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Q.
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Why is there cost and quality information on only certain procedures?
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A.
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We offer information on a range of the most common procedures based on the
availability of our data source.
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Q.
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How is the average cost determined?
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A.
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By taking a broad sampling of cost data for the most common procedures based
on the availability of our data sources.
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Q.
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Why can't specific cost data be displayed?
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A.
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We offer a range of costs which represents a typical range for procedures and
hospitalization. In most cases, the typical costs presented are a summary of the
total cost you can expect to be billed for.
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Q.
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How is hospital quality determined?
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A.
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There are a number of quality measures reported on by various data sources. To
review hospital quality, keep in mind that it's not a ranking tool, rather a measure
of which criteria is important to you and how closely it matches the criteria.
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Q.
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Is there cost and quality information for prescriptions?
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A.
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Blue Cross and Blue Shield of Nebraska does not administer your pharmacy or
prescription drug benefits. Register for AccessBlue, our secure online members-only
portal, to access your personal pharmacy and prescription drug information through
MyRxHealth.
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Q.
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How can I find a specific claim?
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A.
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You can access your claim information via AccessBlue, our secure online
members-only portal under the My Health Plans section and selecting Claims, or
contact our Customer Service Center by dialing the toll free number on the back
of your ID Card. A representative will be happy to assist you.
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Q.
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How do I submit a claim for reimbursement?
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A.
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If you use a BCBSNE In-Network provider or facility, your claims will be filed
for you. If, however, you use an out-of-network provider or facility, you may have
to file the claim for yourself. Forms are available online or by calling our
Customer Service Center.
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Q.
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Can I call to check the status of a claim?
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A.
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Yes. You can contact our Customer Service Center by dialing the toll free
number on the back of your ID card or you can access your claim information via
AccessBlue, our secure online members-only portal, under the My Health Plans
section and selecting claims.
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Q.
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How do I update my address?
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A.
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You should notify your employer of any address change. Once your employer makes
your address change, they will forward the change to us and will update our system.
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Q.
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How long does it take for a medical claim to show up on the web site?
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A.
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Approximately 24-48 hours after receiving a valid claim from a provider
and it has been successfully processed.
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Q.
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What are your Customer Service hours?
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A.
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Our Customer Service Center hours are 7:30 a.m. to 6:00 p.m. (CST) Monday through Friday.
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Q.
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How can I replace a lost member ID card?
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A.
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Contact our Customer Service Center by dialing 1-888-930-2583. A
representative will be happy to assist you.
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Q.
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How can I review my account balances, claims activity, etc.?
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A.
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You can access your claim information via AccessBlue, our secure online
members-only portal, under the My Health Plans section or contact our Customer
Service Center by dialing the toll free number on the back of your ID Card. A
representative will be happy to assist you.
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Q.
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Where do I send a completed medical claim form?
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A.
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Send your claim forms to Blue Cross and Blue Shield of Nebraska at P.O. Box
3248 Omaha, NE 68180-0001.
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Q.
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How do I update my Coordination of Benefits information?
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A.
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You will receive a COB update questionnaire through the mail periodically
throughout the year, we also have COB questionnaires available online at www.bcbsne.com
under download forms or you can contact our Customer Service Center by dialing
the toll free number on the back of your ID Card. A representative will be happy
to assist you.
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Q.
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How do I contact a live BCBSNE Customer Service Representative?
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A.
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Contact a Customer Service Representative by dialing 1-888-930-2583.
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Q.
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When do I need to pre-certify benefits?
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A.
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Blue Cross and Blue Shield of Nebraska must be notified of all medical/surgical
inpatient hospitalizations prior to admission. Benefits must be pre-certified
for all inpatient mental illness and/or substance abuse treatment, physical rehabilitation,
long-term acute care and skilled nursing facility care. Please refer to your Summary Plan
Description (SPD) for further information.
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Q.
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How do I pre-certify benefits for an inpatient hospitalization?
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A.
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If you're responsible for pre-certifying benefits for a hospital stay, you need
to call our Preadmission Certification Department at (402) 390-1870 or 1-800-247-1103.
You can also ask your doctor or the hospital to make the call for you, but it's your
responsibility to make sure they do so. One of the registered nurses who staff our
Preadmission Certification phones will take the information about your proposed hospital
stay and review it using established medical and surgical criteria. If it's determined
that a hospital stay is medically necessary, we will authorize benefits for the
hospitalization according to the terms of your coverage.
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Q.
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Is there a difference between a Participating Provider and a PPO Provider?
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A.
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Yes, they are two different provider networks. When Blue Cross and Blue Shield
got started more than 65 years ago, we established Participating Agreements with
hospitals and doctors across the state. In 1989, we introduced our PPO plan, and
asked providers to sign a similar agreement to join that network. Many providers
are in both networks, but that isn't always the case.
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Q.
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I have a covered eligible dependent(s) attending college outside Nebraska. Are they still
covered under my Blue Cross and Blue Shield of Nebraska contract?
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A.
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Your covered eligible dependent(s) are covered even while living or traveling
in another state. The national BlueCard Program ensures
that your benefits follow you wherever you go.
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Q.
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I have BluePreferred PPO coverage. I know I need to use
BluePreferred network providers in order to receive the highest
level of benefits available to me, but what if I'm outside Nebraska and need medical care?
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A.
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If you're outside Nebraska and therefore outside the BluePreferred
provider network, you can still receive in-network benefits. All you have to do is use a doctor
and hospital in the local Blue Cross and Blue Shield Plan's Blue Card PPO network. To find out
if a particular hospital or doctor is in the national BlueCard network,
call 1-800-810-BLUE
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