It is not a bill, and you should not send any payment to us (if there is a balance listed, the health care provider will notify you of your responsibility). What do I do when my specialist asks if I obtained a referral for my service? You can help! For the most up-to-date provider listings, call the Find a Doctor Support Line at 1-800-821-1388 or visit Find a Doctor & Estimate Costs. Where can I learn more about a particular prescription drug? A PCP must be noted for services to be covered and paid. The network includes a comprehensive listing of doctors in a wide variety of specialties. What is my deductible and has it been met? Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. If you are a Blue Choice member, you should have a PCP on our records, even though you may wish to see providers who are not in the network. New ID cards are issued whenever benefits change. What is the Pharmacy & Therapeutics Committee? If you were insured through Blue Cross Blue Shield of Massachusetts for all 12 months of the tax year, the "Full Year Coverage" box is checked off. If you have a pharmacy benefit, you will need to identify your pharmacy benefit administrator in order to determine your copayment for each medication you receive. Who Do I Call if I Have a Question About a Referral? Medical policy statements contain conclusions about whether a technology, procedure, treatment, supply, equipment, drug or other service improves health outcomes for the health plan's population and therefore is covered or not covered. You might want a PCP with a particular subspecialty, such as gastroenterology or cardiology, or perhaps you want a PCP who is affiliated with a particular hospital. All forms were mailed by January 31, 2020. The questions below will help you understand the Form 1099-HC, which indicates the months you had health insurance coverage that meets the minimum creditable coverage (MCC) standards set by the Commonwealth Health Insurance Connector during the previous year. Plus, you can receive your medications through the mail, at home, or at work, postage paid, within 14 days of mailing your prescription. You can call Blue Cross And Blue Shield Of Massachusetts at (617) 246-5000 phone number, fill out a contact form on their website, or write a letter to 101 Huntington Avenue, Suite 1300, Boston, Massachusetts, 02199, United States. These television and magazine ads have raised people's awareness of new drugs, resulting in a rapid increase in the number of requests for expensive, brand-name prescriptions. It was developed by doctors and pharmacists after careful evaluation of clinical studies to determine which medications are most effective, safe, and maximize cost savings. With a comprehensive understanding of your medical history and conditions, your PCP will be your partner in everyday, preventive care, as well as the coordinator of any specialized care you may need. For more information, visit Health Care Reform. The protection of your privacy will be governed by the privacy policy of that site. This might be the result of your employer's decision or a change in Massachusetts law. Select a location. We rely on a trusted network that includes a wide range of specialists to carry out your treatment plan. By continuing to use this website, you consent to these cookies. Available 24 hours a day, 365 days a year. Your PCP knows your history and overall health, so he or she is best qualified to help you decide if you should see a specialist. Individuals with Medicare supplemental insurance or replacement plans won't receive a Form 1099-HC. No. Blue Cross and Blue Shield does not offer incentives to limit your care. What should I do if I want to see a specialist? The principle mission of the committee is to ensure that our members have drugs covered, or made available on an exception basis, that meet their needs and achieve desired treatment goals. Blue Cross Blue Shield of Massachusetts does not offer incentives to limit your care. Customer Care Representatives are available Monday through Friday from 7 a.m. to 9 p.m. Eastern Time, and Saturday & Sunday from 8 a.m. to 6:30 p.m. Eastern Time. What do I do if I disagree with a decision that Blue Cross Blue Shield of Massachusetts made? Contact Empire Blue Cross And Blue Shield customer service. ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-472-2689 (TTY: 711) ។. Your PCP will work with you to explore all the available options and make sure your medical needs are met. However, the following are instances when you do not need a referral: Blue Choice members have the option to self-refer at a higher level of out-of-pocket costs for any other covered service. Talking with a PCP can also help you understand what's involved with specialty care if you need it. The name of your pharmacy benefit administrator (e.g., Express Scripts, Inc.) is printed on the back of your member ID card on the bottom of the card. Students who are dependents on a parent's insurance plan will need information contained on the 1099-HC form to complete their income tax returns. Does my plan cover routine physicals and immunizations? If there is an alternate address on the policy, the 1099-HC form will be mailed to the alternate address. Your subscriber certificate will tell you what services are covered. Some examples of independent clinical labs include Quest Diagnostics and LabCorp. For example, if your plan does not cover prescription drugs you will be responsible to pay for the medications your doctor prescribes. P.O. Your network includes a comprehensive listing of doctors in a wide variety of specialties. (HMO Blue New England, Blue Choice New England, Blue Care Elect, and our indemnity products do not cover this benefit.). If you lose your card and need a replacement, simply create an account or sign in to MyBlue to request a new card online, or call Member Service. Box 52057 Your Form 1099-HC, which you'll receive from Blue Cross via mail and your MyBlue account, will indicate which months in 2019 you had a Blue Cross Blue Shield of Massachusetts health insurance policy. Your ID card contains valuable information, including phone numbers and copayment amounts, so be sure to read both sides carefully. No. What are the special features of being a member (for example, health club reimbursement and discounts on complementary medicine services)? I'm a Blue Cross Blue Shield of Massachusetts member, but I live outside of Massachusetts. If you don't receive your form by the first week of February, please call Member Service using the number on your ID card. If you need routine care (checkups, vaccinations, etc.) Free for all members, MyBlue gives you access to exclusive wellness tools that help you live healthy. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-472-2689 TTY: 711 ). A referral is required by your HMO health plan before the plan will cover certain services. Generic and brand-name drugs must meet the same FDA standards for safety, purity, strength, and effectiveness. Then you can find a PCP in one of three ways: Yes. Why should I use an independent lab or freestanding imaging center? Your copayments are usually a fixed dollar amount (for example, $10, $20, or $30) you pay each time you use a particular medical service or fill a prescription. You can obtain a Provider Directory for your plan by calling, You can also call our Physician Selection Service at, Ask your doctor to refer you to a non-hospital provider, Call Member Service at the number on your Blue Cross ID card, Refer to the Diagnostic Tests and Imaging Centers section in your health plan Provider Directory, Electronic capabilities (e.g., electronic medical records, electronic prescribing, and web consultation). You won't receive a form if you: If you still have questions about whether you're eligible or excluded, please refer to your tax advisor or the Massachusetts Department of Revenue or call 1-800-392-6089. Pittsburgh, PA 15230-1590, Report Fraud To check if a certain drug is under review and not yet covered, call the Member Service number on the front of your ID card. The liability is determined by the procedure(s) performed as well as the outcome or diagnosis determined at the visit. Drugs generally require prior authorization in cases where the patient must meet certain medical-necessity criteria. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. 1099-HC forms will be issued to subscribers of Blue Cross Blue Shield of Massachusetts and will list spouse and dependent information. What do I do when I get a survey asking about my other health insurance? For assistance, please call Member Service at the number on the front of your ID card. Please see your plan sponsor for details. If you have questions about how any patient balance was determined, you can create an account or login to view your account or check your member literature to determine coverage, including any applicable deductible, copayment, or co-insurance that might apply. Our representatives are trained to help resolve any problems or concerns you may be having. Create an account or sign in to MyBlue to view your Summary of Benefits online. Do I have coverage for eye exams under my plan? If you or a family member is having a life-threatening emergency, call 911 or your local emergency care service and get help immediately.