If I go out of State – California  or the USA – Country 

What does Blue Shield pay for Emergencies

Urgent Care? 

Regular Doctor Visits? 

Colds?

Care for Covered Urgent Care and Emergency Services

Outside the United States

Benefits will also be provided for Covered Services received while temporarily traveling outside of the United States, Puerto Rico and U.S. Virgin Islands for emergency care of an illness or injury. If you need urgent care while out of the country, contact the Blue Cross Blue Shield Global™ (BCBS Global™) Service Center through the toll-free BlueCard Access number at 1-800-810-2583 or call collect at 1-804-673-1177, 24 hours a day, and seven days a week. In an emergency, go directly to the nearest hospital. If your coverage requires pre-certification or prior authorization, you should also call Blue Shield of California at the Customer Service telephone number indicated on the back of the Member’s identification card. For inpatient hospital care, contact the Blue Cross Blue Shield Global™ (BCBS Global™) Service Cente to arrange cashless access. If cashless access is arranged, you are responsible for the usual out-of-pocket expenses (non-covered charges, Deductibles, and copayments). If cashless access is not arranged, you will have to pay the entire bill for your medical care and submit a claim. When you receive services from a physician, you will have to pay the doctor and then submit a claim. Before traveling abroad, call your local Customer Service office for the most current listing of providers or you can go on-line at www.bcbs.com and select “Find a Doctor or Hospital” and “Blue Cross Blue Shield Global™ (BCBS Global™) Service Center”

 

Emergency Medical Condition

An illness, injury, symptom (including severe pain), or condition severe enough to risk serious danger to your health if you didn’t get medical attention right away. If you didn’t get immediate medical attention you could reasonably expect one of the following:

1) Your health would be put in serious danger; or

2) You would have serious problems with your bodily functions; or

3) You would have serious damage to any part or organ of your body. Health Net Glossary *

 

Urgent Care

Care for an illness, injury, or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.

Out of Area Programs

Benefits will be provided for Covered Services received by Subscribers and their Dependent(s) who are temporarily traveling outside of California within the United States, Puerto Rico and U.S. Virgin Islands. (Temporarily traveling is defined as a Subscriber or Dependent(s) who spends in the aggregate not more than 180 days each Calendar Year outside the State of California.) Blue Shield of California calculates the Subscriber’s copayment as a percentage of the Allowable Amount, as defined in this booklet. When Covered Services are received in another state, the Subscriber’s copayment will be based on the local Blue Cross and/or Blue Shield plan’s arrangement with its providers.ee the BlueCard Program section in this booklet.

If you do not see a Participating Provider through the BlueCard Program, you will have to pay for the entire bill for your medical care and submit a claim to the local Blue Cross and/or Blue Shield plan or to Blue Shield of California for payment. Blue Shield of California will notify you of its determination within thirty (30) days after the receipt of the claim. Blue Shield of California will pay you at the Non-Participating Provider benefit level. Remember that your copayment is higher when you see a Non-Participating Provider. You will be responsible for paying the entire difference between the amount paid by Blue Shield of California and the amount billed.

Charges for services which are not covered, and charges by Non-Participating Providers in excess of the amount covered by the plan, are the Subscriber’s responsibility and are not included in copayment calculations.

To receive the maximum benefits of your plan, please follow the procedure below. When you require Covered Services while temporarily traveling outside of California:

1) call BlueCard Access® at 1-800-810-BLUE (2583) to locate physicians and hospitals that participate with the local Blue Cross and/or Blue Shield plan, or go on-line at www.bcbs.com and select the “Find a Doctor or Hospital” tab; and,

2) visit the participating physician or hospital and present your membership card.

The participating physician or hospital will verify your eligibility and coverage information by calling BlueCard Eligibility at 1-800-676-BLUE. Once verified and after services are provided, a claim is submitted electronically and the participating physician or hospital is paid directly. You may be asked to pay for your applicable copayment and plan Deductible at the time you receive the service.

You will receive an Explanation of Benefits, which will show your payment responsibility. You are responsible for the copayment and plan Deductible amounts shown in the Explanation of Benefits.  Pre-admission review is required for all inpatient hospital services and notification is required for inpatient emergency services. Prior Authorization is required for selected inpatient and outpatient services, supplies, and durable medical equipment. To receive pre-admission review from Blue Shield of California, the out-of-area provider should call the Customer Service telephone number indicated on the back of the Member’s identification card.

If you need Emergency Services, you should seek immediate care from the nearest medical facility.  The Benefits of this plan will be provided for Covered Services received anywhere in the world for the emergency care of an illness or injury.

