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What is the Preferred Medical Doctor (PMD) Program?
The Preferred Medical Doctor program allows you freedom of choice when selecting a doctor, outpatient facility or hospital. This program is often referred to as Preferred Care and its enhanced benefits provide a very high level of coverage for you and your family's health care needs. With PMD, many services are covered in full with no deductible required. These include:
The following preventive lab and diagnostic tests are also covered:
What will I pay for a physician visit when I use a PMD physician?
Blue Cross and Blue Shield of Alabama provides excellent benefits for physicians office visits. After you make a $25 copayment for the office visit, Blue Cross reimburses the doctor 100% for the services you receive when visiting a Preferred Provider.
If the physician you see is not one of the over 9,000 Preferred Providers, you still receive an excellent reimbursement of 80 percent of the Usual, Customary and Reasonable charge after your Major Medical deductible is met. Surgical and diagnostic services are covered at 100% UCR with no deductible if you do not use a Preferred Provider.
What is my Major Medical deductible?
When you visit a Preferred Provider, there is no deductible required. The University's major medical deductible is $200 with a maximum of three per family each year.
What is the Baby Yourself Program?
A program offered by Blue Cross and Blue Shield of Alabama to ensure your baby and you receive the best possible care during your pregnancy. There is no cost to you when you participate. With this program you have a registered nurse monitoring your pregnancy and making sure you and your baby have everything you need for good health. This benefit is particularly important for high-risk pregnancies. When you find out you are pregnant, you should contact the Baby Yourself program by calling 1 800 222-4379.
What kind of coverage do I have for accidents?
What kind of coverage do I have for prescription drugs?
What if I'm out of town and cannot find a Participating Pharmacy?
If you do not use a Participating Pharmacy, you have reduced coverage. You have the same copays and prescription drug deductible that you would at a Participating Pharmacy, but the drugs are covered at 75% after you pay the copay and have met the deductible. You must file the claim and we will pay you. You will also pay any difference above the amount we would pay a Participating Pharmacy. Over 97 percent of the pharmacies in Alabama and over 38,000 nationally are Participating Pharmacies.
What is Individual Case Management?
This is a benefit that offers alternatives to lengthy hospitalizations and is designed to provide the patient with the best environment for recovery and the most cost effective long term arrangement. A Blue Cross and Blue Shield of Alabama registered nurse monitors your care and makes sure you are in the best environment possible for recovery. All decisions are made with the consent of the patient, family and physician.
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