2025 Blue Cross and Blue Shield Service Benefit Plan - Standard and Basic Option
Index
Page 162
Index
Page 162
Medically necessary - 155
Medicare - 1, 142-151
Member facilities - 13-14
Mental health/substance use disorder - 93-97, 163, 165
MRIs - 39-40, 77-81
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 39-40, 77-81
Never Events - 6-8, 155
Newborn care - 25, 46-47
No Surprises Act (NSA) - 31
Non-member facilities - 13-14, 156-157
Non-participating providers - 13-14, 24, 28-31, 156-158
Non-preferred providers - 28-31
Nurse - 58, 84-86, 125
Nutritional counseling - 38-39, 41-45
Observation care - 155
Obstetrical care - 46-47
Occupational therapy - 52-53
Office visits - 38-39, 94-95
Oral surgery - 66
Organ/tissue transplants - 61-73
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 28-33
Outpatient facility services - 77-81
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58, 84-86
Pap tests - 41-45
Participating providers - 13-14, 156-157
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 39-40, 77-81
Pharmacotherapy - 38-39, 51-52
Physical examination - 41-45
Physical therapy - 52-53, 84-86
Physician - 154
Plan allowance - 156-157
PPO - 13-14, 156-158
Pre-admission testing - 75-77
Precertification - 21, 24, 158
Preferred providers - 13-14, 19-20, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs
Prior approval - 20-24, 158
Professional providers - 17
Prostate cancer tests - 41-43
Prosthetic devices - 55-56, 75-77
Psychotherapy - 93-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 26, 139-141
Renal dialysis - 51-52, 77-81
Replacement coverage - 12
Reproductive services - 49-50Residential Treatment Center (RTC) - 17-19, 21, 24, 82-83, 95-96
Retail Pharmacy Program - 98-99, 102-103, 131-132, 163-166
Rights and responsibilities - 13-14
Room and board - 75-77, 82-83, 95-96
Screening services - 158
Second surgical opinion - 38-39
Self-injectable drugs - 98-102
Skilled nursing facility (SNF) care - 17-19, 83-84
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-107, 137-138, 163-166
Specialty drugs - 99-111, 137-138, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants - 67-70
Sterilization procedures - 48-49, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 163, 165
Surgery
Telehealth
Tobacco cessation - 59-60, 114-119, 125
Transplants - 61-73
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 39-40, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 33, 150
Vision services - 53-54, 145
Waivers - 28
Weight control - 125-126, 133-135
Wheelchairs - 56-57
Wigs - 55-56
X-rays - 39-40, 77-81
Medicare - 1, 142-151
Reimbursement account - 127
Medications and supplies - 103-107, 111-120Member facilities - 13-14
Mental health/substance use disorder - 93-97, 163, 165
MRIs - 39-40, 77-81
Multiple procedures - 62-63
MyBlue Customer eService - 127
National Doctor & Hospital Finder - 127
Neurological testing - 39-40, 77-81
Never Events - 6-8, 155
Newborn care - 25, 46-47
No Surprises Act (NSA) - 31
Non-member facilities - 13-14, 156-157
Non-participating providers - 13-14, 24, 28-31, 156-158
Non-preferred providers - 28-31
Nurse - 58, 84-86, 125
Nutritional counseling - 38-39, 41-45
Observation care - 155
Obstetrical care - 46-47
Occupational therapy - 52-53
Office visits - 38-39, 94-95
Oral surgery - 66
Organ/tissue transplants - 61-73
Orthopedic devices - 55-56, 77-81
Osteopathic manipulative treatment - 58-59
Osteoporosis screening - 158
Ostomy and catheter supplies - 57-58
Out-of-pocket expenses - 28-33
Outpatient facility services - 77-81
Outpatient professional services - 38-39
Overpayments - 33
Overseas Assistance Center - 130
Overseas services, drugs, supplies and claims - 130-132
Oxygen - 56-58, 84-86