 

The Blue Card Program for
International & Domestic Travel

 

The Blue Card program  worldwide 1-800-810-BLUE (2583)  gives Blue Cross/Blue Shield PPO members access to doctors and hospitals in participating local Blue plan networks throughout the nation. The program features assistance in locating these participating providers from a roster including more than 70 percent of doctors and 80 percent of hospitals in America. Blue Card extends “Power of Blue” cost savings and the security of access to quality health care, wherever you travel within the U.S. Blue Cross GROUP Sales Brochure Page 12  Blue Shield GROUP – Blue Card Brochure  Blue Shield International Claim Form

Read your specific EOC – Don’t trust general information on the Internet.  Even OUR prestigious site!

Resources & Links

Blue Shield CA on Blue Card Program  for providers

Anthem Blue Cross Blue Card

Find a doctor in New York

Going to Urgent Care vs ER Emergency Room
What if you’re out of the area, out of state?

Visiting an urgent care center can cost up to five times less than a visit to the ER and significantly reduce your wait time. While the average wait at a California ER is 4 hours and 34 minutes, urgent care center wait times are usually under an hour*. That means you can bypass the crowds and take your first step on the road to recovery.

Blue Shield Flyer
Urgent Care preferred to ER Emergency Room

 

Additional Reading

*”Urgent Care or the ER – Which is the Right Choice?” Health Alerts, Johns Hopkins Medicine, January 2011.  Read more   Accessing Urgent Care

49 Ways to stay out of the ER – Emergency Room Kevin MD.com

The Insurance Company might base the claim payment on final diagnosis, rather than if a reasonable person felt their life was in danger?

World Wide Travel

Health Net 

Travel Guides

Members can download claim forms at www.healthnet.com. Claim forms can also be found under the Applications and Forms section on this page.

PPO Travel Guide – English (PDF)

Blue Cross – Specimen Platinum PPO –

Policy – Travel Section

Sorry, under ObamaCare – Blue Cross does not appear to participate in the Blue Card Program unless it’s an emergency or urgent care.  Double check this – 2016 might have changed!

Blue Shield HMO

Kaiser – KP.org Travel Care away from home * 951-268-3900  *

Provider Finder for all our companies

BLUE (Shield & Cross) CARD PROGRAM

US News & World Report 10.2015 – Coverage while outside USA

Free Quotes, Brochures and complete information on travel coverage and International Medical Plans 

Medicare Coverage Outside of USA # 11037

$50k Emergency Coverage in Supplemental & Advantage Plans

Medicare.Gov/Travel

 

Steve talks about International Travel Insurance

steve's video on travel insurance

Get Travel Quotes & Information

Steve Shorr
Website Introduction Video

Steve Shorr - website introduction

Instant Health Quotes & Enroll

15 Reasons to appoint us as your broker - No extra charge

 

Our Webpage on Insurance Coverage for 

COVID 19 

Information on Insurance Coverage for COVID 19

 

 

Too Many Claims

Blue Card Claims
Blue Card Claims

To get an authoritative answer to most any question on Insurance Coverage

 

1st – Find the actual Evidence of Coverage for the plan you have or are thinking of getting.

Here’s Blue Shield’s webpage with all the EOC’s and summary of benefits.   Here’s our webpage with Benefit Summaries, which IMHO are easier to read than the Federal Summary of Benefits, but neither one will really answer the technical question posed here.

Be sure to use the CURRENT EOC for the plan that you have or are thinking of getting.

If you want the short and quick answer (which might be wrong, as you really should follow the instructions below) click on the link  to jump to our Sample EOC for Emergency Services or here for Oscar EPO.

 

Blue Shield for 2019 & beyond  (Silver PPO EOC page 19) will only have Urgent &  emergency coverage out of state!

 

This Blue Shield plan provides limited coverage for health care services received outside of the Plan Service Area. Out-of-Area Covered Health Care Services are restricted to Emergency Services,

Definitions

Emergency Medical Condition (including a psychiatric emergency) — a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

1) placing the Member’s health in serious jeopardy;
2) serious impairment to bodily functions;
3) serious dysfunction of any bodily organ or part. EOC *

Click on link for definition of Emergency Services

Urgent Services, and Out-of-Area Follow-up Care. Any other services will not be covered when processed through an Inter-Plan Arrangement unless prior authorized by Blue Shield. Prior authorization is required for non-emergency services. Please see the Benefits Management Program section for additional information on prior authorization and emergency admission notification.

In an effort to reduce costs, Blue Shield  has quietly decided to scale back participation in the national Blue Card program that since 1994 has allowed Blue Shield’s members to receive a range of primary and specialty care services out of state. That could be a big problem for frequent travelers, college students, snowbirds and other people who divide their time between states – and for rural patients  who live close to state borders.

