General Questions BCBSAZ HMO Questions BCBSAZ PPO Questions
 
General Questions


What are my out-of-pocket costs for covered services?

  • Your BCBSAZ ID card shows your applicable copay amounts for Primary Care Physician (PCP) office visits
    and specialists’ (SPC) office visits
  • You will be provided with a schedule page that contains additional information, such as copays not listed on
    your ID card.The Schedule Page is an outline of basic benefits and shows you the copay amounts that apply
    to the benefits

Certain benefits only pay up to a maximum dollar amount (see Hearing Exams and Hearing Aids for an example) or have a day limit (see Behavioral and Mental Health Services as an example). Be sure to check if the services you might require have a limit. If so, you would be responsible for all costs above that limit.

What kind of ID card will I receive?


ID cards include both the contract holder’s name and the names of dependents. Additional ID cards may be obtained by calling (602) 995-6960 or by requesting more cards through a member’s BlueNet account.

How can I minimize my out-of-pocket costs ?

  1. Use network providers. Check your provider’s network status with BCBSAZ before you receive services. To find out if your provider is part of the HMO or PPO network, call BCBSAZ or check the online provider directory at azblue.com. You can also request a provider directory by calling our Supply Line at (602) 995-6960.
  2. Utilize emergency room services wisely. You can lower your out-of-pocket costs if you avoid using an ER for non-emergencies. If you have a non-emergency condition that needs treatment on a weekend or after hours, you may save money by using one of the specially contracted urgent care centers instead of an emergency room. Urgent care providers are listed in your directory and at azblue.com/cityofphoenix.
  3. Use your preventive care benefits. Use these services to catch medical problems early, before they become serious. Preventive care helps you feel better overall, and it may even save you money. The key is identifying and treating illnesses or conditions while they are less complicated to treat. Your benefit plan includes periodic well-woman exams, mammograms, bone density testing, and various cancer screening tests.

What should I do if I have more questions?


BCBSAZ strives to give you the best customer service and the answers you need.
  • Call: Phoenix Area: (602) 864-4857 or Toll-free outside Phoenix Area: (800) 232-2345, ext. 4857
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BCBSAZ HMO Questions


What is the BCBSAZ HMO plan?


The BCBSAZ HMO plan features a large network of providers (doctors, hospitals, etc.). These providers are specially contracted with BCBSAZ to provide health care services to its members. In order to receive covered services, you must use the providers within the BCBSAZ HMO network. When you choose the BCBSAZ HMO plan, you’re not required to have a primary care physician (PCP) direct your care.This means you don’t need a referral to see a specialist or other ancillary providers within the BCBSAZ HMO network.

How do I obtain health care services?


The first step toward receiving covered services is to choose an HMO provider. Just select your doctor from the list of providers who are part of the BCBSAZ HMO network. The list features an extensive physician and hospital network; chances are – your current physician is part of it. To view the online provider directory, click here .

What’s covered (and what’s not)?


The best way to fully understand your medical coverage under the BCBSAZ HMO plan is to refer to the specific provisions found in your open enrollment materials for complete information on your benefits, limitations and exclusions. In all cases, except emergency or urgently needed services, services must be provided and/or pre-authorized by HMO providers.

What if I need medical care out-of-state?


For short trips outside of Arizona (fewer than 90 days), members have access to Blue Cross and Blue Shield (BC/BS) network providers for urgent care. Follow-up care authorized by your HMO provider is also covered. If you become ill or have an urgent situation outside Arizona, call BlueCard Access at (800) 810-BLUE (2583) (also listed on the back of your ID card) to be directed to a BC/BS network provider. You may also visit the “BlueCard” Doctor and Hospital Finder at www.bcbs.com. After you receive any urgent or follow-up care from a network provider, you should not have to complete any claim forms. Covered services are subject to their usual copayments. With the BCBSAZ HMO plan, emergencies are always covered, whether you are in Arizona or out-of-state. Always go to the nearest emergency room, or other source of medical care, or dial 911 in the event of an emergency.
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BCBSAZ PPO Questions

What is the BCBSAZ PPO plan?

The BCBSAZ PPO plan features a large network of providers (doctors, hospitals, etc.) who are contracted with BCBSAZ. When you use BCBSAZ PPO providers, you will usually have lower out-of-pocket costs than if you use providers who are not part of BCBSAZ’s PPO network. The BCBSAZ PPO plan is all about options. It’s a health plan that gives you freedom of choice from a large selection of providers.

Choose from:

  1. PPO providers (In-Network)
    PPO providers are part of the BCBSAZ PPO network.These providers have agreed to accept the BCBSAZ allowed amount for covered services.What does that mean to you? Your out-of-pocket costs are lower when you use PPO providers for covered services.
  2. Non-PPO providers (Out-of-Network)
    Noncontracted providers have no agreement with BCBSAZ. Because of this, your out-of-pocket expenses are higher when you use noncontracted providers. In addition to your Out-of-Network deductible and coinsurance, these providers may also charge you the difference between their billed charges and the BCBSAZ allowed amount. This is called a “balance bill,” and the amount of the balance bill may be substantial.

With the BCBSAZ PPO plan, you choose whether to use an In-Network or an Out-of-Network provider for most services.You should also note that preventive care (Note: diagnostic mammography is covered Out-of-Network) and routine physical exam benefits are only covered when provided by PPO providers.

What is the BlueCard® Program?


Many providers outside Arizona have agreements with other independent Blue Cross and Blue Shield (BC/BS) Plans.That means the benefits of the BCBSAZ PPO plan follow you. If you receive covered services outside Arizona from a health care provider participating as a PPO provider with the local BC/BS Plan, amounts for covered services will be paid at the PPO level of benefits.Amounts for covered services received outside Arizona from a provider who doesn’t participate as a PPO provider with the local BC/BS Plan are paid at the Out-of-Network level of benefits.To locate a local BC/BS network PPO provider in another state, call (800) 810-BLUE (2583) or check the BlueCard Doctor and Hospital Finder at www.bcbs.com.

How do I file a claim?

  • Providers who are contracted with BCBSAZ
  • If you receive covered services outside Arizona from a health care provider who participates with the local BC/BS Plan; the provider will file your claim for you under the BlueCard Program.
  • Noncontracted providers are not obligated to file claims for you. But, if your provider does not file the claim for you, just call (602) 995-6960 to request a claim form(s). Send your completed claim form(s) to BCBSAZ. The city of Phoenix benefits office will also have claims forms available for your convenince.

How do I know what’s been paid?


Once the claim is processed, you will receive an Explanation of Benefits (EOB).The EOB identifies the provider who rendered the services, the amount the provider billed for those services, the amount BCBSAZ allows (and will reimburse for those services), amounts credited to your deductible and other information related to your claim.You may also check the status of a claim by accessing BCBSAZ BlueNet online services.

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