Pap tests - 41-45
Participating providers - 13-14, 156-157
Patient Safety and Quality Monitoring (PSQM) Program - 99-102
Personal Health Record - 125
PET scans - 39-40, 77-81
Pharmacotherapy - 38-39, 51-52
Physical examination - 41-45
Physical therapy - 52-53, 84-86
Physician - 154
Plan allowance - 156-157
PPO - 13-14, 156-158
Pre-admission testing - 75-77
Precertification - 21, 24, 158
Preferred providers - 13-14, 19-20, 28-31
Pregnancy (see: Maternity care)
Pregnancy Care Incentive Program - 126-127
Prescription drugs
Brand-name drugs - 103-107, 111-114
Drugs from other sources - 119-120
Generic drugs - 99-102, 108-111
Mail Service Prescription Drug Program - 103-107, 111-119, 131-132, 137-138
Preferred retail pharmacies - 103-107, 137-138
Retail Pharmacy Program - 102-103, 131-132, 163-166
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 103-107, 137-138, 163-166
Specialty drugs - 99-107, 137-138, 159
Preventive carePrimary care provider - 17, 163, 165Drugs from other sources - 119-120
Generic drugs - 99-102, 108-111
Mail Service Prescription Drug Program - 103-107, 111-119, 131-132, 137-138
Preferred retail pharmacies - 103-107, 137-138
Retail Pharmacy Program - 102-103, 131-132, 163-166
Self-injectable drugs - 98-99
Specialty Drug Pharmacy Program - 103-107, 137-138, 163-166
Specialty drugs - 99-107, 137-138, 159
Prior approval - 20-24, 158
Professional providers - 17
Prostate cancer tests - 41-43
Prosthetic devices - 55-56, 75-77
Psychotherapy - 93-97
Pulmonary rehabilitation - 51-52, 77-81
Radiation therapy - 51-52, 77-81
Reconsiderations - 26, 139-141
Renal dialysis - 51-52, 77-81
Replacement coverage - 12
Reproductive services - 49-50Residential Treatment Center (RTC) - 17-19, 21, 24, 82-83, 95-96
Retail Pharmacy Program - 98-99, 102-103, 131-132, 163-166
Rights and responsibilities - 13-14
Room and board - 75-77, 82-83, 95-96
Screening services - 158
Second surgical opinion - 38-39
Self-injectable drugs - 98-102
Skilled nursing facility (SNF) care - 17-19, 83-84
Smoking cessation - 59-60, 114-119, 125
Social worker - 127-128
Specialty Drug Pharmacy Program - 98-107, 137-138, 163-166
Specialty drugs - 99-111, 137-138, 159
Speech therapy - 52-53, 77-81, 84-86
Speech-Generating Devices - 56-57
Stem Cell Transplants - 67-70
Sterilization procedures - 48-49, 62-63
Subrogation - 143-144, 159
Substance use disorder - 93-97, 163, 165
Surgery
Assistant surgeon - 19-20, 62-63
Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 63-65
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 77-82
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48-49, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Syringes - 103-107, 111-114Eye: cataract, amblyopia, strabismus - 53-54, 62-63
Gender affirming - 63-65
Multiple procedures - 62-63
Oral and maxillofacial - 66
Outpatient - 77-82
Reconstructive - 63-65
Sterilization, reversal of voluntary - 48-49, 62-63
Surgical implants - 55-56, 77-81
Surgical treatment of severe obesity - 21-24, 62-63
Telehealth
Dermatology - 17, 129, 159
Mental health/substance use disorder - 17, 94-95, 129
Minor acute conditions - 17, 129, 155
Nutritional counseling - 17, 41-45, 129
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 17, 94-95, 129
Minor acute conditions - 17, 129, 155
Nutritional counseling - 17, 41-45, 129
Tobacco cessation - 59-60, 114-119, 125
Transplants - 61-73
Travel benefit - 71-72, 125
Treatment therapies - 51-52
TRICARE - 142-143
Ultrasounds - 39-40, 77-81
Urgent care center - 90-92
Urgent care claims - 25, 159-160
VA facilities - 33, 150
Vision services - 53-54, 145
Waivers - 28
Weight control - 125-126, 133-135
Wheelchairs - 56-57
Wigs - 55-56
X-rays - 39-40, 77-81