Frequently Asked Questions

Yes. Check out Classic Blue's Available Benefits for additional information on your coverage.

If you go to an emergency room for treatment of an emergency, your benefits will be the same, regardless of whether you use a participating or nonparticipating provider. If you are admitted to the hospital from the emergency room, your initial hospital admission is eligible for inpatient benefits. If you are held for observation, outpatient benefits apply. Once you are admitted as a hospital inpatient, your benefits will be paid like any other inpatient hospital or physician charges. However, you may need to transfer to a participating hospital once your condition has been stabilized.

Blue Cross and Blue Shield's traditional BlueCard program allows members residing outside of the North Carolina service area to visit participating providers and take advantage of the savings that the local Blue Cross and Blue Shield plan has negotiated with doctors and hospitals in that area. You should not have to pay any amount above these negotiated discounts. The provider will file the claim to BCBSNC. You may also visit www.bcbs.com to obtain detailed information about the program as well as check for BlueCard participating providers by specialty and geographic location.

If you need to fill a prescription, BCBSNC offers a comprehensive pharmacy network within the 50 United States and you will receive the in-network level of prescription drug benefits at any participating pharmacy. Call BCBSNC Customer Service at 1-877-258-3334 to identify participating pharmacies in the 50 United States. For non-participating pharmacies you will receive out-of-network benefits. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately. Please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Blue Cross and Blue Shield's traditional BlueCard program offers cost-effective, quality health care for covered members traveling outside of North Carolina. You may call toll-free 1-800-810-BLUE to find participating providers anywhere in the United States. You may also visit www.bcbs.com to obtain detailed information about the program as well as check for BlueCard participating providers by specialty and geographic location. Make sure to show your ID card to identify yourself as a Blue Cross and Blue Shield member. The participating provider will file the claim for you.

If you need to fill a prescription, BCBSNC offers a comprehensive pharmacy network within the 50 United States and you will receive the in-network level of prescription drug benefits at any participating pharmacy. Call BCBSNC Customer Service at 1-877-258-3334 to identify participating pharmacies in the 50 United States. For non-participating pharmacies you will receive out-of-network benefits. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Blue Cross and Blue Shield's traditional BlueCard program allows members traveling outside or temporarily residing outside of the North Carolina service area to visit participating providers and take advantage of the savings that the local Blue Cross and Blue Shield plan has negotiated with doctors and hospitals in that area. You should not have to pay any amount above these negotiated discounts. The provider will file the claim to BCBSNC.

In addition, BlueCard Worldwide offers Classic Blue members the ability to receive in-network benefits for inpatient health care at participating hospitals in major travel destinations and business centers throughout the world. You can find out which providers participate by calling toll-free 1-800-810-BLUE. You can also visit www.bcbs.com to access the BlueCard Doctor and Hospital Finder. The member is responsible for contacting BCBSNC for any care requiring precertification.

If you need to fill a prescription, BCBSNC offers a comprehensive pharmacy network within the 50 United States and you will receive the in-network level of prescription drug benefits at any participating pharmacy. Call BCBSNC Customer Service at 1-877-258-3334 to identify participating pharmacies in the 50 United States. For non-participating pharmacies you will receive out-of-network benefits. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

Blue Cross and Blue Shield's traditional BlueCard program allows members traveling outside or temporarily residing outside of the North Carolina service area to visit participating providers and take advantage of the savings that the local Blue Cross and Blue Shield plan has negotiated with doctors and hospitals in that area. You should not have to pay any amount above these negotiated discounts. The provider will file the claim to BCBSNC.

In addition, BlueCard Worldwide offers Classic Blue members the ability to receive in-network benefits for inpatient health care at participating hospitals in major travel destinations and business centers throughout the world. You can find out which providers participate by calling toll-free 1-800-810-BLUE. You can also visit www.bcbs.com to access the BlueCard Doctor and Hospital Finder. The member is responsible for contacting BCBSNC for any care requiring precertification.

If you currently cover your dependent(s) under a Classic Blue plan, your dependent(s) moving out-of-state will continue to be covered until age 26 (in most cases). Please review your Member Guide or consult your employer regarding dependent eligibility requirements.

Emergency coverage is the same whether your dependent seeks care in-state or out-of-state. In case of an emergency, call 911 or go to the nearest hospital for treatment.

For urgent or follow-up care, your dependent(s) are encouraged to call 1-800-810-BLUE to find a participating BlueCard provider in the state where they're seeking treatment.

If your dependent needs to fill a prescription, BCBSNC offers a comprehensive pharmacy network within the 50 United States and they will receive the in-network level of prescription drug benefits at any participating pharmacy. Call BCBSNC Customer Service at 1-877-258-3334 to identify participating pharmacies in the 50 United States. For non-participating pharmacies you will receive out-of-network benefits. (In some cases, employer groups carve out the prescription drug benefit and contract with a vendor separately, please refer to your Member Guide to confirm that your pharmacy benefits are offered through BCBSNC.)

As a Classic Blue member, you may visit any provider. Participating providers will not bill you any amounts over the allowed amount of charges. You can locate participating providers by visiting our online Provider Search or by calling Customer Service at 1-877-258-3334.

Yes, you may visit any provider. However, BCBSNC will pay only up to the allowed amount. Nonparticipating providers may bill you the difference between what BCBSNC pays and the actual charge.

Prior Approval
All private duty nursing, skilled nursing facility admissions and inpatient hospital admissions require certification with two exceptions - maternity (including newborn nursery care) and emergency.

For maternity admissions, your doctor is not required to obtain certification from BCBSNC for prescribing a length of stay up to 48 hours for a normal vaginal delivery or up to 96 hours for delivery by cesarean section. You or your doctor must request certification for coverage for additional days. Although no certification is required for emergency situations, please notify BCBSNC of your inpatient admission as soon as reasonably possible.

In addition, BCBSNC also requires prior approval for certain health care services. For more information, please refer to our Prior Approval List.

Services for mental health and substance abuse must be approved in advance by Magellan Behavioral Health.

Referrals
You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. However, some participating specialists may require a new patient introduction from your treating doctor. BCBSNC recommends that you take advantage of your primary care provider's expertise in coordinating your care.

Prior Approval
Your participating primary care provider or specialist will coordinate prior approvals or pre-certification for hospital admissions for you. You may want to check with your participating provider to make sure certification has been obtained.

The member should work with their provider to get authorization for private duty nursing, skilled nursing facility admissions and inpatient hospital admissions.

Referrals
You do not need to get a referral from your primary care provider to receive covered services from a participating specialist. However, some participating specialists may require a new patient introduction from your treating doctor.

If you receive a bill for inpatient, outpatient or professional medical care received outside the United States, send the bill with an international claim form to our foreign claims center at: BlueCard Worldwide Service Center P. O. Box 90320 Richmond, VA 23230 You may view a listing of participating hospitals or obtain an international claim form at http://www.bcbs.com/bluecardworldwide/index.html. The BlueCard Worldwide Service Center translates foreign claims and calculates the foreign exchange rate. The Service Center then forwards the claim to BCBSNC to be processed. If you receive a foreign medical bill for prescription drugs, outpatient hospital services or other medical services that you received outside of the United States, please file those claims directly to BCBSNC.

Yes. You may be reimbursed for prescription drugs that you received from a non-participating pharmacy, but you may have to pay full charges at the pharmacy and file the claim. You will be responsible for paying the copayment amount (or other member liability such as coinsurance or deductible) plus any charges exceeding the allowed amount.