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PPO plans offer out-of-network benefits. EPO plans do not provide out-of-network benefits except for true emergencies. Coordination of benefits COB occurs when a person has health care coverage under more than one insurance plan.

All plans require information from employees and retirees on other coverage that they or their dependents have from another health insurance carrier to determine which plan is primary.

Providers may decide to terminate from a plan network at any time. A provider terminating from a plan is not considered a qualifying event that would allow coverage to be canceled or changed. Employees must wait until the next Open Enrollment period to make any changes to plans. Lexington St. All rights reserved. Why do you donate? Tell us in the comments section! Pages liked by this Page. Baltimore Miler. Washington Mystics. Baltimore Running Festival. Baltimore Ravens.

Facebook is showing information to help you better understand the purpose of a Page. See actions taken by the people who manage and post content. Martin Luther King Day celebrates the life and achievements of Rev. Martin Luther King, Jr. On this day, we give our employees time off to honor Rev. We want all our employees to feel empowered to strengthen their communities and create solutions that move us closer to Rev.

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If the provider does not participate with a BCBS plan, you must pay at the time of service. However, if you visit a non-participating provider or non-participating pharmacy for service, you must submit the claim yourself. You can submit your claim one of two ways:. To ensure you are receiving the most appropriate medication for your condition s , additional information may be required from your doctor before filling certain prescriptions. In those instances, CareFirst will work with you and your doctor to manage the process.

To see whether your drug is excluded or requires prior authorization, step therapy or quantity limits, visit the Drug Search page and select your plan year to find your specific formulary. If the drug does not meet the needs of your particular condition or is excluded from the formulary, your doctor can request an exception with a Prior Authorization Form. To ensure our members have access to safe and effective care, CareFirst reviews new developments in medical technology and new applications of existing technology for inclusion as a covered benefit.

We evaluate new and existing technologies for medical and behavioral health procedures, medications and devices through a formal review process. We also consider input from medical professionals, government agencies and published articles about scientific studies. If you have concerns regarding a decision that adversely affect coverage, such as a denial, a reduction of benefits, or a denial of authorization for services, you may call the Member Services telephone number on the back of your member ID card.

A representative can assist you with resolving the issue or initiating the appeal process. If needed, language interpretation is available. 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. As the largest not-for-profit healthcare company, serving more than 3. From teaming up on after-school programming, gardens and CPR programs, CareFirst and the American Heart Association routinely work together to ensure a healthier you.

One recent example of this enduring relationship is the Greater Maryland Heart Walk, which took place this past October 8. Staged within the historic Maryland State Fairgrounds, CareFirst supported the American Heart Association for the third year in a rowo engage the community about the importance of fundraising, a key to facilitating continued research aimed at preventing and treating heart disease and impacting total health.

According to Dr. Tich Changamire, vice president and chief medical officer CMO of CareFirst BlueCross BlueShield, working in concert with the American Heart Association is an invaluable and highly essential effort to help combat chronic health and heart disease while enhancing total health.

The walking events we stage with the American Heart Association create awareness for heart disease and help encourage people to go out, walk, exercise, and get some fresh air. One critical aspect of this effort is funding. As a condition that knows no boundaries, heart disease can impact anyone regardless of race, gender or ethnicity.

It is inspiring to see an entire community of individuals from diverse backgrounds come together for an event like the Greater Maryland Heart Walk.

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