1. Do I have to use a PPO contracting doctor or hospital?
No, but in order to receive the highest level of benefits, members should use PPO network doctors and hospitals whenever possible. Members can seek treatment from non-PPO doctors and hospitals; however, benefits will be at the non-PPO benefit level and will be subject to usual and customary allowed amounts. Additionally, doctors and hospitals who are not contracted are allowed to balance bill you for fees that exceed usual and customary amounts.
2. How can I find a PPO network doctor or hospital?
You can search the online list of Doctors & Hospitals for information on contracting doctors and hospitals. With it, you can search for PPO doctors and hospitals in your area, or search for a specific doctor by name. You can also print out your search results in a customized report.
3. What if I can’t find a PPO doctor or hospital in my area?
If you are unable to locate a network doctor or hospital in your area using our online Provider Finder® tool, please call Customer Service and a representative can assist you in your search. Your Customer Service number is listed on the back of your ID card.
You can also nominate a doctor for inclusion into the contracting network.
4. What if my doctor is not in the network?
If you do not find the doctor you are looking for you can nominate a doctor for inclusion into the contracting network.
5. What if I am currently undergoing treatment and my current doctor is not contracted in the PPO network?
For associates enrolling for the first time, you may be eligible to temporarily continue treatment with that doctor and receive the in-network benefit level. If you believe that you have a situation which may qualify for this special handling, contact Customer Service by calling the number on the back of your card.
In order to qualify for this transitional benefit, you must contact BCBSIL prior to the start of the new Plan year (by December 31, 2009).
Examples of medical condition that may meet the guidelines:
- Pregnancy (if confirmed prior to January 1, 2010)
- Patients whose hospitalization continues beyond December 31, 2009
- Terminal illness where life expectancy is less than six months
- Chemotherapy/Radiation therapy
- Physical therapy
Examples of medical conditions that would not meet the guidelines:
- Routine care (immunizations, physicals)
- Chronic conditions which are stabilized (asthma, diabetes)
- Minor illness (flu, sprains)
- Elective surgery
6. Do I need to pre-notify for care?
As a member of the medical 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, you do need to pre-notify any inpatient hospital care and certain outpatient hospital procedures. In addition, all infertility services must be pre-notified. If you have further questions about pre-notifying for care, please contact Customer Service by calling the number on the back of your ID card.
7. How do I pre-notify for care?
To pre-notify an inpatient hospital admission, call the number on the back of your ID card and asked to be connected with Utilization Management. The Utilization Management department is staffed with knowledgeable professionals who will help you determine may be the most appropriate and cost-effective way to meet your health care needs and maximize available benefits.
8. What is a medical emergency?
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. If you are in a situation in which you need emergency medical care, go directly to the nearest hospital, immediate care center or doctor.
9. What if I lose my ID card?
If you lose your ID card you can print a temporary card and request new cards through your secure Blue Access® for Members account. You can also order a new card by calling (800) 516-1270.
10. Will my family members receive their own identification cards?
UPS medical plan participants with "member only" coverage are sent one identification (ID) card. Participants with "member-plus-one" or "family coverage" receive two ID cards. If additional cards are needed, you can obtain them by contacting the Group Medical Customer Service Unit using the number on the back of your card. Members can also request additional ID cards by visiting Blue Access for Members.
