BCBS - Prescription Drugs
What should I consider before I fill a prescription drug?
Here are few things to keep in mind before you fill a prescription drug.
• Use a participating pharmacy and Preferred Generic drugs (when available) to lower your cost (see your cost now by using our Drug Pricing tool). Using mail-order for ongoing maintenance medication may also save you money.
• Some drugs may require your doctor to submit a prior authorization before they’re covered (See drugs that may require Prior Authorization in our Medication Guide).
• Some drugs may be limited in the amount you can fill within thirty days, unless a special approval is obtained (see the Responsible Quantity Program in our Medication Guide).
• For plans that cover brand name drugs, certain brand name drugs may not be covered or will cost you more unless you have tried the generic alternative first (see the Responsible Steps Program in our Medication Guide).
• Many specialty drugs require a Prior Authorization and must be purchased from our Specialty Pharmacy network, Caremark to pay the lowest amount. Call Caremark at 1-866-278-5108 for more information (see more about Specialty Drugs in our Medication Guide).
IMPORTANT NOTE: Not all health plans come with pharmacy coverage and coverage varies by plan. If you’re part of an employer group, your employer may provide prescription drug benefits through another company. Please refer to your Benefit Booklet for coverage details, limitations and exclusions.
If I am outside the state of Florida and need to have a prescription filled, what do I do?
When you’re outside the state of Florida, take your prescription to a pharmacy that participates in our National Pharmacy Network. You can find National Participating pharmacies using our pharmacy website. If you don’t have your member ID card with you, you’ll have to pay for your prescription drug in full and then submit a claim form along with your receipt to the address shown on the form. If you go to a non-participating pharmacy, reimbursement will be based on our contracted rate (what we pay a participating pharmacy), less the amount of your applicable deductible and/or coinsurance. For help locating a National participating pharmacy, call the Customer Service number listed on your member ID card.
I went to a BCBSF participating pharmacy and left my ID card at home. I paid for my prescription drug in full. What do I do?
Simply complete the Claim Form(PDF), attach your receipt and send to the address indicated on the form.
I left my ID card at home and paid full price for my medication. How do I get reimbursed?
You have two reimbursement options:
1) If you return to the pharmacy with your ID card, within two weeks of your purchase, most pharmacies will rerun the prescription claim and reimburse the amount owed to you.
2) You can complete a Prescription Drug Program Claim form, attach your receipt(s) and send to the address shown on the form. Reimbursement will be based on our contracted rate (what we pay participating pharmacies), less the amount of your applicable copayment or deductible and/or coinsurance.
Learn Medical Billing Process, Tips to best AR Specialist. Medical Insurance Billing codes, Denial, procedure code and ICD 10, coverage guidelines. Demographic, charge, payment entry, AR process and eligibility and follow up. How to Guide.
Pages
- Home
- Medical Billing Question and Answer - Terms
- Insurance Denial Claim Appeal Guidelines.
- Medical Billing Downloads
- Understand Medical Billing
- Medical Billing Outsource
- Medicare Coverage and Plan Overview
- Advertise with us
- EVALUATION AND MANAGEMENT CPT code [99201-99499] - Full List
- Overall Medical billing process
- CPT Code 99201, 99202, 99203, 99204, 99205 - Which code to USE
- Internal Medical Billing Audit - how to do

Subscribe to:
Post Comments (Atom)
Medical Billing Popular Articles
-
CPT CODE AND Description 99391 - Periodic comprehensive preventive medicine reevaluation and management of an individual including an age...
-
Procedure CODES and Descriptions 99401 - Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an indi...
-
CPT Code and description 99381 - Initial comprehensive preventive medicine evaluation and management of an individual including an age an...
-
Procedure code and Description 99251 Inpatient consultation for a new or established patient, which requires these 3 key components: A pro...
-
CPT code and description 80050 - General health panel This panel must include the following: Comprehensive metabolic panel (80053), ...
-
Billed amount: It is the Amount charged for each service performed by the provider. In other words it is the total charge value of the cla...
-
93000-93010: Hone Your ECG Coding Skills With 3 Essential Pointers Whether you call them ECGs or EKGs, chances are you see a lot of elec...
-
When an ERA is received, providers may: •Post decision and payment information automatically, for individual claims included in an R...
-
Medicare denial code and Descripiton 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent ...
-
Background: Type of Service (TOS) is an indicator that the contractor places on the Form CMS-1500 paper form or electronic format. The indic...

No comments:
Post a Comment