Do I need to pre-notify for care?
As a member of the Network Plan, you do not need to pre-notify for routine care from your doctor, such as when you seek care in your doctor's office. However, notification required prior to all elective admissions. Emergency and obstetric inpatient admission notification required within 2 business days of admittance. Notification required prior to all infertility services. Notification required prior to all Mental Health/ Substance Abuse Services. Failure to notify for infertility services or emergency inpatient admission for Mental Health/ Substance Abuse services will result in a $500 penalty. Failure to notify for outpatient Mental Health/ Substance Abuse services or an inpatient non- emergency admission for Mental Health/ Substance Abuse services will result in no covered benefits.
To pre-notify, call Customer Services at (800) 435-0108 to be connected with the Utilization Management (UM) department. The Utilization Management department is staffed with knowledgeable professionals who will help you determine what is the most appropriate and cost-effective way to meet your health care needs and maximize available benefits.
A medical emergency is generally defined as a medical condition that has symptoms of an injury or illness serious enough to make you, as a prudent layperson with an average knowledge of health and medicine, believe that any delay in seeking care may result in significant impairment or death.
Where can I call if I have questions about my benefits?
If you have any questions about your benefits, contact the Accenture Customer Services at (800) 435-0108.
How much will I pay at the pharmacy?
Your benefit plan is based on a three-tier design which means that your copayment or coinsurance share will be lowest for generic medications or slightly higher for brand name drugs that are on the formulary, and highest for brand name drugs that are not on the formulary.
Yes. The U.S. Food and Drug Administration (FDA) must review and approve generic drugs before they are made available to the public. Plus, generic drugs must have the same active ingredients as their compatible brand name drugs, which have years of testing and clinical research behind them.
The prescription drug formulary is a list of preferred drugs selected by a panel of doctors and pharmacists. The formulary includes all generic drugs and a select group of brand name drugs.
What are maintenance medications?
Maintenance medications are those used on a continual basis for treatment of chronic health conditions.
Am I covered if I travel outside the United States?
As a Blue Cross Blue Shield Plan member, you have access when traveling or working abroad to BlueCard Worldwide® doctors and hospitals in more than 200 countries. Please note, you must use a BlueCard provider, unless it is emergency or urgent care, to receive benefits when traveling outside the United States.
What if my doctor is not in the network?
If you do not find a doctor you are looking for you can nominate a doctor for inclusion into the contracting network.
What should I do if I lose my ID card?
If you lose your ID card you can request a new card on Blue Access for Members.
