2023 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Page 138
Index
Page 138
Medications to promote better health - 44-45, 93-100
Member facilities - 17-18
Mental health/substance use disorder - 85-88
MRIs - 40-41, 73-76, 128
Multiple procedures - 57-59
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 40-41, 73-76
Never Events - 6-8, 131
Newborn care - 26, 39-40, 44-47, 71-73
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 34-37
Non-member facilities - 17-18
Non-participating providers - 29-30, 133
Non-preferred providers - 16, 29-30
Nurse - 54-55, 77-79
Nutritional counseling - 39-45, 57-59, 70-73
Observation care - 132
Obstetrical care - 45-47, 71-73
Occupational therapy - 50, 73-79
Office visits - 39-40, 85-86
Online Health Coach (OHC) - 103
Oral surgery - 61
Organ/tissue transplants - 19-22, 61-63, 65-68
Orthopedic devices - 52, 59-61, 73-76
Osteoporosis screening - 134
Ostomy and catheter supplies - 54
Out-of-pocket expenses - 30, 133
Outpatient facility services - 73-76, 102
Outpatient professional services - 39-40, 85-86
Overpayments - 31
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 30, 107-109
Oxygen - 53-54, 70-79
Pap tests - 41-45
Participating providers - 29-30
Patient Safety and Quality Monitoring (PSQM) program - 89-90
Personal Health Record - 103
PET scans - 40-41, 73-76, 128
Pharmacotherapy - 39-40, 49
Physical examinations - 73-76, 111-112
Physical therapy - 50, 73-79
Physician - 16, 123, 126, 130, 133
Plan allowance - 29, 132-133
PPO - 13-14, 17-18, 133
Pre-admission testing - 70-71
Precertification - 19-22, 24-26, 56-57, 69, 76-77, 85, 87,133-134
Preferred providers - 13-14, 16, 104
Pregnancy (see: Maternity care)
Prescription drugs
Prior approval - 19-25, 40-44, 49, 53-54, 56-59, 61-63, 66-69, 73-80, 85-86, 89-90, 134
Professional providers - 16
Prostate cancer - 41-44
Prosthetic devices - 52, 57-59, 70-71, 73-76
Psychotherapy - 85-88
Pulmonary rehabilitation - 49, 73-76
Radiation therapy - 49, 73-76
Reconsiderations - 27, 116-118
Replacement coverage - 11-12
Reproductive services - 47-48, 128Residential treatment center (RTC) - 17-19, 24-26, 76-77, 87
Rights and responsibilities - 13-14
Room and board - 70-71, 76-77, 87
Routine Annual Physical Incentive Program - 106
Screening services - 134
Second surgical opinion - 39, 40
Self-injectable drugs - 89-100
Skilled nursing facility (SNF) care - 77, 129
Smoking cessation - 55, 93-100
Social worker - 104
Specialty Drug Pharmacy Program - 93-100, 108-109, 114
Specialty drugs - 89-100, 134
Speech therapy - 50, 73-79
Speech-generating devices - 53-54
Stem cell transplants - 19-22, 61-63
Sterilization procedures - 47, 57-59
Subrogation - 120-121, 135
Substance use disorder - 85-88
Surgery - 17-22, 51-52, 56-69, 129
Telehealth
Tobacco cessation - 55, 93-100
Transplants - 17-22, 49, 61-68
Travel benefit - 66-68,103
Treatment therapies - 49-50
TRICARE - 119-122 -
Ultrasounds - 40-41, 73-76
Urgent care center - 82-84
Urgent care claims - 25, 135
VA facility - 126
Vaccines - 41-45, 93-100
Verbal statements - 4, 27, 104
Vision services - 51-52
Waivers - 29
Weight control - 19-22, 57-59
Wheelchairs - 53-54
Wigs - 37, 52
WRAP benefits - 34-37
X-rays - 40-41, 73-76
Member facilities - 17-18
Mental health/substance use disorder - 85-88
MRIs - 40-41, 73-76, 128
Multiple procedures - 57-59
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 40-41, 73-76
Never Events - 6-8, 131
Newborn care - 26, 39-40, 44-47, 71-73
No Surprises Act (NSA) - 29-30
NON-CORE benefits - 34-37
Non-member facilities - 17-18
Non-participating providers - 29-30, 133
Non-preferred providers - 16, 29-30
Nurse - 54-55, 77-79
Nutritional counseling - 39-45, 57-59, 70-73
Observation care - 132
Obstetrical care - 45-47, 71-73
Occupational therapy - 50, 73-79
Office visits - 39-40, 85-86
Online Health Coach (OHC) - 103
Oral surgery - 61
Organ/tissue transplants - 19-22, 61-63, 65-68
Orthopedic devices - 52, 59-61, 73-76
