July 29, 2025
Waivers granted to members receiving out-of-state care beyond the border counties of Wisconsin, Iowa, Missouri, Kentucky and Indiana will be subject to review and discontinuation if in-state care is available.
If we granted you a waiver for in-network coverage beyond the border counties, those approved services will be re-evaluated when there is a change in treatment level or differing stages of care. If an in-state, in-network provider is available during review, we will direct members to those in-state, in-network providers.
Here’s one example of a waiver use scenario:
- If a member has an approved waiver to get care in an inpatient setting outside Illinois or its contiguous counties, the approved waiver applies only to that inpatient setting.
- Before the member moves to an outpatient or other treatment setting outside Illinois or its contiguous counties, they would need a new approved waiver, even if they remain under the care of the same doctor or provider.
- An approved waiver for care by that provider would expire if and when the treatment setting changes.
If a member requests and receives an approved waiver, be sure to let us know if any of the follow happen:
- The treatment plan or the level of care changes.
- The doctor or facility that orders the care changes.
- The date of the service changes or is canceled.
How to request a waiver:
- Out-of-state providers should call customer service at BCBSIL at 800-538-8833 to request a waiver.
- In-state or out-of-network providers should request a waiver by submitting a Referral request in Availity® Essentials. You can access the request in the main navigation menu under Patient Registration.
Learn more about our program, which began Jan. 1, 2025, for members with Blue Choice Preferred PPOSM and MyBlue Plus POSSM plans purchased on or off the marketplace exchange. Remember this program does not apply to members with coverage through employer groups.
More information: Check members’ eligibility and benefits through Availity Essentials or your preferred vendor prior to rendering services or recommending care.
To find in-network care, check our provider directory.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to Blue Cross and Blue Shield of Illinois. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors.