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If you would like to review the procedure for filing an appeal, visit carefirst. For a printed copy, call Member Services at the telephone number on the back of your member ID card. In addition, many members have a right to an independent external review of any final appeal or grievance decision. Refer to your Evidence of Coverage for more specific information regarding initiating an external review, a final appeal determination or a complaint.
If you need language assistance or have questions, call the Member Services telephone number on the back of your member ID card. Get a Quote. Skip Navigation. Login Register. Have questions about health insurance? Explore our Insurance Basics pages. Need Insurance? Log In or Register. Insurance Basics. We know healthcare can be complicated. To learn more, choose a topic from the list below. Expand All Collapse All Covered benefits. All of our plans include core health benefits, including: Office visits Maternity and newborn care Prescription drugs Laboratory tests and X-rays Preventive and wellness care Dental and vision for children under age 19 Emergency services Hospitalization Behavioral health and substance use disorder Physical, speech and occupational therapy.
Common non-covered benefits. Finding a primary care provider. Finding a specialist, behavioral health or hospital resource. After office hours or emergency care. Out-of-area care and benefit coverage. How to submit a claim. You can submit your claim one of two ways: Mail your claim form To print and mail your claim form, log in to My Account, select the My Documents tab, choose Forms. Choose the form for your type of claim and fill in the required information.
Then, mail the form using the directions included. If you do not have internet access, you may request a paper claim form by calling Member Services at the telephone number on the back of your member ID card.
Submit your claim form online CareFirst also offers online claims submission for medical, dental and behavioral health claims. From your computer or mobile device, log in to My Account and select Claims. Enter the requested information, upload the required documents and submit.
Understanding the review process. The medical review process includes, but is not limited to: Preservice review The preservice review serves as a check to assure that members receive the right service in the right setting at the right time. Requests for review include high-cost, complex inpatient, experimental, cosmetic, and outpatient services. The preservice review also helps ensure services are provided by in-network providers. Your doctor must initiate your authorization request.
All admissions are reviewed and categorized by severity level. The urgent review process continues until the member is approved to go home. Concurrent review decisions are made within 24 hours. Post-service review Members may be eligible for a post-service review. CareFirst collaborates with facility administrators, medical clinicians and members to determine needs based on medical criteria and member benefits. Decisions must be made within 30 calendar days of the initial request.
Pharmacy procedures. Generics are dispensed when available unless your provider determines that a brand-name drug is necessary for your overall health.
There may be cost-sharing implications for choosing non-preferred brand medications when generics are available. You should always check with your doctor to make sure a generic alternative is right for you.