Product Disclosures

How to Request Precertification

The following outlines the process providers take to submit requests for precertification of certain services, genetic and genomic tests and specialty drugs administered in an inpatient, outpatient or provider's office setting.

Confirm Requirements

How to Submit

Obtain precertification as follows:

• See the list of services that require precertification
• Precertification for Behavioral Health and Substance Use Disorder conditions are done in conjunction with Magellan HealthCare.
• Call the phone number listed on the member/participant's ID card to reach the utilization review

What You Need

Providers should complete with the Standard Health Care Services form or the DME, Medication and Medical Device form, and be prepared to provide the following information for the request:

• Patient's medical or behavioral health condition
• Proposed treatment plan
• Date of service, estimated length of stay (if the patient is being admitted)
• Patient ID and name/date of birth
• Place of treatment
• Provider NPI, name and address
• Diagnosis code(s)
• Procedure code(s) (if applicable)

Renewal of an existing prior authorization can be requested up to 60 days before the expiration of the existing prior authorization.

Forms should be sent to:

Approval Process

After the request is submitted, the service or drug is reviewed to determine if it:

• is covered by the health plan, and
• meets the health plan's definition of "medically necessary."

The prior authorization is then completed, and the results are sent to the provider.

If you have questions regarding the response, contact the utilization review department at AmeriHealth Administrators.

08/15/2018 - Network Adequacy and Accessibility

While in Connecticut, GeoBlue members have access to Anthem Blue Cross Blue Shield of Connecticut's network of doctors, hospitals and facilities throughout the state via the BlueCard® Program. To review Frequently Asked Questions about their network, please click on the link below

Anthem Blue Cross Blue Shield of Connecticut FAQs

To review how Anthem Blue Cross Blue Shield of Connecticut chooses providers and facilities for their network, please see this document available on Anthem's website describing the criteria used to build their network, including quality of care, the member experience, accessibility and cost.

Anthem Blue Cross Blue Shield of Connecticut Doctor/Facility Selection Criteria

10/15/2018 - Provider Access Notice

You may select primary and specialty providers via electronic access using the provider search tool known as Find-a-Doc. Log on to www.geo-blue.com anytime you're on the web to browse our online provider directory or directly link to the Blue National Doctor and Hospital Finder, which is updated weekly. You can search by languages spoken, specialty, hospital association, and more. Additionally, you can request a copy of the provider directory through a toll-free number (1-855-282-3517).

When you need medical attention when you're traveling, or if you live in another Blue Cross Blue Shield area, you can get a list of doctors and hospitals across or outside the U.S. by calling 1-800-810-BLUE (2583), or by visiting the Blue National Doctor and Hospital Finder.

Service Area

In the event that you cannot find a primary or specialty provider without unreasonable travel or delay from your Connecticut residence, or if the services is not available through a Participating Provider, Covered Expenses for the services of a Non-Participating Provider will be paid according to the in-network benefit schedule. Please call Customer Service at 1.888.412.6403 to notify us in advance, so we can ensure the claim is processed correctly. In the event the claim is not processed correctly, please contact customer service to inform us and we will adjust the claim.

10/15/2018 - Pharmacy Availability & Accessibility Table

Individuals enrolled in a Blue Cross Blue Shield Global Expat plan have access to a pharmacy network while residing in or visiting Connecticut. The adequacy of the pharmacy network in terms of the number of pharmacies and the time in minutes and distance in miles for current insured residents of Connecticut is shown by county in this pharmacy time and distance table.

08/01/2019 - Provider Networks

For any members in Minnesota, members have access to a large network of medical providers in Minnesota established by Blue Cross Blue Shield of Minnesota and available to GeoBlue members insured under a Blue Cross Blue Shield Global product through the BlueCard® program. For a list of providers, which is updated at least monthly, please go to Blue Cross Blue Shield Provider Finder.

Although we strive to have a broad network available to you, if you live in Minnesota and you are unable to find a primary care physician, mental health services or general hospital services within 30 miles or 30 minutes of your residence, or for other health services within 60 miles or 60 minutes, you are eligible to have your out-of-network services paid at the in-network rate.

In the event a network provider is not accessible, please Contact Customer Service at 1.888.412.6403 or +1.610.254.5830, or by email at customerservice@geo-blue.com, to let them know and to ensure that your claims, when submitted, will be paid at the in-network rate.

How to Request Precertification/Preauthorization and View Precertification Statistical Data

For Texas Providers, please follow these procedural guidelines, which outline the steps to be followed when requesting precertification for a GeoBlue member. Within the guidelines you will find when precertification is needed, what documentation is required, and any forms needed to be submitted with your request. In addition, the appeals process is outlined if needed. Also, under the Related Resources section, information on the prior years precertification statistical data can be found.

