Medical Frequently Asked Questions for Group Members

Categories

Expand All | Collapse All

Benefits

Answer: Please call the Member Services number on the back of your Identification card Monday-Friday, 7 a.m. to 7 p.m. Plan and benefit information can also be found on My Account or contact your Benefits Administrator.
Answer: Please contact Davis Vision at 800-783-5602.
Answer: Prior authorizations are for certain services and/or procedures that require review and approval prior to being provided. These include certain behavioral health, hospitalization and surgical procedures. Please call 866-773-2884 with any questions.

Expand All | Collapse All

Expand All | Collapse All

Member Services

Answer: You can visit My Account to print or order ID cards.
Answer: You can email us at quality.care.complaints@carefirst.com or call Member Services at the number on the back of your ID card.
Answer: Whether you need a doctor or a facility, use our Find A Doctor tool to find what you're looking for based on your specific needs. The site is updated weekly, so you always have the most up-to-date information available.
Answer: Our Treatment Cost Estimator is your online resource designed to help you estimate your personal cost for procedures, doctor’s office visits, lab tests and surgery beforehand. Talk with your doctor about which treatment options are right for you. With Treatment Cost Estimator you can:
  • Receive personalized estimates based on your health care plan and factor in your remaining deductible, benefit maximums, copayments and coinsurance
  • Avoid surprises and save money by comparing costs from different doctors and facilities
  • Plan ahead to keep health costs under control and make the best care decisions for you

Access My Account and either log in or create an account to take a look.

Answer: Access My Account, go to the Claims tab and select "Deductible/Out-of-Pocket."
Answer: To get a preferred list of drugs, log in to My Account. On the My Coverage tab, select "Drug and Pharmacy Resources," then click the "View My Plan Summary" link. In the new window that opens, select "Covered Drug List."
Answer: For serious, life-threatening conditions, you should always turn to the Emergency Room (ER) for care.

Expand All | Collapse All

Expand All | Collapse All

Coverage

Answer: Some plans require referrals. This information can be found on My Account or call the Member Services number on the back of your ID card.

Expand All | Collapse All

Expand All | Collapse All

Claims

Answer: Some plans require referrals. This information can be found on My Account or call the Member Services number on the back of your ID card.
Answer: A written member/provider appeal can be mailed to the following address:

CareFirst BlueCross BlueShield
PO Box 14114
Lexington, KY 40512-4116

Your written member appeal should include:

  • Member name and ID number
  • Provider name
  • Date(s) of service
  • Admission and discharge date (if applicable)
  • A copy of the original Explanation of Benefits, voucher or bill
  • Medical records (Emergency room records, X-rays, etc.)
  • The purpose of the appeal

You can view additional information on the Claims Appeals page.

Answer: Visit My Account and either log in or create an account. Go to the online claims submission link to submit the non-participating (out-of-network) provider claims and corresponding receipts to CareFirst online. For participating provider claims, the provider should submit the claim (Large Group only).
Answer: Log in to My Account and go to the Claims tab, then select "View My Claims."

Expand All | Collapse All

Go to Frequently Asked Questions

Have a Question, But Can’t Find the Answer Here?

Ask A Question