Frequently Asked Questions

The copays below apply to members who are in the Health Benefits for Immigrant Adults and Seniors (HBIA/HBIS) program.

• Nonemergency inpatient hospitalizations: Up to $250 copay.

• Ambulatory Surgical Centers and Outpatient Services: Up to 10% of the Medicaid payment. The amount members can be charged will vary. It depends on the service. Providers will tell members what they will be charged before they provide service. 
  

Log in to your Blue Access for Members℠ account to access your digital member ID card. You can request a new ID card or print a temporary one. You can also call Member Services at 1-877-860-2837 (TTY/TDD: 711) to ask for a new ID card. The call is no cost to you. It may take up to two weeks to get a new card. 
 

If you need to update or change your address, contact the State (the Department of Healthcare and Family Services). To change your address, call HFS at 1-877-912-8880, Monday to Friday, from 8 a.m. to 6 p.m. The call is no cost to you. BCCHP can only receive changes on your address directly from HFS.

Yes, if they are listed in the Preferred Drug List (PDL). The PDL is a list showing the drugs that are covered by Blue Cross Community Health Plans℠ (BCCHP). Restrictions may apply to some drugs. Learn more about Drug Coverage for BCCHP and for HBIA/HBIS.

Please Note: Prescription drug benefits are not covered for Managed Long Term Supports and Services (MLTSS) plan members. MLTSS members should contact their Medicare Part-D plan for prescription coverage.

The drug list (sometimes called a formulary) is a list showing the drugs that can be covered by the plan. The drugs listed will be covered as long as you:

• Have a medical need for them
• Fill the medication orders at an in-network pharmacy
• Follow the other plan rules

Check the Preferred Drug List . It contains more FAQs about your Rx coverage.

Usually only drugs on the PDL are covered. If the plan does not cover your drug, you have a couple options:

• Talk to your provider to decide if you can first try a drug on the PDL.
• Call Member Services to ask for an exception to cover your drug. Send a statement from your doctor to back up your request. 

You must choose a primary care provider (PCP) when you join the plan. There's also a wide selection of specialists to choose from. You can use the Provider Finder^® to find a doctor or hospital online. You can also check providers listed in the Provider Directory . Call Member Services at 1-877-860-2837 (TTY/TDD: 711) for help to find a provider. 

A provider that is contracted with BCCHP to provide services to members. They are also called a participating provider. BCCHP does not pay for services from out-of-network providers unless you receive prior authorization for those services.

A PCP is your personal doctor who will give you most of your care. They know your medical history and present state of health. Knowing this helps your PCP make the best decisions when you need medical care. They may send you to other providers if you need specialty care. With BCCHP, you can pick your PCP. You can have one PCP for your whole family or you can choose other PCPs for each family member.

You can change your PCP by logging into Blue Access for Members. Go to My Health > Find Care. Under your provider information, click on “Change Provider.”

You can also, call Member Services to change your PCP. We can be reached at 1-877-860-2837 (TTY/TDD: 711). The call is no cost to you. 

There is no limit on how many times you can change your PCP. 

• If you ask to change your PCP anytime during the month, you may go to your new PCP within 30 days of getting your request for change.
• You’ll get a new member ID card with your PCP’s information on it. You can go to your newly assigned PCP prior to receiving your new member ID card.
• If your PCP is not-in-network or is no longer accepting patients, your request may not be approved by BCCHP. 

Certain services must be approved by BCCHP. This approval is called a "prior authorization." If approval is not obtained, those services will not be covered. Check your Blue Kit Member Handbook for a list of services that need approval. To ask for approval, you or your provider must call BCCHP. Providers know which services need approval. They can handle the details for you. 

Yes. You can get a second opinion for any procedure or treatment. Your doctor can recommend a specialist. You or your doctor can also call Member Services for help. 

No. However, make sure the specialist is in the BCCHP network. Also, confirm that the services are covered before you make an appointment. If not, you will be responsible for costs of treatments that are not covered. Even if you don’t need a referral for some specialty care, you may need prior approval. Ask your PCP. They are the best person to coordinate your medical care, including visits to a specialist.

An emergency is a sudden medical condition with severe symptoms, including intense pain. Without immediate medical help, your health and life could be in danger. Examples of emergency health issues:

• Stroke 
• Shortness of breath or severe trouble breathing
• Severe vomiting or diarrhea
• Drug or alcohol overdose
• Severe injuries, broken bones
• Heavy bleeding
• Chest pain
• Having thoughts of harming self or others 
  

Services received in an emergency room (ER) or other trauma centers must meet the definition of “emergency” to be covered. You do not need prior approval for emergency services. Care received in a doctor’s office or urgent care facility are not considered emergencies. Check your Blue Kit Member Handbook for guidelines on emergency care coverage. 

BCCHP wants to make sure you get proper care in an emergency. Here’s what you need to do:

• Call “911” or other community emergency resources for assistance in emergency situations.
• Go to the nearest hospital or trauma center.
• Call Member Services within 48 hours of hospital or trauma center admission. We can be reached at 1-877-860-2837 (TTY/TDD: 711). The call is no cost to you.
• Call your PCP as soon as reasonably possible after getting emergency treatment. They will help arrange for follow-up care.

If you have an unexpected medical situation, call the Nurseline at 1-888-343-2697. A nurse can help you decide if you should call your doctor, visit the ER or urgent care, or treat the problem at home.

You can get a ride to a provider’s appointment, pharmacy or a BCCHP-sponsored event at no cost. Just make sure to request your ride at least 3 days in advance. BCCHP does not cover rides for non-medical reasons, except to BCCHP sponsored events. Get more details on how to schedule a ride on the Transportation page. 

A parent or caregiver may ride with children or members with special needs. If you are a member who is a single caregiver, and you have more than one minor child in your care, you can ask Member Services to approve transportation for additional minor children. Caregivers or other children must be approved by BCCHP when the ride is scheduled.

Yes. You may pre-schedule a return ride if you know what time you will be done. If you pre-schedule your return ride, the driver should come within 30 minutes. If you do not have a pre-scheduled pick-up time, call ModivCare at 1-877-831-3148 when you are done with your visit. The driver should come within an hour of the call.

You may use either the ModivCare app or the Mileage Reimbursement Trip Log .

Follow the instructions on the Trip Log to submit a request.

Search “ModivCare” on either Google Play^® or the Apple App Store^® to download the ModivCare app. Make sure to have an email address handy to create your account. You will need to add a driver by calling ModivCare to complete your first trip. You can reach ModivCare at 1-877-831-3148.

To add a new driver, you must call ModivCare to schedule the first trip. The driver information will be added by a representative.

Yes, members may be eligible for reimbursement if they drive themselves to an appointment. If you have not already, you must call ModivCare to be added as a driver.

You can check on the status using the app or by calling ModivCare at 1-877-831-3148.

Once approved, a check will be mailed to the preferred address within 14 days.