Here's what we're doing for our members
Blue Cross NC is taking steps to help our members prepare, stay healthy and get the care they need. We will continue to respond to this crisis to best serve our members and support doctors, nurses and hospitals.
COVID-19 (Coronavirus) - 5 Steps We're Taking to Support Members
The vaccine will be available at no cost to all members
Coverage for Telehealth, phone, or virtual visits with primary care and specialty doctors
No cost-sharing for COVID-19 doctor visits, testing and related treatments1
Members with COVID-19 will have no prior authorization for tests and services deemed necessary by the CDC
Members will need no prior authorization for COVID-19 testing or services related to COVID-19
Don't delay. Get the care you need now.
It’s important to keep your total health top-of-mind during this time. If you have a chronic illness, an emergency or need health care for something else, don’t delay your care. Call your doctor to learn any protocols they are following and schedule visits that you feel comfortable with. Ask about virtual visits or contactless waiting to make sure you get the care you need in a way that you feel safe. Doctor’s offices are following strict health and safety guidelines to make sure you can feel comfortable getting routine care.
Care that should not be delayed:
- Flu Shots
- Routine Physicals
- Cancer Screenings
- Childhood Vaccinations
- Mental Health Screenings and Treatment
- Preventive Care
We are committed to carrying out actions to assist our members and community in the face of COVID-19. We will continue to reevaluate and take recommendations from the CDC into consideration.2
COVID-19 Vaccine Coverage
The COVID-19 vaccine will be available at no cost to all Blue Cross NC members. This means you’ll pay nothing out of pocket for the vaccine once it’s available.
Even after the COVID-19 crisis has ended, the vaccine will still be covered for you at no cost as part of our preventive care benefits. This is similar to a yearly flu shot or other vaccinations.
The COVID-19 vaccine will be available to the public in phases. These phases have been determined by the Federal Government and NCDHHS.
You can find all the information regarding each phase on the North Carolina Department of Health and Human Services (NCDHHS ) website.
Members who live outside North Carolina will need to follow their local and state guidelines to figure out when and how they can receive the vaccine.
Covering virtual doctor's visits and care (Telehealth)
We are increasing your ability to use virtual (video or over-the-phone) appointments with your in-network doctor.3
Blue Cross NC will cover all telehealth visits at the same cost as face-to-face visits. This means, what you normally pay when you visit a doctor in-office is what you’ll pay for a telehealth visit.
Virtual (or telehealth) visits can be used with your primary care doctors, specialists, and behavioral health providers. Or any licensed NC provider who can provide telehealth services.
To use your telehealth benefits you should:
- Call your doctor before going into the office to see if telehealth is available. This will help prevent the spread of illness.
- Make sure the doctor you are using is in-network. These benefits are only for in-network doctors.
- Check to see if you have MDLive or Teladoc services. You can find this information on your ID card.
Eligible fully insured group and IU65 members can earn a $25 gift card from Blue RewardsSM by activating your MDLIVE account*. Just visit mdlive.bcbsnc.com - or text "bcbsnc" to MDLIVE (635483) to set up your account with help from Sophie, MDLIVE's personal health assistant chatbot.
No prior approval on COVID-19 testing
COVID-19 tests will not need prior approval. That means, your doctor doesn’t need to ask us for approval before you’re tested for COVID-19.
If you think you have COVID-19, please call your doctor. Be ready to answer questions about your symptoms and if you could have been exposed to the virus.
Coverage and no cost-sharing for COVID-19 testing and treatment
Blue Cross NC will provide coverage and will not apply cost-sharing for COVID-19 tests and COVID-19 treatments. This means, if you get tested for COVID-19 and/or have the virus, you won’t pay anything out of pocket for COVID-19 related treatment. See the full details below.
COVID-19 Doctor Visits and Testing4
We will provide coverage and waive your out-of-pocket costs (like deductibles, copays, and coinsurance) for any doctor’s visit you have to determine if you have COVID-19.
We will also cover all COVID-19 related visits whether virtually, outpatient, urgent care, or ER visits.
We will cover, at no cost-share to you, COVID-19 testing methods that meet all three criteria:
- It’s ordered by a doctor or health care provider
- Your doctor has deemed it medically necessary in order for them to provide you with the right care and treatment
- Has been cleared, approved, or given emergency authorization (EUA) by the U.S. Food and Drug Administration (FDA).
Most testing prescribed by your doctor will automatically meet these requirements with no additional work from you.
COVID-19 Related Treatment5:
These changes are in place until March 31, 2021. We are constantly evaluating the virus to see if they should be extended.
Blue Cross NC is waiving cost-sharing (how much you pay out of pocket) for all COVID-19 related treatments for both in-network and out-of-network providers. All doctors providing COVID-19 care will be paid as in-network – whether they are or not. This means, you’ll have more flexibility and less hassle finding care during this difficult time – you can see any doctor you need to in order to get care.
If you receive a bill from an out-of-network doctor that tells you that you owe more money for COVID-19 related care, please call the customer service number on the back of your ID card for help.
*Medicare members will need to submit a refund request for COVID-19 medications. The form is available here.
What is Cost Sharing?
Cost sharing means you pay some of your health care costs and your insurance company pays some of your health insurance costs. Your costs are usually better known as copays, deductible, or coinsurance. No cost share would mean Blue Cross NC covers all your costs except your premium payment.
No prior approval on COVID-19 treatment
The following change is in effect through March 31, 2021.
Blue Cross NC won’t require prior approval for any care you receive if you are diagnosed with COVID-19.
We are waiving all prior authorization for emergency hospital stays, medical equipment and post-hospital care that are needed to treat COVID-19. This is for all our members.6 This means, you don’t need to get approval for any of these services before we will cover them.
Updates for members on employer plans
The Department of Labor and the IRS are offering more relief to group members on an employer plan.
Group members now have an extra 60 days after the COVID-19 pandemic is over to:
- Submit a claim for out-of-network services - this could be both by the member or directly from the out-of-network provider
- Appeal a claim
You can also submit claims or an appeal for any service on or after March 1, 2020 that normally would have expired. We will review your request based on your current plan benefits.
This extension does not apply to State Health Plan, FEP, Medicare or Individual plans - including Dental and Vision.
Updates for skilled nursing facilities and residential treatment centers
Due to the spike in COVID-19 cases and hospitalizations, we will waive prior authorization requirements for all conditions, including non-COVID-19 conditions, and require notification only for covered services incurred at in-network skilled nursing facilities (SNFs) and residential treatment centers (RTCs).
This temporary change is effective Dec. 21, 2020 and will be reevaluated and automatically renewed every 30 days, as needed, through March 31, 2021.
This waiver only applies to services incurred at in-network SNFs or RTCs for members discharging from inpatient level of care. Medical necessity review is required for length-of-stay extensions beyond the days allowed on the initial approval.
This measure applies to fully insured, self-funded employer groups (including State Health Plan) and all Medicare Advantage plans offered or administered by Blue Cross NC, including Experience Health. This does not apply to Federal Employee Program members.
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