Part 1 – Member Services (continued) WORDS IN ITALICS ARE EXPLAINED IN PART 2. Page 3 Subscriber Certificate for the times when in-network benefits will be provided if you receive covered services from a covered provider who is not a preferred provider. When You Need Help to Find a Health Care Provider There are a few ways for you to find a health care provider who participates in your health care network. At the time you enroll in this health plan, a directory of health care providers for your specific plan option will be made available to you at no additional cost. To find out if a health care provider participates in your health care network, you can look in this provider directory. Or, you can also use any one of the following ways to find a provider who participates in your health care network. You can: Call the Blue Cross Blue Shield HMO Blue customer service office. The toll free phone number to call is shown on your ID card. They will tell you if a provider is in your health care network. Or, they can help you find a covered provider who is in your local area. Call the Blue Cross Blue Shield HMO Blue Find a Doctor support line at 1-800-821-1388. Use the Blue Cross Blue Shield HMO Blue online physician directory (Find a Doctor). To do this, log on to www.bluecrossma.org. This online provider directory will provide you with the most current list of health care providers who participate in your health care network. If you or your physician cannot find a provider in your health care network who can furnish a medically necessary covered service for you, you can ask Blue Cross Blue Shield HMO Blue for help. To ask for this help, you can call the Blue Cross Blue Shield HMO Blue customer service office. They will help you find providers in your health care network who can furnish the covered service. They will tell you who those providers are. If there is not a provider in your health care network who can furnish the covered service, Blue Cross Blue Shield HMO Blue will arrange for the covered service to be furnished by another health care provider. If you are looking for more specific information about your physician, the Massachusetts Board of Registration in Medicine may have a profile. To see this profile, you can log on to www.massmedboard.org. When You Are Traveling Outside of Massachusetts If you are traveling outside of Massachusetts, you can get help to find a health care provider. Just call 1-800-810-BLUE. You can call this phone number 24 hours a day for help to find a health care provider. When you call, you should have your ID card ready. You must be sure to let the representative know that you are looking for health care providers that participate with the BlueCard PPO program. Or, you can also use the internet. To use the online “Blue National Doctor & Hospital Finder,” log on to www.bcbs.com. (For some types of covered providers, a local Blue Cross and/or Blue Shield Plan may not have, in the opinion of Blue Cross Blue Shield HMO Blue, established an adequate PPO health care network. If this is the case and you obtain covered services from this type of covered provider, the in-network benefit level will be provided for these covered services. See Part 8 in this Subscriber Certificate.) If you are outside the United States, Puerto Rico, and the U.S. Virgin Islands, there are no local Blue Cross and/or Blue Shield Plans. But, you can still call 1-800-810-BLUE. (Or, you can call collect at 1-804-673-1177.) In this case, the Blue Cross Blue Shield Global Core Service Center can help you to access a health care provider. Then, if you are admitted as an inpatient, you should call the service center and the hospital should submit the claim for you. (See Part 9.) Your Identification Card After you enroll in this health plan, you will receive an identification (ID) card. The ID card will identify you as a person who has the right to coverage in this health plan. The ID card is for identification purposes only. Under federal law, your ID card is required to include information about applicable
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