Blue Cross/Blue Shield of TN
The following local providers will no longer be in the Blue Cross Network S after October 1, 2013:
Chattanooga Surgery Center
Parkridge Medical Center
Parkridge East Hospital (East Ridge)
Parkridge Valley Hospital is NOT affected. Also, not all physician groups housed in Parkridge are affected; please check with BCBST Member Services for inquiries about individual physician and physician groups.
Blue Cross Network S continues to include providers at Erlanger and Memorial. Your health plan allows you to choose any provider for care; however, you will get the most value from your health plan by using providers in-network. If you have questions or need assistance finding in-network providers, contact BCBST Member Service department at (800) 558-6213, Monday through Friday, 8 am - 5:15 pm. BCBST can also help coordinate your care for future treatments, hospital stays or surgeries, by contacting BCBST Member Service Department.
Partnership PPO and Standard PPO
In many ways, the Partnership PPO and Standard PPO are identical. They cover the same types of services, treatments and products. However, there's an important difference between the two options. If you choose the Partnership PPO, you must commit to a partnership promise, and the state will reward you with lower monthly premiums; lower annual deductible; lower pharmacy copays; lower coinsurance; lower out-of-pocket maximum.
Blue Cross/Blue Shield issues two ID cards per household; however, additional cards are available upon request. The cards list the name of the head of contract, so family members use the same card for coverage. Members may request additional cards by phoning (800) 558-6213 or by logging onto the Blue Cross/Blue Shield website and printing a temporary card.
CVS Caremark is the pharmacy benefits manager. Call the CVS Caremark Call Center, open 24/7, at (877) 522-8679 to order a replacement card and for instructions on how to print a temporary card from the Caremark Website. You will be able to use your temporary card until your new card arrives.
Filling a prescription
Use a network pharmacy when filling prescriptions with up to a 30-day supply. The network includes more than 1,600 pharmacies across the state and chain pharmacies such as CVS, Kroger, Publix, RiteAid, Sam's, Target, Walgreens, and Walmart. Many local, independent pharmacies are also in the network.
Use the CVS Caremark Mail Service Pharmacy to fill your 90-day supply prescription or receive a 90-day supply from a participating retail pharmacy store. The mail-at-retail network will be different from the 30-day retail network.
In Network vs. Out of Network Providers
You can see any doctor or go to any health care facility you want. However, if you use an in-network provider, you will always pay less. That’s because an in-network provider agrees to provide services to our members at discounted rates. Non-network health care providers can bill you for any difference between actual charges and the approved amount plus any charges for services deemed not medically necessary or not authorized by BlueCross/BlueShield of Tennessee.
Services requiring copays are not subject to a deductible and do not apply to the annual out-of-pocket coinsurance maximum. Services requiring copays include preventive care (well-baby, well-child visits); adult annual physical; annual well-woman exam; immunizations as recommended by the CDC; primary care and specialist office visits; urgent care facilities; emergency room visit; x-ray and lab; prescriptions.
Some services require that you pay coinsurance after you meet a deductible. Coinsurance is a percentage of the total cost. Typical coinsurance charges include hospital stays; home care; ambulance services; advanced X-ray, scans, imaging; rehabilitation and therapy services.
A deductible is the amount you pay out of your pocket before the plan pays for hospital charges and other services that require coinsurance. It does not apply to services with a copay. Payments toward the deductible count toward the annual out-of-pocket maximum.
Out-of-Pocket Coinsurance Maximum
An out-of-pocket coinsurance maximum is the most you will pay for your deductible and coinsurance each year. It does not include your copays. Once you reach your out-of-pocket maximum, the plan pays 100 percent of covered medical expenses.