Medical Frequently Asked Questions for Individual Members

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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.
Answer: Please contact Davis Vision at 800-783-5602.

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Coverage

Answer: Most likely, yes. CareFirst has the region’s largest group or “network” of providers—doctors, hospitals and pharmacies—you can receive benefits and services from. Search for your doctor within our network.
Answer: No. Regardless of your plan (specific to individual and family plans), you do not need a referral to see a specialist.
Answer: Yes. All CareFirst plans include prescription drug coverage (specific to individual and family plans). This includes: a nationwide network of more than 60,000 participating pharmacies, approximately 5,000 covered prescription drugs, Mail Service Pharmacy, and coordinated medical and pharmacy programs to help improve your overall health and reduce costs.

Find out whether your drugs are covered by using our Drug Search page.

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 seek treatment at an Urgent Care Center, such as Patient First, Righttime and Doctors Express.
Answer: Maryland residents can use the Membership Change Form and submit it directly to CareFirst. Virginia residents must submit a new application. And in Washington, D.C., you must contact the DC Health Link to make any changes.

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Claims

Answer: Please call the Member Services number on the back of your ID card. Plan and benefit information can also be found on My Account.
Answer: To appeal a claim payment or denial, follow these steps:


Step 1: Contact Us

Call the Member Services phone number on your member ID card. If your concern is not resolved via a call with a CareFirst representative, you may submit a written appeal.

Step 2: Submit a Written Appeal

CareFirst must receive your written appeal within 180 days or six months of receiving the written notification of claim denial. Send it to Mail Administrator, P.O. Box 14114, Lexington, KY 40512. If you prefer, you can send a secure email with your request through My Account.

In the letter 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.)

Step 3: Appeal Decisions

All appeal decisions will be sent to you in writing and will include a detailed explanation about the decision, as well as any documentation to support the decision. You will also receive information on next steps you may take if you are not satisfied with the appeal decision.

Learn more about this process.

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Member Services

Answer: For members who buy their medical health plans through us, we offer a variety of payment options. Visit the Payment Options page for more details.
Answer:

Maryland Health Connection
855-642-8572
TTY/TDD 855-642-8573

DC Health Link
855-532-5465
TTY/TDD 855-889-4325

Virginia Health Insurance Marketplace
800-318-2596
TTY/TDD 855-889-4325

Answer: ID cards can be printed and ordered through My Account. Members can also contact Member Services at:
  • Members who bought ACA Plans directly from CareFirst (off exchange): 855-444-3122
  • Members who bought ACA Plans through an Exchange or Marketplace (on exchange): 855-444-3121
  • Members with Grandfathered/Non-ACA* Plans: 800-722-2467
  • Medigap Members: 800-722-2235

* Grandfathered coverage is coverage that was purchased prior to March 23rd, 2010, when the Patient Protection and Affordable Care Act went into effect.

Answer: Registration for My Account is simple and quick, but you will need information from your Member ID card. To register, click the "Register Now" button on the My Account home page.

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