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Highmark ppo blue faq

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What kind of preventive care is covered? Are there limitations on that care, such as the number of visits per year? Maximums ó Are there limits on how much the plan will pay for your care? Health Savings Account ó To enjoy the tax advantages of a Health Savings Account, should you consider enrolling in a qualified high-deductible health plan?

There are lots of things you can do to improve your health, become an educated health care consumer and help control health care costs. With more providers than competitive plans, chances are good that your current physician and hospital are part of our extensive provider network.

Find a Doctor, Hospital or Medical Provider to see if your provider is in our network. Your PPO Plan has you covered no matter where you are. As a Highmark member, you enjoy all the services of BlueCard Worldwide.

Your coverage travels with you through a worldwide network of care providers. For more details, please ask your local Highmark Direct health insurance store associate.

To help make health insurance more affordable, the government offers two types of financial help to eligible households - depending on your household income and other factors. If you qualify, a Premium Tax Credit may be applied in advance to lower what you pay in monthly premiums on any Health Insurance Marketplace plan.

The amount of a Premium Tax Credit is based mostly on family size and income. Cost-Sharing Reductions CSR will lower your out-of-pocket costs that you may pay at the time of service for doctor's visits, lab tests, drugs and other covered services. You can only get these savings if you enroll in a Marketplace Silver Metal Level plan. Visit your local Highmark Direct store or Healthcare.

If your plan does not have set copays, services will be subject to your in-network deductible. This does not include any services not covered by your plan. Your premium depends on the plan you select. Your premium is the amount you pay each month for your health insurance. A Highmark Direct health insurance store licensed associate will be able to walk you through plan options to help you understand your benefits and find a plan that fits your needs.

Your deductible or coinsurance depends on the plan you select. Your copay, if any, depends on the plan you select and if you are seeing your primary care physician or a specialist. Prescription drug coverage varies based upon your health insurance plan.

If you are current Highmark member and have questions regarding your medication costs, please contact customer service reference the back of your ID card for contact details or if you are shopping for insurance, speak to an associate at your local Highmark Direct health insurance store for more information.

Once you have this information, you can contact member service for the medical procedure cost. We offer a standalone dental policy through United Concordia. At this time, we do not offer a standalone vision plan, however vision is included in most of our policies. If you have specific questions, please contact your local Highmark Direct health insurance store. Please note: Short Term coverage does not cover pre-existing conditions. There are many services that are eligible as part of your preventive benefits package.

Eligibility of services will be based on age, gender, and when the last service date was. It is best to contact member service at the time of your visit with a list of services that your health care provider will be performing or check the Preventive Schedule on our website.

Under the Affordable Care Act ACA , health insurance plans must provide coverage for adult dependents under age 26 on their parents' policies. Your number of visits depends on your selected plan. Gym memberships are not a covered benefit under the terms of your health insurance policy.

However, you may be entitled to receive a discount through our member wellness discount program. Would you like to view these online or schedule an appointment? Enter your starting address. Enter your zip code to continue. Please select your county to continue. You have selected the store. Would you like to schedule an appointment at this location? For accommodations of persons with special needs at meetings call and TTY may call There is no obligation to enroll. Call your local Highmark Direct Retail Store or click the link above to schedule an appointment.

What can I do at a Highmark Direct health insurance store? Current and potential Highmark plan members meet one-on-one with a store associate to: Learn about plan options Compare and shop for plans Enroll in a plan Make payments Receive help with health care tasks, such as scheduling appointments, finding a provider and transferring medical records Resolve medical billing issues Engage in other store services You also can attend free programs and seminars on healthy living and Medicare.

Our plan options include: Highmark Medicare Advantage plans , including private health insurance Part C , standalone prescription drug coverage Part D and Medigap supplemental insurance Individual and family plans Other insurance, such as travel and dental insurance How much time should I expect to spend at my appointment?

What is a Highmark Direct health insurance store? We offer many convenient options in-store to help answer your customer service questions: In-Person Customer Advocates -- We now offer in-store customer service at all of our Highmark Direct health insurance store locations. A Customer Advocate can help answer your customer service inquiries. Connect with a customer service rep from one of customer service walk-in centers to have your questions answered.

