Things to Consider After Enrolling in a Plan

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  1. Help is available:

    If you have questions about your benefits, or would like to voice a complaint, please call the number on the back of your member ID card and we will be happy to help.

    If needed, simply request a translator and one will be provided to assist you in understanding your benefits.

  2. Having a primary care physician is a good decision:

    Although most plans we administer do not require you to have a primary care physician, it is a good idea to establish a relationship with one.

    Having a primary care physician has many benefits, including:

    • Seeing a physician who knows you and understands your medical history
    • Having someone you can count on as a key resource for your healthcare questions
    • Help when you need to coordinate care with specialists and other providers

    Typically, primary care physicians specialize in family medicine, internal medicine or pediatrics. Find a physician in your area by visiting Find a Doctor.

  3. Seeing a specialist or behavioral health provider is easy:

    If you need to see a specialist or behavioral health provider, you can contact their office directly to make an appointment. If you choose to see a specialist or behavioral health provider in our BlueCard® PPO or Blue Choice® Behavioral Health networks, you will have in-network benefits for services covered under the plan. If you choose to see an out-of-network specialist or behavioral health provider, your benefits could be lower. Please refer to the plan's Benefit Booklet to determine the plan's out-of-network coverage.

  4. Utilization Management helps lower healthcare costs for all:

    We use Utilization Management (UM) to monitor the appropriateness of healthcare services to our members and to help you get the most out of your healthcare dollars. Our UM program involves review of services before, during and after the services are performed.

    The four procedures that make up our Utilization Management program are:

    • Pre-service – evaluation of services or supplies prior to them being rendered
    • Concurrent – evaluation of services or supplies made while you are in the process of receiving care
    • Post-service – evaluation of services or supplies after they have already been received
    • Appeals – the right to dispute a decision we have made

    For additional information on Utilization Management, including how to appeal a decision, please review the plan's Benefit Booklet.

  5. Receiving medical care:

    Even if your plan does not cover an expense or service, you and your physician are responsible for deciding whether you should receive the care or treatment.

    Generally, after-hours care is provided by your physician. They may have a variety of ways of addressing your needs. You should call your physician for instructions on how to receive medical care after the physician's normal business hours, on weekends and holidays, or to receive non-emergency care for a condition that is not life threatening, but requires medical attention.

    If you are in severe pain or your condition is endangering your life, you may obtain emergency care by calling 911 or visiting an emergency room.

  6. Your privacy is important to us:

    The protection of our members' medical and personal information is a top priority. We take our commitment seriously and have strict privacy policies addressing our members' protected health information (PHI). Each employee must complete training on the policies and sign a privacy acknowledgment form binding them to follow those policies and procedures. All vendors who use PHI must adopt similar procedures to maintain privacy. Also, we have safeguards in place to protect your electronic information.

    View our HIPAA Privacy Notice. If you would like a printed copy, please call the number on the back of your member ID card.