CareFirst BlueCross BlueShield - Frequently Asked Questions
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Frequently Asked Questions - BlueChoice Opt-Out Plus

The Frequently Asked Questions below refer to the BlueChoice Opt-Out Plus health plan. If this is not your plan, please return to the FAQ Home Page.


Appeals and Complaints
What is the procedure for lodging a complaint against a provider?
How do I appeal a certification or authorization denial?
How do I appeal a claim payment or denial?
Is there a procedure for handling an urgent or emergency appeal?
My Explanation of Benefits says I received services that I did not have. What should I do?

Approvals and Referrals
What services require prior approval or a referral?
How do I get prior approval or a referral?
What if I don’t get prior approval or a referral?
When do I need a referral from my PCP?
Do I need a referral to see an obstetrician or gynecologist (OB/GYN)?
How do I know which specialist I can use? Can I use any specialist in the CareFirst BlueChoice Provider Directory?

Claims
How do I file a claim?
How long do I have to file a claim?
A provider has billed me; how do I know how much of the bill to pay?
How can I check the status of my claim?
What is the difference between deductibles and copayments?
How does my out-of-pocket maximum work?
What is Coordination of Benefits (COB)?
Why did I receive a Coordination of Benefit questionnaire? Do I have to return it?

Emergency Care
What do I do in case of an emergency?
Do you cover emergency care?

Enrollment
How can I cover my newborn from birth?
How do I obtain coverage for my newly adopted child?
How do I add or delete coverage for family members?
How often can I change benefit plans?

General Information
What happens to my coverage if I quit my job or I'm laid off or fired?
What happens to my coverage if I turn 65?
What happens to my coverage if I retire?
Is my child covered while in college?
How do I obtain a copy of my Certificate of Coverage?
What if I become disabled?
What happens to my coverage if I move out of the area?
What if my spouse and I divorce?
Can I cover a dependent who lives out-of-state or is away at school?
Do I have coverage for pre-existing conditions?
How long can my children remain covered?
How long can my child be covered if he or she has disabilities?

ID Cards
How do I order additional ID cards?
Do I need to carry my ID card with me at all times?

ID Number Conversion to Non-SSN
Why is CareFirst replacing my identification (ID) number?
What will my new number look like?
Will my dependents receive new ID numbers as well?
Will I receive a new ID card?
Will CareFirst still use my Social Security number?
What if I live in a state where legislation banning the use of Social Security numbers has already been passed?
Does my doctor know to use the new number when submitting my claims?
If I submit my own claims, what number should I use?
Should I show my new ID card to my doctor?
What should I do when I receive my new ID card?

Member Services
How do I get additional information about my plan or benefits?
How do I change my name or address?
What are your Member Services hours?

Pharmacy
What is the difference between generic and brand name drugs? How does that difference affect my benefits?
Can I get reimbursed for drugs I got from a pharmacy not in the network?
How do I get prescriptions filled through a mail order pharmacy?
If I am going to be out of town for an extended time, how do I get an extra supply of drugs to cover me through that period?
What is a Formulary (or preferred drug list) and how does it affect me?
How do I get a list of preferred drugs (Formulary information)?

Physicians and Other Providers
How do I find a network provider?
What is a primary care physician (PCP)?
What are the advantages of using network providers?
How do I know if my doctor is a CareFirst BlueChoice primary care physician (PCP)
What happens if my current physician is not a network provider?
How do I change my primary care physician (PCP)?
Can I change my PCP any time I want?
What if a primary care physician cannot see me right away?
Can I go to a non-network provider?
What if a network provider isn’t available to treat my condition?

Travel Coverage
What routine coverage do I have while I am traveling?
What emergency coverage do I have while I am traveling?

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Serving Maryland, the District of Columbia and portions of Virginia. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueChoice, Inc., an affiliate company, also offers health benefit products and services on this site.

CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. are independent licensees of the Blue Cross and Blue Shield Association.

® Registered trademark of the Blue Cross and Blue Shield Association. ®' Registered trademark of CareFirst of Maryland, Inc.