Most health plan members of Anthem Blue Cross of California and Blue Shield of California have access to the BlueCard program that allows them to seek health care services when they are out of their plan area, such as traveling in another state. While emergency services are always covered, the BlueCard Program allows members to seek more routine health care services such as a doctor office visit without getting hit with large out-of-network charges. Even HMO plans can have the BlueCard program benefits.
BlueCard Travel Benefits
The BlueCard Program enables members to obtain Covered Services outside of California, as defined, from a healthcare provider participating with a Host Plan, where available. The participating healthcare provider will automatically file a claim for the Covered Services provided to you, so there are no claim forms for you to fill out. You will be responsible for the Member Copayment and Deductible amounts, if any, as stated in the Evidence of Coverage.
When you receive Covered Services outside of your coverage area and the claim is processed through the BlueCard Program, the amount you pay maybe calculated based on the lower of:
- The billed charges for Covered Services; or
- The negotiated price that the Host Blue health plan.
Often, this “negotiated price” will be a simple discount that reflects an actual price that the Host Blue pays to the Provider. Sometimes, it is an estimated price that takes into account special arrangements with that Provider. Sometimes, such an arrangement may be an average price, based on a discount that results in expected average savings for services provided by similar types of Providers. Estimated and average pricing arrangements may also involve types of settlements, incentive payments and/or other credits or charges.
Crucial to obtaining BlueCard Program services is that members search NOT for local Blue Cross or Blue Shield providers in the state they happen to be in, but that they search the national database of BlueCare Program providers. If you are an Anthem Blue Cross member, you can search through the regular online Find A Doctor search tool but select National PPO (BlueCard) as the network. You can also search the national database directly by going to http://provider.bcbs.com/ or calling 1-888-630-BLUE.
However, certain health care services may need prior authorization or precertification before any subsequent claim for will be honored. Always call the member services telephone number on your member ID card. The providers of the services can also initiated precertification in some instances.
If you are going to be spending an extended period of time outside of your plan area, for work, vacation, or going to college, carefully review your plan’s Evidence of Coverage to make sure the BlueCard Program is part of the covered benefits. I was surprised to learn that both Blue Cross and Blue Shield HMO plans included the BlueCard Program for 2017. But plan benefits can change from year to year, so always read the fine print carefully and follow the rules when using the benefits of the BlueCard Program.