The change applies only to members with individual market preferred provider health plans,- not those with group coverage or Medicare. The restrictions appear to be confined to California.

“Consumers are price-sensitive to premiums,”  Under the ACA, “there is a more limited set of tools for insurers to lower premiums. They can’t discriminate against people based on their health status.”  CA Healthline 12.11.2018  *

Let’s use the Silver PPO Off Exchange for an example.  I imagine that all the PPO plans have the same relevant out of area clauses, but you must check yours. Let’s scroll down to the Table of Contents.  ​

Alternatives for Blue Card Changes 


for Blue Shield INDIVIDUAL Plans

blueshieldca.com/getcare  

Unauthorized Excerpt of Confidential Agent Guide

Unauthorized Excerpt of Confidential Agent Guide

Guaranteed Issue - No Pre X Clause
Quote & Subsidy Calculation 
Find out your premium with Covered CA
or Direct without Subsidies

Instant complementary quotes & subsidy calculation

Missed Open Enrollment?
See our Special Enrollment page

No charge for our complementary services 

Detailed Video Instructions on using our Quote Engine

detailed instructions to use quote engine

How to use our FREE Quote Engine, Subsidy Calculator  and get the MOST from the experience.

When you get a FREE quote, you can also see the benefits, view actual brochures, MD and Hospital Lists all ONE easy process with no obligation & it can be anonymous.   Enter your zip code, date of birth, family - household taxation relationships (MAGI - Definition),    Estimated MAGI - Modified Adjusted Gross Income for the upcoming - current year.  Last years tax return only gives an idea so that Covered CA can approve your advance tax credit to help pay premiums.

If you qualify for tax credits - subsidies and want them in advance (Pros-Cons) of filing your taxes click on "Health On Exchange" - Covered CAillustrated below.

This website and are individual consultation are provided to you FREE of Charge!  We are paid by Covered CA and/or the Insurance Companies to help you.  When you fill out the Covered CA ONLINE Application, just appoint us as your agent under Find Help in the Upper Right Hand Corner so that we get paid for helping you.  Click here for screen shots for more detail of how to do it.  If you prefer, you can pay us a consultation fee in lieu of appointing us as your agent, for educational services only.

You can then see all the quotes on the exchange, showing the Cost Share Reduction - Enhanced Silver  if available, subsidy - tax credit amount and your net premium.    If you click "Off Exchange" you will see more plans and companies which  may have larger provider lists.   Scroll down for more screen shots.

Then click on "View Plan Details" - "View Doctor's & Providers" - to compare and get more information.  Please note that the quote engine does not show enhanced silver, but shows silver at 70%.  Check our chart for the better silver coverage.

Learn more about the right to change plans when Silver Level Enhanced Changes

To apply, click on apply now or use the links in the right hand column, ON THIS PAGE, but it will have you redo the quote for that specific company.   The price is the SAME, no matter if you use us, go direct to Covered CA or the Insurance Company, as mandated by law!  If applying through Covered CA, be sure to sign the form to appoint us as your agent.  It's not all the easy to figure out how to do it on their website.

If you have any questions email [email protected] or call us 310.519.1335

Covered CA Certified Agent

Covered CA Certified Agent  
No extra charge for complementary assistance 
Appoint us as your broker  

Set Consultation Meeting via Phone, Skype or Face to Face

Instant Health Quotes & Enroll
including subsidy calculation

Videos on how great agents are

Enrolling in health plans has helped people focus on their families and careers, and feel protected against unexpected medical issues.

I'm in Charles 

 

I'm in Charles

I'm in Sonia  

I'm in Sonia

 

6 comments on “Blue Card Program”

  1. Anonymous says:
    With the 2020 Blue Shield 1950 PPO plan, is there a blue card coverage while travelling in Canada.

    If so, is there the payment more limited than in network emergency service?

    Is travel insurance advisable in addition to Blue card coverage?

     
  2. Anonymous says:
    I have a small employer Blue Cross HMO group health plan, in CA. My child will be going to school in New York.

    Will she be covered under our plan?

    If not, what do we do?

     
    • I’m double checking on the definition of service area. If that means Blue Cross of CA or if that includes anywhere BC/BS has a list of MD’s. See our page on residency.

      Normally for visits and travel, it’s not a problem.

       
    • Here’s the reply from Blue Cross Broker Support:

      Because you are on a Select HMO plan, coverage out of the state of CA is limited to emergency services only.

      If you were on a PPO plan, she would be subject to in network doctors in NY through the “blue card” program regardless if the services are for emergency or not.

      Unfortunately, her going to school isn’t a qualifying event to change your plan to a PPO.