Osteoporosis screening - 134
Ostomy and catheter supplies - 54
Out-of-pocket expenses - 30, 133
Outpatient facility services - 73-76, 102
Outpatient professional services - 39-40, 85-86
Overpayments - 31
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 30, 107-109
Oxygen - 53-54, 70-79
Pap tests - 41-45
Participating providers - 29-30
Patient Safety and Quality Monitoring (PSQM) program - 89-90
Personal Health Record - 103
PET scans - 40-41, 73-76, 128
Pharmacotherapy - 39-40, 49
Physical examinations - 73-76, 111-112
Physical therapy - 50, 73-79
Physician - 16, 123, 126, 130, 133
Plan allowance - 29, 132-133
PPO - 13-14, 17-18, 133
Pre-admission testing - 70-71
Precertification - 19-22, 24-26, 56-57, 69, 76-77, 85, 87,133-134
Preferred providers - 13-14, 16, 104
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 93-100
Drugs from other sources - 100
Generic drugs - 93-100
Preferred retail pharmacies - 93-100, 114
Retail Pharmacy Program - 89-90, 108-109
Self-injectable drugs - 93-100
Specialty Drug Pharmacy Program - 89-90, 93-100, 114
Specialty drugs - 93-100, 134
Preventive carePrimary care provider (PCP) - 34 Drugs from other sources - 100
Generic drugs - 93-100
Preferred retail pharmacies - 93-100, 114
Retail Pharmacy Program - 89-90, 108-109
Self-injectable drugs - 93-100
Specialty Drug Pharmacy Program - 89-90, 93-100, 114
Specialty drugs - 93-100, 134
Prior approval - 19-25, 40-44, 49, 53-54, 56-59, 61-63, 66-69, 73-80, 85-86, 89-90, 134
Professional providers - 16
Prostate cancer - 41-44
Prosthetic devices - 52, 57-59, 70-71, 73-76
Psychotherapy - 85-88
Pulmonary rehabilitation - 49, 73-76
Radiation therapy - 49, 73-76
Reconsiderations - 27, 116-118
Replacement coverage - 11-12
Reproductive services - 47-48, 128Residential treatment center (RTC) - 17-19, 24-26, 76-77, 87
Rights and responsibilities - 13-14
Room and board - 70-71, 76-77, 87
Routine Annual Physical Incentive Program - 106
Screening services - 134
Second surgical opinion - 39, 40
Self-injectable drugs - 89-100
Skilled nursing facility (SNF) care - 77, 129
Smoking cessation - 55, 93-100
Social worker - 104
Specialty Drug Pharmacy Program - 93-100, 108-109, 114
Specialty drugs - 89-100, 134
Speech therapy - 50, 73-79
Speech-generating devices - 53-54
Stem cell transplants - 19-22, 61-63
Sterilization procedures - 47, 57-59
Subrogation - 120-121, 135
Substance use disorder - 85-88
Surgery - 17-22, 51-52, 56-69, 129
Assistant surgeon - 18
Eye: cataract, amblyopia, strabismus - 57-59
Gender affirming - 19-24, 57-59
Multiple procedures - 56-59
Oral and maxillofacial - 61
Outpatient - 57-59, 73-76
Reconstructive - 19-22, 59-61
Sterilization, reversal of voluntary - 47, 57-59
Surgical implants - 52, 73-76
Surgical treatment of morbid obesity - 19-22, 57-59
Transplants - 19-22, 61-68
Syringes - 93-100Eye: cataract, amblyopia, strabismus - 57-59
Gender affirming - 19-24, 57-59
Multiple procedures - 56-59
Oral and maxillofacial - 61
Outpatient - 57-59, 73-76
Reconstructive - 19-22, 59-61
Sterilization, reversal of voluntary - 47, 57-59
Surgical implants - 52, 73-76
Surgical treatment of morbid obesity - 19-22, 57-59
Transplants - 19-22, 61-68
Telehealth
Dermatology - 39-40, 135
Mental health/substance use disorder - 85-86, 135
Minor acute conditions - 39-40, 131
Nutritional counseling - 41-45, 105
Temporary Continuation of Coverage (TCC) - 11-12Mental health/substance use disorder - 85-86, 135
Minor acute conditions - 39-40, 131
Nutritional counseling - 41-45, 105
Tobacco cessation - 55, 93-100
Transplants - 17-22, 49, 61-68
Travel benefit - 66-68,103
Treatment therapies - 49-50
TRICARE - 119-122 -
Ultrasounds - 40-41, 73-76
Urgent care center - 82-84
Urgent care claims - 25, 135
VA facility - 126
Vaccines - 41-45, 93-100
Verbal statements - 4, 27, 104
Vision services - 51-52
Waivers - 29
Weight control - 19-22, 57-59
Wheelchairs - 53-54
Wigs - 37, 52
WRAP benefits - 34-37
X-rays - 40-41, 73-76