Frequently Asked Questions

We’ve answered some of the most commonly asked questions about health insurance to help break down what things are, how they work and what you can expect from your care.

 

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  • Networks & ID Cards
  • Updating Your Information
  • Changing or Shopping for Plans
  • Claims, Coverage & Costs
  • Pharmacies & Prescriptions
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Networks & ID Cards

What are networks, and which one am I signed up for?

A network is a group of doctors we work with to provide care to our members. Providers in our network agree to offer our members a discount. Providers who aren’t in our network don’t offer that discount, so their rates are higher.

To find your network, look at the front of your Member ID card. It’s most likely on the bottom left corner.

How do I find out if my provider’s in network or find one who is?

You can search for providers by network in the Find Care tool. Either search the provider’s name and check which networks they’re in, or search for providers near you and filter your results by your network. If you log in to BlueAccess, our member portal, your search results will automatically list providers who are in your network.

What happens when I see a provider who’s not in my network?

That depends on your plan benefits. For most plans, if you see a provider who is not in your network, subject to your out-of-network deductible and coinsurance. In that case, we typically pay the amount that we’d pay a provider who is in your network, subject to your out-of-network deductible and coinsurance. You’ll pay whatever is left on your bill. Please keep in mind that some plans, like those you may have purchased through Healthcare.gov or signed up for through TennCare, don’t pay for providers who aren’t in your network.

What if I need care when I’m traveling?

This depends on what kind of plan you have.

Many employer plans include the Blue Cross Blue Shield Global Core® travel program that lets you see providers in other BlueCross networks while you’re traveling. If you see a small suitcase icon on your member ID card, then you have Global Core. If you’re planning a trip and have specific questions, the best thing to do is call Global Core directly at 1-800-810-25831-800-810-2583. They’re ready to help you out.

If you have an individual or family plan, or one through your employer, you can log in to BlueAccess and enter your location into the Find a Doctor tool.

Medicare members should contact us and we’ll help you decide how to get care.

Medicaid or Medicare with Medicaid members can only get coverage for providers out of the state of Tennessee if it’s a true emergency.

How do I get a new Member ID card?

You can order a new Member ID card in BlueAccess or by calling or chatting with us.

You can also download a digital version or print your own copy of your card from the same page in BlueAccess or you can see it in the MyBlueTN℠ mobile app, which you can download here.

How do I change incorrect info on my Member ID card?

Click here to contact us, and we’ll walk you through getting your card updated.

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Updating Your Information

How do I update personal info like my address, last name or payment information?

Click here to contact us, and we’ll get your account updated.

How do I add or remove a dependent?

Click here to contact us, and we’ll get your account updated.

How do I sign up for email and texts from you instead of paper mail?
I’m a Medicaid or Medicare with Medicaid member. How do I switch my primary care provider?

If you want to see a different doctor than the one you were assigned, you can contact us for help, or you can do it yourself through BlueAccess.

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Changing or Shopping for Plans

How/when can I enroll in or switch an Individual or Family plan?

You’ll need to enroll during the Open Enrollment Period from Nov. 1 – Dec. 15 of each year. If you’ve had a major life change (like getting married, losing your coverage, moving out of state, etc.), you could shop now with a special enrollment window for a limited time. There’s more about that here.

How/when can I enroll in or switch my Employer's plan?

Your employer likely has an enrollment window each year for you to sign up, unless you’re a new employee. Talk with your HR team about how to get enrolled.

How/when can I enroll in or switch a Medicare plan?

You’ll need to shop during the Annual Enrollment Period, from Oct. 15 – Dec. 7 each year to switch plans. If you’re just turning 65 or retiring, you have a window of three months before and three months after your birthday to sign up for Medicare. Some big life events – like getting married or moving – might allow you to enroll in a plan outside this window. If you have one coming up, contact us or your broker.

How/when can I enroll in or switch a Medicare with Medicaid (BlueCare Plus℠) plan?

