CareFirst BlueCross BlueShield


10455 Mill Run Circle
Ownings Mills, MD 21117

Member Services:  (410) 581-3660
Web site: www.carefirst.com

Key Staff
General Manager – Chet Burrell, President & CEO
Medical Director – Jon Shematek, MD, Chief Medical Officer
Provider Relations – Bruce Edwards, SVP, Networks Management
Government Relations – Colleen Chichester, VP, Govt. Affairs

Other Contacts
Grievance/Appeals Procedures – Lisa Kraus, RN, VP, Care Management
Quality Improvement –  Ann Doyle, Dir., Clinical Innovations
Pharmacy Benefits – Arif Khan, Sr. Dir., Pharmacy Operations
Provider Contracting – Stacey Breidenstein, VP, Provider Contracting

Specialized Health Care Services
Service In-House Contracted
Mental Health X- Magellan Health Services
Pharmacy Benefit Mgmt. X- CVS CareMark
Vision Care X- Davis Vision
Dental Care  X
Disease Mgmt.  N/A
Utilization Mgmt. X

 

Market Segment
Market Segment HMO/POS PPO Medicare Advantage
Individual X 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
Physician Specialists
Hospitals
OB/GYNs

 

Enrollment (as of January 31, 2017: 197,812)
Standard HMO
Point-of-Service (POS)
PPO
Indemnity

 

Virginia HMO Service Area:
Counties
Alleghany, Arlington, Caroline, Carroll, Fairfax, Fauquier, Loudoun, Montgomery, Prince George, Prince William, Spotsylvania and Stafford, Sussex, Washington

Cities
Aldie, Alexandria, Annandale, Arlington, Ashburn, Baileys Crossroads, Bealeton, Brambleton, Bristol, Broadlands, Burke, Centreville, Chantilly, Clifton, Dale City, Dulles, Dumfries, Dunn Loring, Fairfax, Fairfax Station, Falls Church, Fredericksburg,  Gainsville, Great Falls, Haymarket, Herndon, Kingstowne, Lake Ridge, Landsowne, Leesburg, Lorton, Lovettsville, Manassas, Marshall, McLean, Middleburg, Montclair, Nokesville, Oakton, Occoquon, Potomac Falls, Purcellville, Quantico, Reston, Rosslyn, South Riding, Spotsylvania, Springfield, Stafford, Sterling, Stone Ridge, The Plains, Tysons Corners, Vienna, Warrenton, Waterford, West McLean, Woodbridge