customer Service number on the back of your ID card 8 a.m. to 8 p.m., Monday through Friday, with weekend hours Oct. 1 through Feb. 14. TTY users should call 711. Or go to www.vsp.com.

Fitness
If your plan includes fitness coverage, SilverSneakers® is your fitness provider. To find a participating location near you, call 1-866-584-7352 from 8 a.m. to 8 p.m. Eastern time, Monday through Friday. TTY users should call 711. Or, visit www.silversneakers.com.

Transportation
If your plan includes transportation coverage, your non-emergency transportation services are provided through the BCN Advantage transportation vendor. To schedule transportation, call 1-888-803-4950 from 8 a.m. to 8 p.m. TTY users should call 711.

Durable medical equipment
BCN Advantage works with Northwood Inc. to supply your outpatient durable medical equipment, as well as your prosthetic and orthotic appliances. Your PCP or specialist is responsible for determining your need for this equipment. He or she will write a prescription for the equipment, and you must have the prescription filled at a Northwood-affiliated provider.

In general, durable medical equipment is covered only when appropriate for use in your home. Coverage is provided for the basic equipment or appliances and for any medically necessary features prescribed by your physician. For services that exceed the basic benefit and quantity limitations, your PCP or specialist may need to document medical necessity. You may contact BCN Advantage Customer Service if you have any questions or concerns about benefit coverage. Members who qualify only for basic services but wish to receive items deemed deluxe or not meeting medical necessity criteria may pay the difference between the provider's charge and Northwood's allowed maximum.

To locate the Northwood-affiliated provider nearest you, call 1-800-667-8496, 24 hours a day, seven days a week. TTY users should call 1-800-611-0735. If you have additional questions regarding equipment services, please call BCN Advantage Customer Service.

Diabetic supplies
If you require diabetic supplies, including insulin pumps, blood glucose monitors, test strips and lancets, you will get your items through the J&B Medical Supply Company network of providers. Your physician will write a prescription for the diabetic supplies you need. To locate a J&B provider near you, call J&B Customer Service at 1-888-896-6233 from 8 a.m. to 5 p.m., Monday through Friday. TTY users should call 711.

Outpatient lab services
BCN Advantage uses Joint Venture Hospital Laboratories (JVHL) as its outpatient lab services provider. To locate a JVHL affiliated provider near you, call 1-800-445-4979, 8 a.m. to 5 p.m., Monday through Friday. TTY users should call 711. Or, visit the JVHL website at www.jvhl.org. If you have additional questions about covered lab services, please call the Customer Service number on the back of your ID card.


 

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