HealthyBlue 2.0/HealthyBlue Advantage Member ... - CareFirst

CareFirst BlueChoice &CareFirst PPO Network ProvidersChanging Your PCP—CareFirst BlueChoiceNetwork ProvidersIf you are enrolled in any of the HealthyBlue 2.0plans, you must select a PCP at enrollment. Youcan change your PCP during at any time—just visitMy Account.To get started, visit www.carefirst.com/myaccount. If you haven’t already registeredwith My Account, just click on “Register now” tofollow the easy steps for creating your user nameand password. Make sure you have your memberID card number handy, which is located on yourHealthyBlue ID card.If you don’t have access to the Internet, pleasecontact Member Services at the phone number onyour member ID card and give the representativethe name of the PCP you’d like to see.If the change is requested prior to the 20th ofthe current month, it will be effective on the 1st ofthe following month. Requests received after the20th of the current month will be effective on the1st day of the 2nd month following your request.For example, a request received on January 10would be effective February 1. A request receivedon January 21 would be effective March 1.Once your PCP change request has beenmade, you’ll soon receive a new member ID cardwith your new PCP’s name. Please destroy yourold member ID card once the change becomeseffective.Note: If you are enrolled in any of theHealthyBlue Advantage plans, then you do notneed to select a PCP at enrollment. However, toqualify for the Healthy Reward you will needto work with a CareFirst BlueChoice PCP. If youreside outside the CareFirst BlueChoice ServiceArea, you must work with a BlueCard ® PPOprovider to receive In-Network benefits as well asqualify for the Healthy Reward. The BlueCard ®PPO provider must specialize in general internalmedicine, general pediatrics or geriatrics.CareFirst PPO providers are out-of-network.Scheduling Appointments with a CareFirstBlueChoice or CareFirst PPO ProviderCareFirst BlueChoice and CareFirst PPO doctorssee patients in their own offices. Always call foran appointment before visiting your providerand identify yourself as a HealthyBlue member.Don’t forget to bring your member ID card toyour appointment and present the card to thereceptionist. You should always present yourmember ID card whenever you seek care.CareFirst has set goals for providers in ourparticipating networks regarding appointmentavailability and office waiting times. For nonsymptomaticvisits, such as preventive careor routine wellness, we expect the provider toschedule the appointment within 4 weeks.If you have an urgent problem, call your PCPas soon as possible, and the office staff will arrangean appropriate time for you to be seen. For asymptomatic (acute) problem, most offices try toschedule you within 24-72 hours or less, dependingon the urgency of the problem. The nurse or theappointment staff at your PCP’s office will help youdetermine how quickly you need to be seen.Canceling Appointments with a CareFirstBlueChoice or CareFirst PPO ProviderIf you’re unable to keep a scheduled appointment,call the provider’s office as soon as possible.Our CareFirst BlueChoice and CareFirst PPOproviders prefer at least 24 hours notice so they canoffer your appointment time to another patient.Some providers may charge a fee if you miss anappointment and have not called to cancel.Blue Cross and Blue Shield ParticipatingProvidersIf you use a practitioner, specialist, or hospitalthat participates in the Blue Cross and Blue Shieldnetwork, the provider will file the claim for you.Once the claim is processed, we will send paymentdirectly to the participating provider. You willreceive an Explanation of Benefits form showinghow much the provider was paid and how muchyou owe the provider.10 HealthyBlue Member Handbook