HomeMy WebLinkAboutBlue Shield EPO and Gold PPO Out of Area CoverageEasy access to
coverage – nearly
everywhere
blueshieldca.com
If you’re away from home,
the BlueCard Program travels with you.
The BlueCard® Program gives you and your family
access to covered services when you’re away from
home. With 80% of providers in the United States in
BlueCard’s national network, and providers in more
than 200 countries in the BlueCard Worldwide®
Network, you have access to care wherever you go.
Using BlueCard is easy. When you receive care from a BlueCard provider in
the United States, you:
• Simply show your Blue Shield ID card
• Do not have to complete any claim forms
• Do not have to pay up front for medical services, except for your usual
out-of-pocket expenses (deductible, copayment, coinsurance,
non-covered services)
• Receive an Explanation of Benefits from Blue Shield
How it works
For PPO, POS, or Active Choice Plan members
If you’re a PPO (including Preferred Savings Plan), Point of Service (POS), or
Active Choice®* plan member, you may use the BlueCard Program for access
to covered benefits except dental and vision care, and prescription drugs.
For more information on covered services, please refer to your Evidence of
Coverage (EOC) or Certificate of Insurance (COI) booklet or call the Customer
Service number that appears on your Blue Shield ID card.
You will need to get prior authorization for certain services, including inpatient
surgeries, hospital stays, and outpatient surgeries. Your EOC or COI booklet shows
services requiring prior authorization. A BlueCard provider may complete this
process on your behalf. If a provider does not obtain prior authorization for you,
contact the Customer Service number on your Blue Shield ID card for help.
* Active Choice plans, as well as some PPO and PSP plans, are underwritten by
Blue Shield of California Life & Health Insurance Company.
For HMO plan members
HMO plan members have coverage for emergency and urgent care services,
or authorized medical follow-up care, when they are out of their HMO service
area. In case of a life-threatening emergency, go immediately to the nearest
medical facility, and then get the necessary authorization when it’s possible for
you to do so.
For more information on all covered services, please refer to your EOC booklet,
or call the Blue Shield Member Services number on your ID card.
Finding a provider
Locating a BlueCard provider wherever you are is easy, too. Just go to
blueshieldca.com/findaprovider, and select the Providers Outside of California
link. This takes you to the BlueCard Doctor and Hospital Finder on the BlueCard
Program’s website. Or you can call BlueCard at (800) 810-BLUE (2583), seven
days a week, 24 hours a day.
Please note that you can choose to visit any provider and are not required
to access covered services through a BlueCard provider. However, if you see
a provider who’s not in the BlueCard Program, you may be responsible for
a higher share of costs. A non-BlueCard provider may require full payment
at the time of service. Plus, you may have to submit the claim yourself, since
non-network providers aren’t obligated to submit claims on your behalf.
Claims and payments
Your claim will be paid directly to the local participating BlueCard provider.
We’ll send you an Explanation of Benefits, which details what Blue Shield paid
on your behalf. If you get care from a BlueCard provider, you don’t need to
send us your bill.
If you have any questions, go to blueshieldca.com, log on to I’m a Member,
select the I’ve Had Care tab, and then click Check Claims Status to check
the status of your Blue Shield claim. Or, call the Customer Service number
on your Blue Shield ID card.
An Independent Member of the Blue Shield Association A43405 (5/11) International travel
You can find providers in or near your foreign destinations by going to
blueshieldca.com/findaprovider, and select Coverage Outside U.S. to be
connected to BlueCard Worldwide. Or you can call the BlueCard Worldwide
Service Center at (800) 810-BLUE (2583) from within the United States. If you’re
already outside the country, call collect at (804) 673-1177. In the event that there
are no BlueCard providers in the country you’re visiting, go to any provider, pay
them directly for your healthcare services, and then submit the bill to us
for reimbursement.
If you require inpatient care, call the BlueCard Worldwide Service Center collect
at (804) 673-1177 from outside the country or (800) 810-BLUE (2583) from within
the United States. In most cases, you won’t need to pay up front for inpatient
care at BlueCard Worldwide hospitals, except the out-of-pocket expenses you’d
normally pay. You should also contact the Customer Service number on your
Blue Shield ID card to get medical authorization. The hospital should submit the
claim on your behalf if it is a BlueCard provider.
If you’re taking medication and plan to work or travel abroad, we suggest you
obtain a sufficient supply of your regular prescription drugs to last the duration
of your stay. If you need to get medication as a result of emergency treatment
while traveling abroad, you will need to pay for it at that time and then submit
the bill along with your completed international claim form for reimbursement.
Claims
All international claims should be submitted to us within one year from the date
of service. You can download an international claim form at blueshieldca.com
by logging on to I’m a Member and clicking on the Download Forms link under
I’ve Had Care. Please mail your completed claim forms to:
Blue Shield of California
International Claims
P.O. Box 272550
Chico, CA 95927-2550