Frequently Asked Questions

No, but in order to receive the highest level of benefits, you should use PPO network doctors and hospitals whenever possible. You 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.

You must present your ID card so your doctor knows you are eligible to receive medical benefits. The front of the card includes your name, group number, Rx group number and a unique identifier (not your social security number). The back of the card includes pre-certification requirements and the Customer Service number.

Contact the Customer Service Unit at 1-866-563-8366 to request a replacement ID card. Members can also obtain replacement ID cards by logging in to Blue Access for Members^SM.

Prior to any scheduled inpatient hospitalization and within two business days of an emergency or maternity admission, you must call Blue Cross and Blue Shield for Pre-admission Utilization Review at 1-866-563-8366 which is available 7 a.m. to 6 p.m., Central time, Monday – Friday. This call can be made by:

• The member
• The doctor
• The hospital
• Family or friends of the patient

Benefits may be reduced if the Pre-admission Utilization Management call is not made within the appropriate time frame.

In an emergency, seek immediate attention. While you should always try to access care from a network facility, in some cases it is not feasible. Regardless of whether you access a network or non-network facility, contact Customer Service within two days of an emergency hospital admission.

If you use a contracting PPO doctor or hospital, the doctor or hospital will file the claim for you. If you use a non-PPO doctor or hospital, you may have to pay at the time of service and file a paper claim form for reimbursement.

Search the online list of Doctors and Hospitals for information on contracting doctors and hospitals. You can search for PPO doctors in your area, or search for a specific doctor by name. You can also print out your search results in a customized report.

You will receive an Explanation of Benefits (EOB) after your claim has been processed. The EOB will provide details of what was covered, the level of coverage, and the amount you owe, if any. You can also check claim status via Blue Access for Members^SM.

Please contact your local Human Resources Representative to report any change in family status or an address change.