NECA-IBEW FAMILY MEDICAL CARE PLAN FREQUENTLY ASKED QUESTIONS

  1. How do I know that my current provider participates in the BlueCard PPO network or how can I locate a provider in the network?
    You can easily find a participating provider online at www.anthem.com or call 1-800-810-BLUE (2583).  The Anthem web site address and the phone number are located on the back of your new ID card.  You can also call your provider directly and ask if they participate in the BlueCard PPO network.  You can call the Fund if additional assistance is required, at 1-877-937-9602.
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  3. Can participating providers bill me for the difference between what the Blue Plan reimburses and what the provider charges for covered services?
    No.  The participating PPO providers cannot bill you for the difference between what the Blue Plan reimburses and what the provider charges for covered health services.  You are only responsible for the plan copayments, deductible and coinsurance just as you are today.
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  5. What up-front expenses will I be required to pay?
    If you seek services from a participating Blue Cross Blue Shield provider, you are only required to pay your office visit copay.  You are not required to pay for any services up front when using a participating provider.  Please notify the Fund should a participating provider request an upfront payment as we will work with Anthem to ensure the appropriate provider education is completed.
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  7. How do I file my claims?
    Your Blue Cross and Blue Shield provider will file your claims for you to the local Blue Cross and Blue Shield Plan.  Many healthcare providers will file your claims with the local Blue Cross and Blue Shield Plan even if they are not participating in the network.
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  9. How do I file a claim if I elect to use a non-participating Blue Cross and Blue Shield provider?
    The Blue Cross and Blue Shield PPO provider network is extensive with more than 80 percent of the hospitals and nearly 90 percent of the physicians in the United States.  You are encouraged to use a participating provider so that you aren’t required to pay for medical services up front and so that you can take advantage of the Blue Cross and Blue Shield negotiated provider discounts.  Claims must be filed to the local Blue Cross Blue Shield Plan regardless of the provider’s participation status.  If a non-participating provider won’t file the claim for you, you will be responsible for filing the claim.  Assistance with filing the claim will be provided by the Fund.
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  11. Will Fund notify me about how my claim was paid?
    Yes, the Fund will provide you with an Explanation of Benefits (EOB) like we always have.
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  13. Whom do I contact if I have questions regarding my eligibility or benefits?
    You will contact the Fund just as you have in the past.  The customer service phone number (1-877-937-9602) is listed on the back of your member ID card.
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  15. Whom does my provider contact if they have questions regarding my eligibility or benefits?
    Your provider can get eligibility and benefit information by dialing 1-800-676-BLUE.
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  17. How do I receive services for dental and vision?
    Follow the same procedures you do today for dental and vision services.  Your dental and vision providers will not change.
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  19. What services require pre-certification?
    All Inpatient treatment requires pre-certification.  Durable Medical Equipment and Home Health Care also require pre-certification.  American Health Holding (AHH) is our medical management company.  You or your provider should call AHH at the number provided on the back of your ID card, 1-855-586-4517, for pre-certification for any Inpatient treatment, Durable Medical Equipment, or Home Health Care.
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  21. Do I need to have outpatient procedures like MRI’s, Cat Scans, and outpatient surgery pre-certified?
    No.  Most outpatient procedures and outpatient surgeries do not require pre-certification at this time.  However, the trustees may decide to reverse that decision in the near future….they may decide to start requiring that outpatient procedures require pre-certification.  If the trustees decide to start requiring pre-certification for outpatient procedures, they will send a notice to all FMCP employees advising so.
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  23. Is pregnancy for dependent children covered?
    No.  Pregnancy is not covered for dependent children.  Pregnancy and pregnancy-related conditions are only covered for female employees or spouses of employees.
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  25. Is bariatric surgery for weight loss covered?
    No. The plan specifically excludes coverage for obesity, morbid obesity, or any overweight condition, including charges for bariatric surgery.  Bariatric surgery is not covered even if you doctor states that it is medically necessary.