Does Blue Cross and blue shield of North Carolina have nurses?
But you don’t have to go through it alone. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is here to help. Our nurse advocates, together with your primary care provider (PCP) and behavioral health providers in our network, are ready to give you the support you need to live your best life.
Does Blue Cross and blue shield of North Carolina cover sleep studies?
Sleep Management Program. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a new Sleep Management Program. The new program will consider the medical necessity of studies and the clinical appropriateness of a facility- or home-based test. Prior authorization will also be required for coverage of any subsequent treatment...
What is Blue Cross NC behavioral health?
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) is here to help. Our nurse advocates, together with your primary care provider (PCP) and behavioral health providers in our network, are ready to give you the support you need to live your best life. Behavioral health is part of your total health, so take good care of yourself.
How do I contact Blue Cross and blue shield of North Carolina?
By mail to Blue Cross and Blue Shield of North Carolina, Healthcare Management and Operations, Pharmacy Exception, P. O. Box 2291, Durham, NC 27702
Can Blue Cross Blue Shield NC be used out of state?
Your ID card gives you access to participating providers outside the state of North Carolina through the Blue Card® Program, and benefits are provided at the in-network benefit level.
What is BCBS of NC timely filing limit?
If you need to submit a claim, please mail it in time to be received by Blue Cross NC within 18 months after the service was provided. Claims not received within 18 months from the date the service was provided will not be covered, except in the absence of legal capacity of the member.
Can I use NC health insurance in another state?
The Short Answer: All plans cover emergency services at any hospital in the United States, regardless of what state plan was purchased from, with the exception of Hawaii.
When a provider is non participating they will expect quizlet?
When submitting a claim for a patient with coverage through more than one BCBS plan: submit a claim for the primary insurance, then submit the secondary claim. When a provider is non-participating, they will expect: full reimbursement for charges submitted.
How do I file a claim with Blue Cross Blue Shield of NC?
Visit BlueCrossNC.com/Claims for prescription drug, dental and international claim forms, or call the toll-free number on your ID card. Important Notes When Completing the Claim Form: Type or use blue or black ink to complete. Complete a separate claim form for each covered family member.
Can I use NC Medicaid in Florida?
Can I use my Medicaid coverage in any state? A: No. Because each state has its own Medicaid eligibility requirements, you can't just transfer coverage from one state to another, nor can you use your coverage when you're temporarily visiting another state, unless you need emergency health care.
Can you have 2 medical insurance policies?
BY Anna Porretta Updated on January 21, 2022. Yes, you can have two health insurance plans. Having two health insurance plans is perfectly legal, and many people have multiple health insurance policies under certain circumstances.
Which is better PPO or HMO?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.
When will Blue Cross NC telehealth visits be paid?
Visits to providers that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits as long as they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020.
Does Blue Cross cover OON?
Blue Cross NC and ASO groups will cover vaccine administration fees for out-of-network (OON) providers during the public health emergency. Current federal regulations prohibit any provider from balance billing patients for the COVID-19 vaccine.
Does Blue Cross NC waive coinsurance?
Blue Cross NC will waive member cost-sharing (including deductibles, copayments, and coinsurance) for allowed charges for COVID-19 testing or for a doctor visit or call to determine if testing is necessary. Specifically, there will be no member cost-share for COVID-19 testing or clinical visits to determine if testing is needed through virtual care visits, outpatient office visits, urgent care visits or ER visits. These changes are in line with the federal coronavirus relief package approved and signed into law on March 18, 2020. We continue to encourage the use of virtual visits as the first step to seeking testing. For guidance on COVID-19 testing, please visit the CDC website.
Who can coordinate your care with your PCP?
Behavioral Health Providers. Behavioral health providers – including therapists, psychologists, psychiatrists and addiction counselors – can coordinate your care and their treatment with your PCP. You don’t need a referral from your PCP to seek help, though it helps to keep them informed. Blue Cross NC Nurse Advocates.
What is a PCP?
Your PCP is your total health manager, helping you decide what care you need and connecting you to that care. With the tools we provide, PCPs can better identify issues, understand when your physical health is being affected and help other providers with their knowledge about you. Behavioral Health Providers.
Does Quartet offer Blue Cross?
Quartet is solely responsible for the services it is providing. Quartet does not offer Blue Cross or Blue Shield products or services. EAP is a confidential voluntary, work-based program that offers free counseling for work related and/or personal problems. Ask your employer if there's an EAP program where you work.
Is behavioral health part of total health?
Behavioral health is part of your total health, so take good care of yourself. And please reach out if you need support. Your team is ready and waiting. Explore this page to learn about ways to get help and what you can do to stay healthy in both body and mind.
Sleep Management Program
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will implement a new Sleep Management Program. The new program will consider the medical necessity of studies and the clinical appropriateness of a facility- or home-based test.
