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Frequently Asked Questions:
Arkansas Blue Cross and Blue Shield Plans
*Note: Your health-plan type is listed on the front of your
member ID card.
General
- How do I file a claim?
- Is there a grace period on the billing?
- How do I mail a claim?
- How do I request an appeal?
- If I think an error has been made on my claim, how do I ask
for a review?
- If I have questions about claim status or benefits, whom
do I contact?
- If I have questions about the Explanation of Benefits (EOB), whom
do I contact?
- Why do you want to know if I have other coverage?
- I received my monthly premium statement. Why was my last month's
premium payment not posted?
- Why didn't I get my premium statement this month?
- What Arkansas schools are approved for dependent students?
Medical Benefits
- Do you cover gastric bypass?
- What is preadmission notification (sometimes referred to
as precertification or prenotification) and when is it needed?
- If I go to the emergency room and they admit me, do I have
to pay the copayment?
- What is BlueCard®?
Group Maternity FAQ's
- My husband’s employer is changing insurance plans next month, and I am 4 months pregnant. Will my pregnancy be covered under his new plan?
- My doctor wants me to have an ultrasound. Is this covered?
- My doctor and the hospital want me to pay my coinsurance portion before I have the baby. How much will I be responsible for?
- If my pregnancy goes into a new calendar year, will I have to pay two deductibles to my doctor?
- Does Arkansas Blue Cross and Blue Shield cover midwife services?
- What services are covered under my maternity benefits?
- Does Arkansas Blue Cross and Blue Shield cover epidurals?
General
1. How do I file a claim?
Most providers will file your claim for you. Discuss filing arrangements with the
provider. Be sure the provider has your most current insurance information. Showing
the provider a copy of your ID card, while not a guarantee of benefits,
will assist the provider in completing the claim form properly. The Schedule of
Benefits mailed to you with your ID card has helpful general information that may
benefit providers. Give your provider a copy of this schedule.
You can file a claim when a provider is not filing the claim for you. Contact your
local Arkansas Blue Cross and Blue Shield office for a Claim Form or call the number
on the back of your ID card. Instructions for filing are on the back
of the Claim Form. All bills should be itemized, submitted on the provider's invoice
or stationary, and attached to the Claim Form. A separate form must be submitted
for each patient.
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2. Is there a grace period on the billing?
There is a 30-day grace period on the billing from the due date.
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3. How do I mail a claim?
Mail a completed Claim Form, along with the attached itemized bills, to:
Arkansas Blue Cross and Blue Shield
P O Box 2181
Little Rock AR 72203-2181
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4. How do I request an appeal?
If a claim for payment is denied, the member must ask for an appeal in writing within
180 days after notification of the denial of benefits. Send your request to:
Appeals Coordinator of Arkansas Blue Cross and Blue Shield
P.O. Box 2181
Little Rock AR 72203-2181
Submit issues and comments as well as any additional information relevant to your
claim with your request. A complete review will be made of all information. You
will receive a final decision in writing within 60 days after your request is received
unless special circumstances require extensive review.
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5. If I think an error has been made on my claim, how do
I ask for a review?
After you receive the Explanation of Benefits (EOB), if you need clarification of
the action taken, you should write or call Customer Service. The telephone number and
address are located on the front of this notice. Provide your ID number and refer to the claim number (Claim #) indicated on the upper portion of
the EOB. When calling, having the form in hand will save time.
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6. If I have questions about claim status or benefits,
whom do I contact?
For assistance, call the customer service number that appears on your ID
card.
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7. If I have questions about the Explanation of Benefits (EOB),
whom do I contact?
For assistance with claim inquiries, consult your ID card for
the customer service telephone number or the mailing address.
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8. Why do you want to know if I have other coverage?
A decision must be made as to which coverage is responsible for primary payment.
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9. I received my monthly premium statement. Why was my last
month's premium payment not posted?
