NECA-IBEW FAMILY MEDICAL CARE PLAN FREQUENTLY ASKED QUESTIONS
- 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 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.
- 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.
- What up-front expenses will I be required to pay?
If you seek services from a participating Blue Cross Blue Shield provider, you are typically required to pay your office visit copay. You may be required to pay for coinsurance and deductibles.
- 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.
- 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. Click here for more detailed instructions.
- Will the Fund notify me about how my claim was paid?
Yes, the Fund will provide you with an Explanation of Benefits (EOB).
- Whom do I contact if I have questions regarding my eligibility or benefits?
You will contact the Fund. The customer service phone number (1-877-937-9602) is listed on the back of your member ID card.
- Whom does my provider contact if they have questions regarding my eligibility or benefits?
Your provider can get eligibility and benefit information by dialing 1-844-594-0393.
- What services require pre-certification?
All Inpatient treatment requires pre-certification. Durable Medical Equipment and Home Health Care also require pre-certification. Anthem BCBS is our medical management company. You or your provider should call Anthem at the number provided on the back of your ID card, 1-855-343-4852, for pre-certification for any Inpatient treatment, Durable Medical Equipment, or Home Health Care.
Beginning January 1, 2018,except in the case of an emergency, your physician or provider must obtain pre-certification from AIM Specialty Health of all radiology, imaging and cardiovascular treatments and services in order for these benefits to be covered by the Plan. The contact phone number for AIM Specialty Health is 1-855-343-4852.
- 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.
- 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 or complications resulting from bariatric surgery. Bariatric surgery is not covered even if you doctor states that it is medically necessary.