Blue Cross and Blue Shield of New Mexico (BCBSNM) is committed to having provider networks that meet access standards. To join our networks, providers and BCBSNM must agree to a contract. Our networks include medical and behavioral health providers. On a regular basis, we check to see if:...
If you see a provider that doesn’t file insurance claims for their patients, you may have to pay them directly, then get reimbursed. To get reimbursed, you fill out a claim form and submit it to BCBSMT. We then pay you, rather than the provider. You can find the correct claim form...
“Just like Blue Cross Blue Shield of North Carolina has the right to point fingers at everyone else for losing the contract after 44 years, the State Health Plan, Board of Trustees, professional staff, and I all have a duty to seek the best financial value and member service for those ...
The amount you pay for most covered servicesbefore your health plan starts to pay. When you go to a provider that is in the plan's network, before you meet the deductible you may pay adiscounted amountthat has been negotiated with the provider. The deductible resets at the beginning of th...
When you go to a provider that is in the plan's network, before you meet the deductible you may pay a discounted amount that has been negotiated with the provider. The deductible resets at the beginning of the calendar year or when you enroll in a new plan. Dependent An eligible person...
These can include drugs that must be given to you by a health care provider. These drugs are often given to you in a hospital, doctor’s office or health care setting. Examples of these drugs are contraceptive implants and chemo infusion. If you are taking or prescribed a drug that is ...
“This back-to-school time will require an acute focus from parents, educators and caring adults on both the academic and social success of teens,” said David Bond, LCSW, director of Behavioral Health for Blue Shield of California. ...
(a) the services being rendered to that Member are completed or reasonable and medically appropriate provision is made for the assumption of such services by another contracting provider or (b) in the case of hospital inpatients, those Members are discharged, but in no event later than the ...
Non-Contracting Hospital A hospital that has not contracted with a particular health plan to provide hospital services to members in that plan. O Off-Exchange Health Plan Plans that are enrolled in directly with a private health insurance provider rather than through the public Health Insurance Exch...
Services provided by a physician or other health care provider with a contractual agreement with the insurance company and covered at a higher benefit level. Inpatient Services Services provided when a member is registered as a bed patient in a health care facility, such as a hospital. ...