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    • Welcome to MyBlue!
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          • The Value of Generic Medications
            • What is Generic Medication
            • Your Role: The Rx You Need
            • Helpful Resources
          • Pharmacy Management Program
            • Step Therapy
            • Quality Care Dosing
            • Prior Authorization
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"What Do I Do When..." 

Below you'll find simple answers to our members' most commonly asked questions. If you don't find the answer you are looking for, contact Member Service at the number on the front of your ID card.

Q.What do I do when I receive a Subscriber Claim Summary in the mail?

Your Subscriber Claim Summary explains how we processed a claim. It is not a bill, and you should not send any payment to us (if there is a balance listed, the health care provider will notify you of your responsibility).

The Subscriber Claim Summary includes the name of the health care provider who sent us the claim, the date of service, the type of service (lab, surgery, medical care, etc.) and the amount the provider charged for the service. It also includes any deductible, copayment, or co-insurance that applies, and any patient balance. Deductibles, copayments, or co-insurance are included on some health plans, and simply indicate how much you share in the cost of health care.

If you have questions about the services rendered, you should contact the health care provider. If you have questions about how any patient balance was determined, you can create an accountor login to view your account or check your member literature to determine coverage, including any applicable deductible, copayment, or co-insurance that might apply. If you have questions, please contact Member Service at the number on the front of your ID card.

Q.What do I do when I need a new ID card?

It's important to carry your ID card with you at all times. Your Blue Cross Blue Shield of Massachusetts card is recognized around the world. If you lose your card and need a replacement, simply create an account or login to Member Central to request a new card online, or call Member Service. If you have a family plan, and have access to another family member's ID card, please call the Member Service number shown on the front of the card. If you do not have access to another family member's card, you should call 1-800-462-5601.

Q.What do I do when I get married or have a baby?

Making changes to your membership is simple. If you have your coverage through your employer, simply contact your employer's benefits office to complete the appropriate form. If you have direct-payment coverage (e.g., Access BlueSM Saver II, HMO Blue® Basic Value), call Member Service at the toll-free number on the front of your ID card. We'll send you a form to complete and return. For all of our standard plans, we must receive notification within 30 days of the qualifying event.

Q.What do I do when my child goes to college?

As a result of the health care reform law in Massachusetts, changes have been made that affect dependent eligibility.

For more information, visit Health Care Reform.

Q.What do I do when my child turns 18?

If your child is approaching adulthood, it may be time to speak with them and their pediatrician about transitioning to a doctor with a focus in Adult, Family, or Internal Medicine.

If it's time for a new doctor, we can help! Check out our Find a Doctor & Estimate Costs tool to search hundreds of doctors and find the best one for your young adult.

Q.What do I do when I get a bill from my doctor?

When you receive a bill from your doctor, it is often for your copayment, co-insurance, or deductible. These are features of health plans, and basically have the member share in some of the cost of their health care. For example, some health plans require that the member pay $10 for an office visit and the rest is covered by the plan.

If you have additional questions, please call Member Service at the number on the front of your ID card. Be sure to have your ID number, health care provider's name, and the date of service handy when you call.

Q.What do I do when my specialist asks if I obtained a referral for my service?

Since all network specialists can verify if you have a referral electronically, you should not be asked if you obtained a referral. If you are ever asked, you should advise the specialist to check electronically or they can call Member Service at the number on the front of your ID card, and our Provider Services staff will assist them.

If you have a managed care plan (like HMO Blue or Blue Choice®), your primary care provider (PCP) provides or arranges for most of the care you need. If you require the care of a specialist, in most cases you must obtain a referral from your PCP to receive coverage.

Q.What do I do when I want to know if something is covered?

Create an account or login to Member Central to review your Summary of Benefits or check your benefit materials (In most cases, this is called either the Member Handbook, Subscriber Certificate, or the Summary Plan Description.) Materials are organized in general categories like inpatient care, outpatient care, surgery, medical equipment, prescription drugs, etc. Virtually all questions can be answered with a quick check of your benefit materials.

If you have additional questions or concerns, please contact Member Service at the number on the front of your ID card. When you call, it is important for you to know the specific type of service involved so that a representative can help you.