Your last month's premium payment was most likely received and posted after the
statements were printed.
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10. Why didn't I get my premium statement this month?
If you have not received your statement by the end of the month, call Customer Service
at the number noted on the back of your member ID card.
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11. What Arkansas schools are approved for dependent
students?
A list of all approved schools is available in portable document format (PDF). You
may print and copy the list as needed.
Arkansas Blue Cross and Blue Shield Approved Accredited Schools (15 KB PDF)
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Medical Benefits
1. Do you cover gastric bypass?
Gastric bypass procedures require prior approval. To obtain prior approval, send
provider's written request to:
Arkansas Blue Cross Blue Shield
Attn: Medical Audit and Review
PO Box 2181
Little Rock, AR 72203-2181
Fax: 501-378-6647
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2. What is preadmission notification (sometimes referred
to as precertification or prenotification) and when is it needed?
Consult your benefit booklet or contact the customer service number on your ID card to determine if you are subject to prenotification or precertification
prior to certain medical services.
Preadmission notification is the requirement to contact the insurance plan before
being admitted to a hospital for inpatient care, or within two business days following
an emergency hospital admission. Preadmission notification provides information
to help determine if case management would be an appropriate option for the member.
Preadmission notification is not required for outpatient treatment or any in-state,
in-network inpatient admissions. Preadmission notification is also not required
for maternity admissions unless your medical condition requires you to stay more
than 48 hours after a vaginal delivery or 96 hours after a cesarean section.
If your inpatient admission does not fall within the described exceptions previously
mentioned, your policy may require preadmission notification. You, your admitting
physician, or the hospital would need to contact Integrated Health, the Arkansas
Blue Cross and Blue Shield preadmission notification vender, by calling 1-800-451-7302.
Failure to provide proper preadmission notification can result in a reduction in
contract benefits.
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3. If I go to the emergency room and they admit me, do I
have to pay the copayment?
No, if you are admitted to the hospital within 23 hours for observation or to the
hospital.
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4. What is BlueCard®?
BlueCard is a national program that
enables access (with discounts) to the participating providers of various Blue Cross
and Blue Shield plans. Contact your employer, or call the customer service
number on your ID card to determine if you participate in this program.
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Group Maternity FAQ's
1. My husband’s employer is changing insurance plans next month, and I am 4 months pregnant. Will my pregnancy be covered under his new plan?
Yes. Pregnancy does not fall under the pre-existing condition limitations of a group
health insurance plan that has maternity coverage. Your pregnancy will be covered
from the first day of your husband’s new plan with Arkansas Blue Cross and Blue Shield. Any
charges before you became effective with Arkansas Blue Cross and Blue Shield
would not be covered.
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2. My doctor wants me to have an ultrasound. Is this covered?
We cover ultrasounds if they are medically necessary. This means there must be a specific
medical reason for this test. We also cover one routine ultrasound, such as those to
check the sex of the baby. Additional routine ultrasounds are not covered.
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3. My doctor and the hospital want me to pay my coinsurance portion before I have the baby. How much will I be responsible for?
All charges will be subject to your yearly deductible and coinsurance. Both the doctor and
hospital will prepare an estimate and ask you to pay a specified amount, based on that estimate. We
are not involved in that process, and all financial arrangements are made between the healthcare
providers and insured.
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4. If my pregnancy goes into a new calendar year, will I have to pay two deductibles to my doctor?
No. Your doctor will not file a claim until after you have delivered the baby. We will just apply one deductible to your
maternity claims.
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5. Does Arkansas Blue Cross and Blue Shield cover midwife services?
Yes, coverage is provided through the employing physician for services provided by a certified nurse
midwife employed by a physician.
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6. What services are covered under my maternity benefits?
Physician visits and all necessary lab work are covered under your maternity benefits.
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7. Does Arkansas Blue Cross and Blue Shield cover epidurals?
Yes, we do cover epidurals.
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