None of us want to spend money if we don’t have to. That’s why it’s important to understand how your health plan works, so you can get the most benefit from your plan and avoid unnecessary out-of-pocket expenses.

Following are answers to some frequently asked questions about the BlueCare HMO plan to help you understand your benefits. If you have any other questions, please call the Customer Service number on your member ID card. We’re here for you.

Q: How can I control my out-of-pocket costs?
A: First, always stay within Health Options’ extensive network of participating doctors, hospitals and other health care providers. To make sure you’re using an in-network provider, check the provider directory on our website, www.bcbsfl.com, under “Find a Doctor or Hospital.” We try to keep our online provider directory as current as possible, but we strongly recommend you confirm network participation when you schedule an appointment.

Second, prior authorization is not required for emergency services and care. But if a determination is made that an emergency medical condition does not exist, follow-up care may be denied. Go to the hospital only in a life-threatening situation. If you need care for an acute condition outside of your primary care physician’s office hours, you can go to an urgent care center that participates with Health Options.

Q: What should I do if I get billed from my doctor for an outstanding balance?
A: You are responsible only for your regular copayment, deductible and applicable coinsurance, depending on your plan. As long as you always use doctors and other health care providers who participate in BlueCare, you should not be balance billed. If you do receive a bill from a participating Health Options doctor, call the Customer Service number listed on your BlueCare ID card.

If you have to go to a non-participating hospital emergency room while away from the service area, the hospital may bill you directly. In that case, simply send the unpaid bill to Health Options at the address on your BlueCare ID card, along with an explanation regarding the nature of the emergency. Please refer to your Agreement for the emergency services and care copayment.

Q: What's the difference between an emergency room and an urgent care center?
A: If you’re experiencing a life-threatening condition (can’t breathe, broken bones, head trauma, heart attack, etc.), go to the nearest hospital emergency room. If your condition isn’t life-threatening and your doctor’s office is closed, go to a participating urgent care center. These walk-in clinics offer late and weekend hours and can significantly reduce your out-of-pocket costs compared to a hospital emergency room; your copayment will be the same as if you saw a specialist. Consult our online provider directory at www.bcbsfl.com or call the telephone number listed on your BlueCare ID card to locate your nearest participating center.

Q: If I have an emergency and go to the hospital, do I need to do anything?
A: After you receive treatment, call your primary care physician (PCP) or have someone call for you as soon as possible. Follow-up care to treat your emergency condition must be coordinated by your treating physician (PCP or specialist). If follow-up care is not provided by, or coordinated by, your treating physician, coverage for that care may be denied and you may be responsible for the costs of that care. Do not seek follow-up care at the emergency room.

Q: What if I get sick when I’m out of town on business or vacation? Am I covered even if it isn’t an emergency?
A: For short trips, the BlueCard® Program gives you access to doctors and hospitals almost everywhere. Non-emergency services rendered outside the service area must be authorized in advance by Health Options in order to be covered. You can find local participating providers on the BlueCard Doctor and Hospital Finder website at www.bcbsfl.com, or call BlueCard Access at (800) 810-BLUE [2583]. When you arrive at the local Blue plan participating provider, present your BlueCare ID card. After you receive care from a participating provider, you should not have to complete any claim forms. Nor should you have to pay for medical services other than your usual out-of-pocket expenses (noncovered services, deductible, copayment and/or coinsurance).

Q: If I need laboratory testing, how can I make sure I’m covered?
A: Use Quest Diagnostics for all your laboratory services. They are the participating lab for BlueCare members. To locate the nearest Quest facility, consult our online provider directory at www.bcbsfl.com or call the telephone number listed on your BlueCare ID card.

Q: Can I change my PCP? If so, how do I do that?
A: You may change your PCP by selecting a new one from our online provider directory. By using MyBlueService, our member self-service center, you can submit the request online anytime, day or night. Or you can call Customer Service during regular business hours at the telephone number on your BlueCare ID card to make the change.

If you make the change before the 15th day of the month, the effective date will be the first day of the following month. For requests made after the 15th, the change will not be effective until the first day of the second month. For example, if you request the change on November 10, the effective date of the change will be December 1. If you request the change on November 20, the effective date of the change will be January 1.

Q: Can I use the Internet to communicate with my doctors?
A: Yes, if you and your doctor have signed up for our e–Medicine program. Blue Cross and Blue Shield of Florida is the first health plan in the state to offer you totally secure and confidential Internet access to your doctors for nonurgent medical needs. Hundreds of doctors are already participating. If your doctor’s office is participating, you can schedule or change an appointment, ask a simple question, get a referral when applicable for a specialist, receive lab and test results, request medication refills and receive targeted preventive care reminders when it’s most convenient for you—any time of the day or night.

Depending on your particular BlueCare plan, you also may be covered for an online medical consultation, or webVisit®. If so, you will pay the same out-of-pocket amount as you would for a face-to-face office visit with your doctor. Your doctor may not complete the online consultation if he or she decides you need to be seen.

To sign up for the service, go to our website, www.bcbsfl.com, and click on Members, then Products, Plans & Services and e–Medicine.

Q: If I want to get a second opinion, will the doctor’s charges be covered?
A: Charges for a second medical opinion will be covered from a participating physician in your service area when certain circumstances apply:

• You disagree with Health Options, your PCP or a contracting specialist’s opinion about the necessity of surgical procedures.
• You are subject to a serious injury or illness.
• You feel you are not responding satisfactorily to treatment.

In addition, Health Options may require you to get a second medical opinion. Please refer to your agreement for details.

If you want a second medical opinion from a non-participating physician, it must be authorized by your primary care physician prior to services being rendered.

Q: My dependent child is away at college. Can she still be covered under my HMO plan even though she’s out of the plan’s service area?
A: Yes. In most areas she can be covered under the Away From Home Care® Program. It’s designed to give you peace of mind if you have a dependent attending school out-of-state, have family members living in different service areas or have a long-term work assignment in another state—90 consecutive days or longer. Coverage is limited to another Blue Plan’s HMO service area and available in most states. To sign up, simply call the Customer Service number on your BlueCare ID card.