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Traditional for National Capital Area Frequently Asked Questions

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Approvals and Referrals

How do I obtain specialty care?

Answer: You may choose from the practitioners included in the CareFirst Participating Provider Network or a participating provider with another Blue Cross and Blue Shield (BCBS) Plan.

  • If you choose to see a specialist that does not participate with a BCBS plan, you may be financially responsible for balances over the plan allowance. 
  • You may call Customer Service at (202) 479-1739 to verify if you have coverage for the specialty care you are seeking.

     

Please note that some specialists services may not be included within your particular benefits plan.

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Emergency Care

If I need emergency care, what should I do?

Answer: If you believe a situation is a medical emergency, call 911 immediately or go to the nearest emergency facility. In an urgent (not life-or limb-threatening) situation contact your physician for advice or to arrange for treatment.

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General Information

How can I find out if I have a particular benefit?

Answer: Your benefits are detailed in your individual or group's Certificate of Coverage.

  • You may also call Customer Service at (202) 479-1739 to obtain specific information on contract benefits, such as:
    • medical care
    • vision care
    • dental care
    • prescription benefits

My children are going away to college. What coverage will they have?

Answer: Benefits are available for covered services rendered by network practitioners participating in another Blue Cross Blue Shield (BCBS) plan.

  • Benefits are considered for covered services rendered by practitioners that do not participate with a BCBS plan. However, you may be financially responsible for balances over the plan allowance.

Simply show your ID card and the hospital or doctor can submit the claims. However, if payment is required up-front, contact Customer Service at (202) 479-1739 to obtain a claim form for consideration and reimbursement of charges.

How do I obtain a copy of my Certificate of Coverage?

Answer: You can:
a)Contact the plan administrator if you are in a group plan; or
b)Call Member Services if you have individual coverage.

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ID Cards

What should I know about my ID card?

Answer: Your card is an important tool in getting the most out of your health plan.

  • Always carry your ID card with you and present it wherever you receive care.
  • Our Customer Service telephone number is on the front of your card. The back of the card lists other important telephone numbers to assist you in accessing care.

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ID Number Conversion to Non-SSN

Why is CareFirst replacing my identification (ID) number?

Answer: Identity theft using Social Security numbers is a growing problem. To protect your privacy and security, CareFirst is in the process of replacing all subscriber* ID numbers with numbers not based on your Social Security number.

*A subscriber is the person who holds a contract with CareFirst. A member is anyone in the subscriber's family who may be covered under that contract.

What will my new number look like?

Answer: Your new number will continue to begin with an alpha prefix followed by nine numeric digits (e.g. XIC987654321).

Will my dependents receive new ID numbers as well?

Answer: Only the subscriber who holds the contract with CareFirst will receive a new ID number.
All dependents covered under the contract will continue to use the subscriber’s number.

Will I receive a new member ID card?

Answer: Yes, as soon as your new number is assigned, you will receive a new member ID card. Please continue to use your current ID number and card until the new card arrives. Due to the large number of subscribers affected, the process will continue throughout 2005.

Will CareFirst still use my Social Security number?

Answer: Yes, CareFirst will still continue to use your Social Security number internally. We may also require you to provide your Social Security number on documents such as enrollment forms, and Flexible Spending Account forms. CareFirst has adopted and enforces a strict Privacy Policy intended to safeguard the confidentiality of information that is necessary to operate our business.

What if I live in a state where legislation banning the use of Social Security numbers has already been passed?

Answer: If you live in one of these states, you will receive a new ID number and card according to your state’s legislative requirements. If you believe that you should have received a new ID number and have not yet, please contact your HR benefits administrator or call Member Services at the phone number listed on your member ID card.

Does my doctor know to use the new number when submitting my claims?

Answer: We are informing doctors and other health care providers that we are changing your ID number and they should submit the new ID number on claims. However, you should always show your member ID card to your doctor or health care provider at every visit.

If I submit my own claims, what number should I use?

Answer: Include the new ID number on your claim to ensure the claim is filed accurately and to minimize claim payment delays.

Should I show my new member ID card to my doctor?

Answer: Yes, show your new member ID card to your doctor and other health care providers at your next visit. The information on the card will enable the provider to file the claim accurately and minimize claim payment delays.

What should I do when I receive my new member ID card?

Answer: 1. When you receive your new member ID card, take a moment to review the information on it. If you find that your information is listed incorrectly, please contact the Member Services Department at the number listed on your ID card.

2. Destroy your old ID card upon receipt of the new card.

3. Show your new ID card to your doctor and other health care providers at your next visit.

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Member Services

What are your Member Services hours?

Answer: Our Member Services department is available Monday - Friday, 7 a.m. - 7 p.m., EST.

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Physicians and Other Providers

How do I know if my provider participates with CareFirst BlueCross BlueShield?

Answer: The Indemnity program uses CareFirst's Participating Provider Network.

To determine if a provider is a CareFirst Participating Provider, or to locate a participating physician in your area, you may:

  • Search our online provider directory, the most up-to-date provider listing available.
  • Call a Customer Service Representative at (202) 479-1739.

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Travel Coverage

I will be traveling out of town. What coverage will I have?

Answer: Benefits are available for covered services rendered by network practitioners participating another Blue Cross Blue Shield (BCBS) plan.

  • Benefits are considered for covered services rendered by practitioners that do not participate with a BCBS plan. However, you may be financially responsible for balances over the plan allowance.

Simply show your ID card and the hospital or doctor can submit the claims. However, if payment is required up-front, contact Customer Service at (202) 479-1739 to obtain a claim form for consideration and reimbursement of charges.

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