If you qualify for both Medicare and Medicaid, you may sign up for a BlueCare Plus℠ plan throughout the year. Contact us or your broker to get help.

How can I enroll in a Medicaid (also called TennCare) plan?

Enroll with the State of Tennessee here.

How does Medicare work? What do I need to do?

We want you to feel confident in making your Medicare decisions. Here’s a link to get you caught up on the basics or you can give our sales team a call at 1-800-292-51461-800-292-5146.

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Claims, Coverage & Costs

How do I find out if a service is covered? And what do I do if you won't cover something I need?

You can check your coverage in BlueAccess. This will give you all the details on who and what is covered by your plan. Or click here to contact us, and we'll look it up and help you with the next steps if we don't cover a service you need.

I’m confused about or disagree with a claims statement or bill. What do I do?

Click here to contact us, and we’ll walk you through it. You can also watch this quick video that might help introduce you to the Claim Summary.

What does “premium/copay/deductible/coinsurance” mean?

Here’s a quick definition for the most common terms you’ll see in insurance:

Premium: The monthly payment for your insurance policy.

Copayment (Copay): A fixed dollar amount you must pay with your own money for medical services, like office visits or prescription drugs.

Deductible: The amount you pay each year before your health plan begins paying.

Coinsurance: The percentage of costs for care that you'll pay - usually after you've paid your deductible.

Why did my costs change this year?

Your health care costs can change for a number of reasons. The cost of care rising, the amount of people sharing the costs changing or a manufacturer raising or lowering their price on a drug are a few examples. If you’d like to discuss a specific change, click here to contact us, and we’ll try to answer your questions.

How do I pay my premium or change my payment information?

This depends on your plan. For most plans, you can do a bank draft, check by phone, or mail in payment. Contact us and we’ll talk you through it or you can download the form here.

I disagree with what my provider is charging me. What do I do?

Click here to contact us, and we’ll help.

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Pharmacies & Prescriptions

Is my drug covered?

You can check out all our drug lists here.

How do I get one of my drugs covered?

First, talk with your doctor about any generic versions or other drugs on your drug list that might work just as well. If we don’t cover a drug you need, your doctor can send us a request to cover it if they feel it’s important to your treatment. We’ll consider the request and get back to you on our decision.

How do I find a pharmacy in my network?

You can search for pharmacies by network in the Find a Doctor tool. Either search by the pharmacy’s name and check which networks they’re in, or search for ones near you and filter your results by your network. If you log in to BlueAccess first, your search results will automatically list pharmacies in your network. Need more help? Click here to contact us.

What do the drug tiers mean?

When a new drug becomes available, they’re put into one of three categories, or “tiers.”

Tier One: Generic drugs. These drugs are made with the same active ingredients and in the same dosage as the brand-name product, but cost less. They meet the same FDA standards as brand drugs and work just as well.

Tier Two: Preferred Brand Name drugs. These are the most affordable brand-name drugs.

Tier Three: Non-Preferred drugs. These are more expensive brand-name drugs. Often there are other similar ones available at a lower cost in one of the other two categories.

What are “preferred” drugs or pharmacies?

Our doctors and pharmacists create a list of preferred drugs to put in our formulary (your list of covered drugs). Our drug list includes preferred generic (Tier 1) and preferred brand name (Tier 2) drugs. Non-preferred brand name (Tier 3) drugs are not part of the preferred drug list, but are covered by your pharmacy benefits, just at a higher cost.

Some plans have a list of “Preferred Pharmacies” that have agreed to keep costs even lower for our members and you’ll save money if you use them instead of a standard one in your network.

What is a specialty pharmacy or drug?

A specialty drug is a prescription drug that is given by injection or infusion, sometimes by you and sometimes in the doctor’s office. You’ll often get the best price for your medicine by getting it from certain specialty pharmacies, even if it’s your doctor or preferred facility doing the procedure. Learn more.