Sleep Management Program Resources
Get more information on this program, worksheets, and medical policies (Blue Cross NC Commercial plans only) at http://aimspecialtyhealth.com/marketing/gowebsleep
What is residential treatment?
A residential treatment facility is a 24-hour facility that is not a hospital, but which offers treatment for patients that require close monitoring of their behavioral and clinical activities related to their psychiatric treatment, eating disorder, or to their chemical dependency or addiction to drugs or alcohol. These programs are comprehensive and address potential symptoms/behaviors and incorporate psychotherapeutic treatments and education through a multidisciplinary team approach. The treatment plan is individualized and intensive, offering individual therapy, family counseling, group therapy, and recreational activities. The program will generally offer a prolonged after-care component and facilitates peer support. The patient must meet medical necessity criteria for admission into a residential facility.
Does BCBSNC cover residential treatment?
BCBSNC will provide coverage (subject to benefit limitations) for Residential Treatment when it is determined to be medically necessary because the medical criteria and guidelines shown below are met.
Can BCBSNC request medical records?
BCBSNC may request medical records for determination of medical necessity. When medical records are requested, letters of support and/or explanation are often useful, but are not sufficient documentation unless all specific information needed to make a medical necessity determination is included.
Where to mail a fax to Blue Cross and Blue Shield of North Carolina?
By fax (visit the website above for fax form and numbers) By mail to Blue Cross and Blue Shield of North Carolina, Healthcare Management and Operations, Pharmacy Exception, P. O. Box 2291, Durham, NC 27702. By telephone at 1-800-672-7897.
How long does Blue Cross NC extend the time period?
Blue Cross NC may extend this period one time for up to 15 days if additional information is required and will notify you and your provider before the end of the initial 15-day period of the information needed and the date by which Blue Cross NC expects to make a decision.
What is EOB in insurance?
Information on Explanation of Benefits (EOBs) An EOB is a statement an issuer sends the enrollee to explain what medical treatments and/or services it paid for on an enrollee's behalf, the issuer's payment, and the enrollee's financial responsibility pursuant to the terms of the policy.
What is an out of network provider?
Out-of-Network: Services from health care providers who don't have a contract with your plan will usually cost you more than those received from an in-network provider. Out-of-Pocket: The total amount that you will pay during a policy period before your plan begins to pay at 100% of the allowed amount. This limit may include copayments and deductibles. It does not include your premium, charges over allowed amounts, or services that are non-covered.
What is medical necessity?
Medical necessity is used to describe care that is reasonable, necessary, and/or appropriate, based on evidence-based clinical standards of care. Prior authorization (prior review) is a process through which an issuer approves a request to access a covered benefit before the insured accesses the benefit.
How long does it take for Blue Cross to respond to a request?
You will have 45 days to provide the requested information. As soon as Blue Cross NC receives all the requested information, or at the end of the 45 days , whichever is earlier, Blue Cross NC will make a decision within three business days.
How long after a cesarean section is a prior review required?
However, prior review is not required for an emergency or for an inpatient hospital stay for 48 hours after a vaginal delivery or 96 hours after a Cesarean section.
How do doctors negotiate the price of treatment?
Physicians negotiate the price of treatment with health insurers. The health insurance company sets the rates that it will pay the doctor. Insurance companies may also include quality metrics that doctors must meet to get full reimbursement. Insurers set rates, but that doesn't mean that the physician has to agree to these rates.
Why do doctors stop taking insurance?
Many doctors don't take some types of health insurance and some even don't accept any insurance. Doctors may stop taking insurance if they believe the health insurance company isn't offering enough compensation. If a doctor stops taking your health insurance, you have a few avenues, including asking if the doctor will take a reduced fee ...
Why are insurance companies denying claims?
Insurance companies are denying claims and making it harder for doctors to accept patients in their plans by lowering reimbursements. Consequently, lots of doctors are dropping plans," says Lily Talakoub, MD, FAAD, a board-certified dermatologist in McLean, Virginia.
What is direct primary care?
Direct primary care is one type of program in which the patient and health care providers sets up a finacial arrangement. Direct primary care removes health insurance from the equation. So, the provider doesn't file health insurance claims, but instead works directly with the patient.
What to do if your doctor is out of network?
"If your physician is outside of your insurance network coverage, ask if they will submit an out-of-network claim as a courtesy to you," Talakoub says. "If not, ask if they will provide documentation that can help you submit a claim yourself with the necessary paperwork and documentation attached."
Does direct primary care include a monthly fee?
That may include a monthly fee and/or a membership fee. The benefit of direct primary care is that you may like not dealing with health insurance companies. However, you may also have to pay more for care since a plan is no longer helping you pay for coverage.
Do doctors have to accept insurance?
Yes, doctors aren't required to accept health insurance plans or the rates that insurance companies decide to pay doctors. The Affordable Care Act looked to improve health insurance access, but it didn't resolve the issue of rising costs and lower reimbursements offered by some payers. Many choose not to work with particular insurers ...