2024 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Page 139
Index
Page 139
Member facilities - 19 - 20
Mental health/substance use disorder - 81 - 84
MRIs - 39 - 40, 69 - 72, 129
Multiple procedures - 56 - 57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 39 - 40, 69 - 72
Never Events - 6 - 8, 133
Newborn care - 28, 38 - 39, 42 - 45, 67 - 69
No Surprises Act (NSA) - 31 - 32
NON-CORE benefits - 36
Non-member facilities - 19 - 20
Non-participating providers - 31 - 32, 134
Non-preferred providers - 18, 31 - 32
Nurse - 53, 73 - 75
Nutritional counseling - 38 - 43, 56 - 57, 66 - 69
Observation care - 133
Obstetrical care - 44 - 45, 67 - 69
Occupational therapy - 48 - 49, 69 - 75
Office visits - 38 - 39, 81 - 82
Online Health Coach (OHC) - 103
Oral surgery - 59
Organ/tissue transplants - 21 - 24, 59 - 60, 62 - 64
Orthopedic devices - 51, 57 - 59, 69 - 72
Osteoporosis screening - 135
Ostomy and catheter supplies - 52 - 53
Out-of-pocket expenses - 32, 134 - 135
Outpatient facility services - 69 - 72, 102
Outpatient professional services - 38 - 39, 81 - 82
Overpayments - 33
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 32, 107 - 109
Oxygen - 51 - 53, 66 - 75
Pap tests - 40 - 43
Participating providers - 31 - 32
Patient Safety and Quality Monitoring (PSQM) program - 85 - 86
Personal Health Record - 103
PET scans - 39 - 40, 69 - 72, 129
Pharmacotherapy - 38 - 39, 47 - 48
Physical examinations - 69 - 72, 111 - 112
Physical therapy - 48 - 49, 69 - 75
Physician - 18, 123, 127, 131, 135
Plan allowance - 31, 133 - 134
PPO - 13 - 14, 19 - 20, 135
Pre-admission testing - 66 - 67
Precertification - 21 - 24, 26, 28, 55 - 56, 65, 72 - 73, 81, 83, 135
Preferred providers - 13 - 14, 18, 104
Pregnancy (see: Maternity care)
Prescription drugs
Prior approval - 21 - 24, 26, 39 - 42, 47 - 48, 51 - 52, 55 - 57, 59 - 60, 63, 65, 69 - 76, 81 - 82, 85 - 86, 135
Professional providers - 18
Prostate cancer - 40 - 42
Prosthetic devices - 51, 56 - 57, 66 - 67, 69 - 72
Psychotherapy - 81 - 84
Pulmonary rehabilitation - 47 - 48, 69 - 72
Radiation therapy - 47 - 48, 69 - 72
Reconsiderations - 28, 116 - 118
Replacement coverage - 11 - 12
Reproductive services - 46 - 47, 129 Residential treatment center (RTC) - 19 - 21, 26, 28, 72 - 73, 83
Rights and responsibilities - 13 - 14
Room and board - 66 - 67, 72 - 73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 135
Second surgical opinion - 38 - 39
Self-injectable drugs - 85 - 100
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 54, 96 - 99
Social worker - 104 - 105
Specialty Drug Pharmacy Program - 96 - 99, 108 - 109, 114
Specialty drugs - 85 - 100, 136
Speech therapy - 48 - 49, 69 - 75
Speech-generating devices - 51 - 52
Stem cell transplants - 21 - 24, 59 - 60
Sterilization procedures - 45 - 46, 56 - 57
Subrogation - 120 - 121, 136
Substance use disorder -81 - 84
Surgery - 19 - 24, 49 - 51, 55 - 65, 130
Telehealth
Tobacco cessation - 54, 96 - 99
Transplants - 19 - 24, 47 - 48, 59 - 63
Travel benefit - 63, 103
Treatment therapies - 47 - 49
TRICARE - 119 - 122
Ultrasounds - 39 - 40, 69 - 72
Urgent care center - 78 - 80
Urgent care claims - 27, 136
VA facility - 127
Vaccines - 40 - 43, 96 - 99
Verbal statements - 4, 28, 104 - 105
Vision services - 49 - 50
Waivers - 31
Weight control - 21 - 24, 56 - 57
Wheelchairs - 51 - 52
Wigs - 51
WRAP benefits - 36
X-rays - 39 - 40, 69 - 72
Mental health/substance use disorder - 81 - 84
MRIs - 39 - 40, 69 - 72, 129
Multiple procedures - 56 - 57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 39 - 40, 69 - 72
Never Events - 6 - 8, 133
Newborn care - 28, 38 - 39, 42 - 45, 67 - 69
No Surprises Act (NSA) - 31 - 32
NON-CORE benefits - 36
Non-member facilities - 19 - 20
Non-participating providers - 31 - 32, 134
Non-preferred providers - 18, 31 - 32
Nurse - 53, 73 - 75
Nutritional counseling - 38 - 43, 56 - 57, 66 - 69
Observation care - 133
Obstetrical care - 44 - 45, 67 - 69
Occupational therapy - 48 - 49, 69 - 75
Office visits - 38 - 39, 81 - 82
Online Health Coach (OHC) - 103
Oral surgery - 59
Organ/tissue transplants - 21 - 24, 59 - 60, 62 - 64
Orthopedic devices - 51, 57 - 59, 69 - 72
