Emergency and Urgent <strong>CareFirst</strong>Help : 24-HourHealth Care Advice Line(800) 535-9700You can speak with a FirstHelp nurse anytime,day or night. Registered nurses are available toanswer your health care questions and help guideyou to the most appropriate care.If you believe a situation is a medical emergency,call 911 immediately or go to the nearest emergencyfacility.In an urgent situation, contact your PCPfor advice. If your PCP isn’t available, you havesymptoms and don’t know exactly what they meanor how serious they are, <strong>CareFirst</strong> BlueChoiceprovides you with FirstHelp .Here’s how it works:1. Call FirstHelp at (800) 535-9700. The phonenumber is also listed on the back of yourmember ID card. Your call will be answeredpromptly by an experienced registered nurse.2. If the nurse determines your situation is amedical emergency, he or she will advise you toseek immediate medical care. NOTE: If takingthe time to call FirstHelp would seriouslyjeopardize your health, call 911 or go to anemergency facility immediately.3. If your condition isn’t an emergency situation,you’ll be asked about your symptoms. Thenurse will make recommendations to help youdecide the safest and most appropriate courseof action, whether it’s a participating urgentcare center, an appointment at your PCP’soffice, or self-care.4. If the nurse recommends self-care, he or shewill educate you about your condition, explainwhat to do for pain or symptom relief, tell youwhat to expect or watch to for. You may becalled by the nurse the next day to check onyour condition.Now you have the option to securely contactFirstHelp about less urgent medical issues onthe Internet. Simply log on to My Account atwww.carefirst.com/myaccount and click on “AskOur Nurses” to submit your question. Within 24hours, you will receive an e-mail stating that aresponse from a registered nurse is available at MyAccount.FirstHelp nurses won’t be able to answerquestions about the following:➤ Your benefits and what is covered by your<strong>HealthyBlue</strong> plan➤ Information on your claims➤ Pre-authorizationsIf you have questions about your benefitsor claims, please call the <strong>Member</strong> Servicesnumber listed on your member ID card. If youneed authorization for a service, please call theappropriate number listed on the back of yourmember ID card.➤ If your urgent condition is related to mental healthor substance abuse, see the section on “Seeing MentalHealth/ Substance Abuse Specialists” on page 19 inthis handbook.Emergency & Urgent Care When TravelingSeek medical attention immediately in the case of emergencies and urgent conditions.If you’re unsure about the meaning or seriousness of the symptoms, call FirstHelp formedical advice.For assistance in locating Blue Cross and Blue Shield providers and hospitals when outsideof the <strong>CareFirst</strong> BlueChoice Service Area, call BlueCard ® Access at (800) 810-BLUE (2583).The BlueCard ® program allows members who receive care outside of the <strong>CareFirst</strong> ServiceArea to benefit from most claims-filing and hold-harmless agreements that other BlueCrossand BlueShield plans have with their local participating providers.16 <strong>HealthyBlue</strong> <strong>Member</strong> Handbook
Coverage Outside the AreaBlueCard ® Network — Across theCountry and WorldwideYou can take your health care benefits with you – across thecountry and around the world* with BlueCard ® , a programfrom the Blue Cross and Blue Shield Association.Your member ID card enables you and your family membersto receive inpatient and outpatient hospital care and physicianservices when you’re outside the <strong>CareFirst</strong> BlueChoice ServiceArea. The BlueCard ® network program includes medicalassistance services and an expanded network of health careproviders throughout the world.If you are enrolled in any of the <strong>HealthyBlue</strong> <strong>2.0</strong> plans, whenyou visit a provider outside the <strong>CareFirst</strong> BlueChoice servicearea, only emergency and urgent care services are available In-Network. All non-emergency services will be covered as Outof-Network.<strong>Member</strong>s in any of the <strong>HealthyBlue</strong> <strong>Advantage</strong>plans have access to In-Network benefits in emergency andnon-emergency situations outside the <strong>CareFirst</strong> BlueChoiceService Area when they visit a BlueCard ® PPO Provider.The BlueCard ® network includes more than 6,100 hospitalsand 600,000 providers nationally. While you can see anyprovider in the BlueCard ® network, this may be an out-ofnetworkprogram. So, make sure you understand your levelof coverage and the out-of-pocket expenses associated withvisiting an out-of-network provider.For more information on BlueCard ® network, call the <strong>Member</strong>Services phone number on your member ID card.How BlueCard ® Network Works1. When you leave for your next trip outside of the <strong>CareFirst</strong>BlueChoice service area, be sure to take your <strong>HealthyBlue</strong>member ID card with you.2. To locate information on the availability of local providersand hospitals in your travel destination, use your<strong>HealthyBlue</strong> ID card and call the BlueCard ® Access line at800-810-BLUE (2583). (You can use the toll-free numberoutside of the U.S. by using an AT&T Direct ® AccessNumber.) You can also visit http://www.bcbs.com/coverage/bluecard/bluecard-when-traveling.html forinformation on BlueCard ® network when traveling insidethe U.S.3. If you require medical attention while you’re traveling orliving outside the U.S., show your <strong>HealthyBlue</strong> memberID card and call BlueCard ® Access at (800) 810-BLUE(2583). A medical assistance coordinator, in conjunctionwith a nurse, will arrange hospitalization, if necessary, ormake an appointment with a physician. In an emergency,you should bypass this step and go directly to the nearesthospital. You can also visit www.bcbs.com/coverage/bluecard/bluecard-worldwide.html for information onBlueCard ® network when traveling outside the U.S.4. Once you arrive at the hospital, show them your<strong>HealthyBlue</strong> member ID card. By providing your memberID card to the hospital staff, you can avoid paying upfrontfor your inpatient participating hospital services,other than any out-of-pocket expenses (deductibles,copayments, coinsurance and non-covered services). Youalso won’t need to complete a claim form; the hospital willdo that for you. For outpatient hospital care or physicianservices, you will pay the hospital or physician, completean international claim form (if you’re outside of the U.S.)and send it to the BlueCard Worldwide ® Service Center. Toreceive an international claim form, call(800) 810-BLUE (2583).5. If you are admitted to the hospital, your care will bemonitored throughout your hospital stay.If you are in a <strong>HealthyBlue</strong> <strong>2.0</strong> plan, non-emergencyservices from a BlueCard® PPO Provider are covered asOut-of-Network. If you are in a <strong>HealthyBlue</strong> <strong>Advantage</strong>Plan, services from a BlueCard® PPO Provider will becovered as In-Network.For more information on BlueCard Worldwide®, call our<strong>Member</strong> Services department at the telephone numberon your member ID card. AT&T Direct is a registeredtrademark of AT&T. BlueCard® and BlueCard Worldwide®are registered service marks of the Blue Cross and Blue ShieldAssociation, an association of independent, locally-ownedBlue Cross and Blue Shield Plans.* Please note: certain plans only cover emergency serviceswhen traveling outside the United States. Please refer to yourEvidence of Coverage/Agreement for more details.<strong>HealthyBlue</strong> <strong>Member</strong> Handbook17
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