      I have attached a flyer for more information on the Anthem Guest Membership Program, for further information you can call 800-827-6422. Please note, that in very tiny print on the flyer it does indicate that applicants can still be declined if a region within a guest states does not have providers.

      New York is on the list.

       
    • This link will allow you to search based on the 3 letter Alpha Pre-Fix that is on the member’s card. Or you can just select the BlueCard PPO/EPO network option under browse plans.

      the blue card network does not apply to HMO’s.

23 comments on “Blue Shield PPO Out of State & Country

  1. We have a Silver PPO from Blue Shield of CA. (the primary coverage). Here’s the evidence of coverage.

    It has hefty out of network deductibles, co pays and max out of pocket limits. For illustration purposes, let’s say the annual deductible for out of network is $25K and max out of pocket is $50K.

    If we buy an annual travel plan with secondary medical coverage (they all seem to have secondary coverage – your webpage on dual coverage),

    will the annual travel policy play pick up the hefty deductible ($25 k in this notional example) and $50K Max out of pocket, etc that Blue Shield of CA won’t pay if we end up hit by a bus in Italy and end up going to an out of network provider?

  2. How does one get medical coverage for travel out of state and out of country? Do you sell annual medical travel insurance plans?

        • The purpose of travel in the USA, outside of California (and therefore Blue Shield Of California’s coverage network) is to care for sick parents or vacation – not to seek medical coverage out of state.

          • You’re not leaving Blue Shield’s network, there is the Blue Card Program. See link above. The issue is, if you want to get treated for something, it has to be “Urgent” or an “Emergency.”

            Urgent Services — those Covered Services rendered outside of the Plan Service Area (other than Emergency Services) which are Medically Necessary to prevent serious deterioration of a Member’s health resulting from unforeseen illness, injury, or complications of an existing medical condition, for which treatment cannot reasonably be delayed until the Member returns to the Plan Service Area.

            Emergency Medical Condition (including a psychiatric emergency) — a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in any of the following:

            1) placing the Member’s health in serious jeopardy;
            2) serious impairment to bodily functions;
            3) serious dysfunction of any bodily organ or part.

            Emergency Services — the following services provided for an Emergency Medical Condition:

            1) A medical screening examination that is within the capability of the emergency department of a hospital, including ancillary services
            routinely available to the emergency department to evaluate the Emergency Medical Condition; and

            2) Such further medical examination and treatment, to the extent they are within the capabilities of the staff and facilities available
            at the hospital, to stabilize the Member.

            Copied from EOC

  3. Thanks for your answers. Is it fair to say that, in 2019, both PPO options, available in my zip code (San Diego County), Blue Shield of California and Health Net, classify (hence reinburse) non emergency treatment OUTSIDE of CALIFORNIA as out of network / non preferred providers.

  4. In 2019, Are there any PPOs in California, that provide services considered in network, our of state or out of the country. Blue shield used to but apparently will stop in 2019

    • First try our quote engine and see.

      Here’s a sample proposal. Please note that this is for San Pedro, CA. Different plans are offered in different counties, zip codes. 19 rating areas in CA.

      Health Net Enhanced Care PPO is the only other one.

      HN Covered CA information

      30 page disclosure

      Evidence of Coverage Silver 87 Enhanced Care PPO

      Page 7 :

      THIS BENEFIT PLAN PROVIDES BOTH PREFERRED PROVIDER AND OUT-OF-NETWORK PROVIDER BENEFITS FOR SERVICES (INCLUDING BEHAVIORAL HEALTH TREATMENT) ONLY WITHIN CALIFORNIA.

      THIS BENEFIT PLAN DOES NOT PROVIDE BENEFITS FOR SERVICES (INCLUDING SERVICES FOR BEHAVIORAL HEALTH TREATMENT) OUTSIDE OF CALIFORNIA, EXCEPT FOR URGENT CARE AND EMERGENCY CARE.

      OUTSIDE THE UNITED STATES, COVERAGE IS LIMITED TO URGENT CARE AND EMERGENCY CARE, AS DESCRIBED BELOW UNDER “FOREIGN TRAVEL OR WORK ASSIGNMENT” IN THIS “MISCELLANEOUS PROVISIONS” SECTION.

  5. If Blue Shield of California PPO plans ( either on or off the exchange ) no longer cover non – emergency coverage – then are they any better than an HMO?

    What am I paying the extra for???

    • This new restriction is only if you are out of state.

      Apparently too many adults were getting elective procedures done out of state.

      out of state

      VIDEO UCSF cardiologist Rita Redberg talks about the negative effects of variation on patients’ health and medical costs and what can be done to change it. https://youtu.be/rBia7wbnaz4

Leave a Reply

Your email address will not be published.