Have a complaint or need help?

If you have a problem with a claim or your premium, call your insurance company or HMO first. If you can't work out the issue, the Texas Department of Insurance may be able to help.

Even if you file a complaint with the Texas Department of Insurance, you should also file a complaint or appeal through your insurance company or HMO. If you don't, you may lose your right to appeal.

Please see the attached notice for information on how to file a complaint.

Texas Complaint Notification Instructions

¿Tiene una queja o necesita ayuda?

Si tiene un problema con una reclamación o con su prima de seguro, llame primero a su compañía de seguros o HMO. Si no puede resolver el problema, es posible que el Departamento de Seguros de Texas (Texas Department of Insurance, por su nombre en inglés) pueda ayudar.

Aun si usted presenta una queja ante el Departamento de Seguros de Texas, también debe presentar una queja a través del proceso de quejas o de apelaciones de su compañía de seguros o HMO. Si no lo hace, podría perder su derecho para apelar.

Consulte el aviso adjunto para obtener información sobre cómo presentar una queja.

Texas Complaint Notification Instructions

08/01/2018 - Telehealth Medical Service and Telemedicine Medical Services for Texas based Group Plans

In accordance with Chapter 1455 of the Texas Insurance Code, Blue Cross Blue Shield Global Expatriate Health plans provides benefits for covered services that are appropriately provided through Telehealth Medical Service and Telemedicine Medical Services, subject to the terms and conditions of the Plan. In-person contact between a health care Provider and the patient is not required for these services, and the type of setting where these services are provided is not limited. Telehealth Medical Service and Telemedicine Medical Services does not include consultations between the patient and the health care Provider, or between health care Providers, by telephone, facsimile machine, or electronic mail.

Equipment costs and transmission costs associated with Telehealth Medical Service and Telemedicine Medical Services are not reimbursable.

Texas Department of Insurance Notice

• You have the right to an adequate network of preferred providers (also known as "Blue Choice PPO Network"). If you believe that the network is inadequate, you may file a complaint with the Texas Department of Insurance.
• You have the right, in most cases, to obtain estimates in advance:
  • from out-of-network providers of what they will charge for their services; and
  • from your insurer of what it will pay for the services.
• You may obtain a current directory of preferred providers at the following website: www.geo-blue.com or by calling Customer Service at 1.888.412.6403 or +1.610.254.5830 or by email at customerservice@geo-blue.com for assistance in finding available preferred providers.
• If you are treated by a provider or facility that is not a preferred provider, you may be billed for anything not paid by the insurer.
• If the amount you owe to an out-of-network hospital-based radiologist, anesthesiologist, pathologist, emergency department physician, neonatologist, or assistant surgeon, including the amount unpaid by the administrator or insurer, is greater than $500 (not including your copayment, coinsurance, and deductible responsibilities) for services received in a network hospital, you may be entitled to have the parties participate in a teleconference, and, if the result is not to your satisfaction, in a mandatory mediation at no cost to you. You can learn more about mediation at the Texas Department of Insurance website: www.tdi.texas.gov/consumer/cpmmediation.html.
• If directory information is materially inaccurate and you rely on it, you may be entitled to have an out-of-network claim paid at the in-network percentage level of reimbursement and your out-of-pocket expenses counted toward your in-network deductible and out-of-pocket maximum.

28 TAC §3.3705(f)(1)

Florida Mental Health Parity Notice

What are Your Rights Under the Mental Health Parity Laws?

Your health coverage is subject to state and federal Mental Health Parity laws, which generally prohibit insurance plans from providing mental health or substance use disorder benefits in a manner that is no more restrictive than other medical benefits.

If you believe our standards or practices relating to the provision of mental health or substance use disorder benefits are not compliant with the mental health parity laws, you, or your authorized representative, may submit a complaint to the Florida Division of Consumer Services.

For instructions on how to file a complaint, as well as our statement on the Mental Health Parity please click on the link below.

Florida Mental Health Parity Notice

Notice of Nondiscrimination

Both GeoBlue® and 4 Ever Life Insurance Company comply with applicable Federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity or sexual identity. GeoBlue® and 4 Ever Life Insurance Company do not exclude people or treat them differently because of race, color, national origin, age, disability, sex, gender identity or sexual orientation.

To see our Notice of Nondiscrimination, please click on the link below.

Washington Notice of Nondiscrimination