Log into your Highmark Member website. To access your site, select the service region noted on your member ID card. Do I need a referral for any services?

Why do I need health insurance coverage? When selecting a health care coverage plan, you will want to research specific details about the plans you are considering, including: Covered services ó Most plans cover doctor visits, hospital stays, surgery and emergency care. Exercise, eat right, maintain a healthy weight and control stress. Enroll in wellness classes to help you meet your goals. Select a provider by researching their credentials, their service costs and their quality performance ratings.

Get your preventive care, so a condition can be treated before it becomes serious. Be sure to discuss possible medication side effects and interactions with your doctor and your pharmacist and keep both of them informed of all the medications you take. Research treatment options. Talk to your doctor about alternative treatments to determine the option that is appropriate for you.

Learn about tests, procedures, surgeries and their costs, so you can communicate more effectively with your doctors. Ask your doctor to prescribe generic drugs when possible. Review your Explanation of Benefits EOBs to make sure the services you received are listed correctly.

Track your health care spending. Use this information to choose health care coverage that suits your needs and budget. Read information about health topics and stay informed about changes in the health care industry. Do I qualify for financial assistance? Do you offer Dental and Vision coverage? Is it included in your plans? Member Login Contact Us Privacy.

Cancel Submit. The ZIP code you entered is outside the service areas of the states in which we operate. If you have any concern that the person calling you is not with BCBSIL, ask the caller for a number you can use to call us back. You may have received this error message during your registration for a number of reasons. Many times, the information you entered may not have matched the data in our system. Please remember to have your group and member ID numbers handy when you register.

Both of these numbers can be found on your welcome letter and your member ID card. Register now. If you would like to receive available Spanish communications, you can log in to your Blue Access for Members account, go to the Settings tab and choose Preferences. You can also call the customer service number listed on your member ID card. Customer Service will record your preference. We also have the following tools available to meet the Spanish language preference of our members:.

In most cases, you can only sign up for a health insurance plan during the open enrollment period. If you missed open enrollment, you may be able to enroll during the special enrollment period. To be eligible, you must have had a qualifying "life event" within the past 60 days or experienced other complications that did not allow you to complete your enrollment. Learn more about special enrollment. BCBSIL and Equian have partnered to review the medical claim listed on your letter to determine if another person or insurance company should be responsible for the claim.

The claim we are investigating may be for treatment you received from an injury experienced at work or from an auto accident. The information we are requesting is important.

It could help to get back money that should be paid by someone else, like another insurance carrier. Call the number on the letter to answer the claim question. Here are convenient ways you can pay your bill. We sincerely apologize for our error in drafting your bank account twice for your premium payment.

This occurs when we have two active policies for you in our system, which pulled your records twice when the automated drafts were processed. Call our billing office at to report this so we can correct the error in our system, if we haven't already, so this will not happen again. We will mail a refund check for the overpayment amount within 5 days of correcting the error. If you don't see it soon, please give us a call.

In addition, if you had overdraft fees as a result of the double billing, please call our billing office so we can refund these charges as well. We cannot process a cancellation request for a Marketplace plan. If you want to cancel your Marketplace plan, you can call the Marketplace at If you want to cancel our off-Marketplace plan, we can process that cancellation for you. Call Customer Service at You can also log in to your Blue Access for Members account and send us a secure email message.

A policy will also automatically be cancelled for nonpayment if you don't pay the premium. This may be your best option. You would simply pay the premium for the plan you want to keep and not pay the premium for the plan you want to cancel. Log in to your Blue Access for Members account from a desktop or mobile browser for more information about benefits, claim status and more.

A Health Maintenance Organization HMO is a type of health plan that gives you access to certain doctors and hospitals that have contracted with the HMO, often called a provider network or just network. An HMO is different from other health care plans in a number of ways:. Be sure the doctor you select is accepting new patients. You must have a primary care physician assigned.