Q.What do I do when I have more than one health plan to choose from?

Everyone has different priorities, and therefore their needs in a health plan can differ. However, here are some key elements that most everyone would find important in the benefits of a health plan:

  • Does the provider network include your physician and hospital?
  • Can your physician make referrals to specialists without first checking in with the health plan?
  • Is the health plan recognized across the country and around the world?
  • Does the health plan cover the services you are interested in receiving?
  • Does the health plan have convenient customer service hours?
  • What are the special features of being a member (for example, health club reimbursement and discounts on complementary medicine services)?
Q.What do I do when I get a survey asking about my other health insurance?

People sometimes have insurance coverage under more than one health plan, so we periodically send a survey to our members asking them if they have other coverage. This is to ensure that claims are processed correctly and that overpayments are not made. We see significant cost savings by coordinating payments with other insurers—savings that ultimately result in more affordable premiums for our members.

When you receive a survey, it's important that you complete and return it so that we have the most up-to-date information and can process your claims correctly. We make it easy for you to reply by providing postage-paid return envelopes and 24-hour telephone reply options.

 

Q.What do I do if I get a survey asking whether or not I'm satisfied with my health plan?

We regularly survey a random sample of our members to determine how satisfied they are with the coverage and services we provide. By listening to this feedback, we have taken steps to bring satisfaction to world-class levels. If you do receive a survey, please complete and return it. Your participation is critical to the direction we take on coverage and service issues.

Q.What do I do if I disagree with a decision that Blue Cross Blue Shield of Massachusetts made?

We don't expect that you will ever have a concern, but if you do, most issues can be handled with just one phone call. For help resolving a problem or concern, please first call Member Service at the toll-free number on the front of your ID card. A Member Service representative will work with you to help you understand your coverage and resolve your problem or concern as quickly as possible. If you disagree with the resolution provided by the Member Service representative, you may request a review through our formal Appeal and Grievance Program.

 

Q.What to do when I move and need to change my address?

Please contact your Human Resources department to ensure that they have your new address on file. Periodically, your employer will submit updated enrollment information to Blue Cross Blue Shield of Massachusetts. If your Human Resources department has your old address on file, your new address may be overwritten.

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ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-472-2689 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar  1-800-472-2689 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-472-2689  (TTY : 711 ).

注意:如果您讲中文,我们可向您免费提供语言协助服务。请拨打您 ID  卡上的号码联系会员服务部 通话 1-800-472-2689(TTY  号码:711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-472-2689 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-472-2689 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов  1-800-472-2689 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ  វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្  រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ  វាសមា  ជិកតាមល េខន  ៅល.  ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-472-2689 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata  1-800-472-2689 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-472-2689 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-472-2689 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-472-2689 (TTY: 711 ).

ध्यान दें: य दि  आप ह िन् दी बोलते ह ैं, तो भा षा  सहाय  ता  सेवा एँ, आप के लि ए नि :शुल्क  उपलब्ध ह ैं। सदस्य  सेवा ओं को आपके आई.डी. कार  ्ड पर दि ए गए नंबर पर कॉल करें  कॉल 1-800-472-2689 ( टी .टी .वा ई.: 711).

ધ્યાન આપો:  જો તમે ગુજરા તી બોલતા  હો, તો તમને ભા ષા કીય  સહાય  તા  સેવા ઓ વિ ના  મૂલ્યે  ઉપલબ્ધ છે. તમા રા  આઈડી કાર  ્ડ પર આપેલા  નંબર પર Member Service  ને કૉલ કરો કૉલ કરો 1-800-472-2689 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-472-2689 (TTY: 711 ).

お知らせ:日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-472-2689(TTY: 711 )。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-472-2689 (TTY: 711 ).

ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-472-2689 (TTY: 711).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-472-2689 (TTY: 711).

BAA !KOHWIINDZIN DOO&G&: Din4 k’ehj7 y1n7[t’i’go saad bee y1t’i’ 47 t’11j77k’e bee n7k1’a’doowo[go 47 n1’ahoot’i’. D77 bee an7tah7g7 ninaaltsoos bine’d44’ n0omba bik1’7g7ij8’ b44sh bee hod77lnih call 1-800-472-2689 (TTY: 711).