Osteoporosis screening - 135
Ostomy and catheter supplies - 52 - 53
Out-of-pocket expenses - 32, 134 - 135
Outpatient facility services - 69 - 72, 102
Outpatient professional services - 38 - 39, 81 - 82
Overpayments - 33
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 32, 107 - 109
Oxygen - 51 - 53, 66 - 75
Pap tests - 40 - 43
Participating providers - 31 - 32
Patient Safety and Quality Monitoring (PSQM) program - 85 - 86
Personal Health Record - 103
PET scans - 39 - 40, 69 - 72, 129
Pharmacotherapy - 38 - 39, 47 - 48
Physical examinations - 69 - 72, 111 - 112
Physical therapy - 48 - 49, 69 - 75
Physician - 18, 123, 127, 131, 135
Plan allowance - 31, 133 - 134
PPO - 13 - 14, 19 - 20, 135
Pre-admission testing - 66 - 67
Precertification - 21 - 24, 26, 28, 55 - 56, 65, 72 - 73, 81, 83, 135
Preferred providers - 13 - 14, 18, 104
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 96 - 99
Drugs from other sources - 100
Generic drugs - 96 - 99
Preferred retail pharmacies - 96 - 99, 114
Retail Pharmacy Program - 85 - 86, 108 - 109
Self-injectable drugs - 96 - 99
Specialty Drug Pharmacy Program - 85 - 86, 96 - 99, 114
Specialty drugs - 96 - 99, 136
Preventive carePrimary care provider (PCP) - 36 Drugs from other sources - 100
Generic drugs - 96 - 99
Preferred retail pharmacies - 96 - 99, 114
Retail Pharmacy Program - 85 - 86, 108 - 109
Self-injectable drugs - 96 - 99
Specialty Drug Pharmacy Program - 85 - 86, 96 - 99, 114
Specialty drugs - 96 - 99, 136
Prior approval - 21 - 24, 26, 39 - 42, 47 - 48, 51 - 52, 55 - 57, 59 - 60, 63, 65, 69 - 76, 81 - 82, 85 - 86, 135
Professional providers - 18
Prostate cancer - 40 - 42
Prosthetic devices - 51, 56 - 57, 66 - 67, 69 - 72
Psychotherapy - 81 - 84
Pulmonary rehabilitation - 47 - 48, 69 - 72
Radiation therapy - 47 - 48, 69 - 72
Reconsiderations - 28, 116 - 118
Replacement coverage - 11 - 12
Reproductive services - 46 - 47, 129 Residential treatment center (RTC) - 19 - 21, 26, 28, 72 - 73, 83
Rights and responsibilities - 13 - 14
Room and board - 66 - 67, 72 - 73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 135
Second surgical opinion - 38 - 39
Self-injectable drugs - 85 - 100
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 54, 96 - 99
Social worker - 104 - 105
Specialty Drug Pharmacy Program - 96 - 99, 108 - 109, 114
Specialty drugs - 85 - 100, 136
Speech therapy - 48 - 49, 69 - 75
Speech-generating devices - 51 - 52
Stem cell transplants - 21 - 24, 59 - 60
Sterilization procedures - 45 - 46, 56 - 57
Subrogation - 120 - 121, 136
Substance use disorder -81 - 84
Surgery - 19 - 24, 49 - 51, 55 - 65, 130
Assistant surgeon - 20
Eye: cataract, amblyopia, strabismus - 56 - 57
Gender affirming - 21 - 26, 56 - 57
Multiple procedures - 55 - 57
Oral and maxillofacial - 59
Outpatient - 56 - 57, 69 - 72
Reconstructive - 21 - 24, 57 - 59
Eye: cataract, amblyopia, strabismus - 56 - 57
Gender affirming - 21 - 26, 56 - 57
Multiple procedures - 55 - 57
Oral and maxillofacial - 59
Outpatient - 56 - 57, 69 - 72
Reconstructive - 21 - 24, 57 - 59
Sterilization, reversal of voluntary - 45 - 46, 56 - 57
Surgical implants - 51, 69 - 72
Surgical treatment of morbid obesity - 21 - 24, 56 - 57
Transplants - 21 - 24, 59 - 64
Syringes - 96 - 99 Surgical implants - 51, 69 - 72
Surgical treatment of morbid obesity - 21 - 24, 56 - 57
Transplants - 21 - 24, 59 - 64
Telehealth
Dermatology - 38 - 39, 136
Mental health/substance use disorder - 81 - 82, 136
Minor acute conditions - 38 - 39, 133
Nutritional counseling - 40 - 43, 105
Temporary Continuation of Coverage (TCC) - 11 - 12 Mental health/substance use disorder - 81 - 82, 136
Minor acute conditions - 38 - 39, 133
Nutritional counseling - 40 - 43, 105
Tobacco cessation - 54, 96 - 99
Transplants - 19 - 24, 47 - 48, 59 - 63
Travel benefit - 63, 103
Treatment therapies - 47 - 49
TRICARE - 119 - 122
Ultrasounds - 39 - 40, 69 - 72
Urgent care center - 78 - 80
Urgent care claims - 27, 136
VA facility - 127
Vaccines - 40 - 43, 96 - 99
Verbal statements - 4, 28, 104 - 105
Vision services - 49 - 50
Waivers - 31
Weight control - 21 - 24, 56 - 57
Wheelchairs - 51 - 52
Wigs - 51
WRAP benefits - 36
X-rays - 39 - 40, 69 - 72