If you don't select your own, we will assign one to you. No, you do not need a referral. However, if the specialist is not in your plan's network, in most cases, you may have to pay for services that are considered out-of-network. If your doctor is not in the network, you will need to select a new primary care physician PCP. In an emergency, go directly to the nearest hospital.

For non-emergencies, some HMO plans allow you to get health care services from a Blue Cross and Blue Shield-affiliated doctor or hospital when you are traveling outside of Illinois. If you aren't sure, contact customer service at the number listed on your member ID card before you go. It contains helpful information for accessing health care at home or away. If you or a covered family member will be temporarily living outside Illinois for 90 days or more, you may be eligible for guest membership in a Blue Cross and Blue Shield-affiliated HMO.

In some circumstances, moving can also qualify you to be able to enroll in a new plan in your new location. You can call the customer service number listed on your member ID card to find out if your plan covers you when living outside Illinois and to discuss all your options.

We'll work with you to provide coverage for the most appropriate care for your medical situation, especially if you are pregnant or receiving treatment for a serious illness. You may still be able to see your current provider for a brief time. If you are already seeing a specialist for your condition, make sure your doctor is in your plan's network.

If the doctor is not in your plan's network, you will pay more in most cases. Also make sure your specialist uses providers and facilities in your plan's network when sending you for other services or hospitalization. If you have any questions, call us at the customer service number listed on your member ID card. If you are looking for a doctor for your chronic condition, you can use the Provider Finder tool. Click on "Network Type" at the top and select the name of your HMO plan to see a list of doctors and hospitals in your plan's network.

Not all drugs are covered. You can visit our website to view the list of prescriptions your plan covers. This list is called a preferred drug list. To look for your medicines, you will need to know:. While costs can vary depending on your benefit plan, you usually pay less for generic drugs and more for brand name drugs. Your plan may cover some of the costs of drugs not on your preferred drug list. You can learn more by looking in your benefit book, or calling the customer service number listed on your member ID card.

You can call the customer service number listed on the back of your Blue Cross and Blue Shield of Illinois BCBSIL member ID card to make sure the right email and mobile number is linked to your account or to change your contact preferences. Or you can use our online form to update your preferences using your member ID number. Because your account includes private health and financial information, we pledge to keep your account information safe.

It is an extra step, and that can be annoying. But you will have the option to check a box when entering the one-time verification code that will allow you to skip the verification steps on that device for 30 days.

For security reasons, it isn't part of our member accounts system. We've updated Blue Access for Members to give you a better experience, so the website address you saved may have changed. To access the new Blue Access for Members website, go to mybam. In order to process this payment, you will be redirected to Alacriti's secure payment site, OrbiPay. Welcome Employers Producers Providers. Breastfeeding Counseling. Sign Up or Login.

I Have a Question About Membership. How can I learn more about my benefits? Are my medical records kept private? Has my coverage started?

Can I use my health plan? I need to get a prescription filled but don't have my member ID card yet. What can I do? I applied on the Health Marketplace, but haven't heard if my application has been received and accepted. Did my coverage start on the effective date I requested? When will I get my member ID cards, and how many will I get?

I received my member ID cards in the mail but they only have my name on them and not my spouse's. Can I get another ID card with their name on it? When will I get benefit coverage information and the contract on the plan I selected?

I've gotten a call from someone asking me questions about my new coverage. We are calling to: Explain how your plan works Answer questions you may have Tell you about some of the services we offer to help manage your care and your coverage We also check to make sure the information we have is correct, such as the names of everyone on your plan, your address and other details.

When will it be available for me to register? What communications are available in Spanish? We also have the following tools available to meet the Spanish language preference of our members: Spanish language website ó Browse health plans, get information on member services and tips for using your health insurance.

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Highmark Blue Cross Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association. Highmark Blue Cross Blue Shield serves the 29 counties of western . Mar 4, †∑ Freedom Blue PPO is a Medicare Advantage Preferred-Provider Organization that gives you coverage for every need - health, prescription drugs, routine dental, vision, hearing Missing: faq. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Blue Cross Missing: faq.