CareFirst BlueCross BlueShield


840 First Street, NE
Washington, DC
Telephone: (202) 479-8000

Web site: www.carefirst.com

Key Staff
General Manager – David Wolf
Medical Director – Jon Shematek, MD
Director of Provider Relations – Bruce Edwards
Government Relations – Julie Hatton

Other Contacts
General Company Information – Jeffrey Valentine
Grievance/Appeals Procedures – Lisa Kraus
Quality Improvement – John Shemetak, MD
Pharmacy Benefits – Winston Wong, PharmaD

Specialized Health Care Services
Service In-House Contracted
Mental Health X- Magellan Behavioral Health
Pharmacy Benefit Mgmt. X X- Argus Health Systems
Vision Care X- Davis Vision
Dental Care X- The Dental Network
Disease Mgmt. X- First Help
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO
Individual X
Small Group (2-49 Employees) X X
Large Group (50+ Employees) X X
Administrative Services Only (ASO) X X

 

Network Providers Under Contract (numbers are combined HMO/PPO)
Network Providers HMO PPO PAR
PCPs 4631 6692
Physician Specialists 18843 23974
Hospitals 72 78
OB/GYNs 1015 1110

 

Enrollment (as of January 31, 2007)
Standard HMO 35145
Point-of-Service (POS) 37873
PPO 137985
Indemnity 3135

 

Virginia HMO Service Area:
Counties
Arlington, Fairfax, Loudoun, Prince William

Cities
Alexandria, Fairfax, Falls Church, Leesburg, Manassas, Manassas Park