Updates to the Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Preauthorization Lists (2024)

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Recap of Options Offered During the 2016 Open Enrollment Period

February23,2016

January 31 marked the end of the third annual enrollment period through the Health Insurance Marketplace. Blue Cross and Blue Shield of Texas (BCBSTX) remained committed to providing all Texans with sustainable health plan options that meet the varying needs of the state's population and contribute to the state's overall health. BCBSTX offers health insurance in all 254 counties in Texas and is the only health insurance provider offering individuals access to health insurance through the Federal Health Insurance marketplace in 58 of those counties.

2016 Individual Network Options
Individual members are those who buy their own insurance that is not provided by an employer or through a government program (Medicare, Medicaid, or CHIP). The following options were offered to individual members:

  • BCBSTX offered its Blue Advantage (BAV) HMOSM again to individual members both on and off the Health Insurance Marketplace.
  • BCBSTX offered the new Blue Advantage PlusSM HMO plan with added Point of Service (POS) benefits to individual members both on and off the Health Insurance Marketplace. This new HMO utilizes the Blue Advantage HMO network of doctors and hospitals while still having out-of-network benefits.
  • BCBSTX also offered Blue Cross Blue Shield Premier 101SM, a multi-state plan that utilizes the Blue Advantage HMO network; and has the same preauthorization requirements as Blue Advantage HMO. Blue Cross Blue Shield Premier 101 is only available to Individual members on the Health Insurance Marketplace.
    Please Note: Multi-State Plans are designed to increase consumer options on the exchanges. They are only available in the Individual market segment, through the Public Exchange. Multi-State Plans are bound by the same ACA regulations as other Qualified Health Plans, i.e., Essential Health Benefits, Out of Pocket Maximum regulations, etc.

Small Business Health Options Program (SHOP) Options
BCBSTX will continue to offer the Blue Choice PPO to small group members on the Small Business Health Options Program (SHOP). Small Group members will also still have access to our Blue Advantage HMO product. As a reminder, the terms of your BCBSTX agreements apply to plans offered on and off the SHOP. The terms of the agreement also require providers to offer their services to a BCBSTX member, regardless of where they purchased their coverage.

Identifying Your Patients' BCBSTX Insurance Plan
To identify your patient's BCBSTX plan, please view our sample ID cards. Plan specific alpha prefixes are assigned to every Blue Cross Blue Shield (BCBS) plan and start with X, Y, Z or Q. The first two positions indicate the BCBS Plan to which the member/subscriber belongs, while the third position identifies the product in which the member/subscriber is enrolled. Note: ZG identifies the Texas Plan.

  • To identify a patient who has the BAV HMO plan look for the alpha prefix or Texas alpha prefix which will start with “ZG*”" on the member ID card. The first two positions indicate the Plan to which the member/subscriber belongs while the third position identifies the product in which the member/subscriber is enrolled.
  • To identify a patient who has the BAV Plus, look for alpha prefix "ZGN" on the member ID card.
  • To identify a patient who has the 'Blue Cross Blue Shield Premier 101' multi-state plan (not specific to Texas), look for alpha prefix "VAL" on the member ID card.

Resources to Provide to your Patient's with Questions
If you have patients that are seeking assistance with their transition of care, we encourage you and your patients to contact BCBSTX with your questions through the phone numbers below. Our member advocates will work closely with your patients to ensure they have someone to speak with directly regarding their transition of care plan.

Member Customer Service: 888-697-0683
Pre-Authorization: 855-462-1785
Behavioral Health: 800-729-2422

BCBSTX provides a wide range of services and online tools to help renewing members make informed health decisions.

  • Provider Finder®: Members can select the best network provider for their needs based on location, as well as view industry-respected third party quality indicators, costs and patient-submitted reviews on an easy-to-navigate website.
  • Blue Access for MembersSM: Members can access information on their policy, including status of claims, alerts, temporary ID cards and more. This also includes Blue Access MobileSM, which allows members to find a doctor, hospital or urgent care facility in addition to benefit information.
  • 24/7 Nurseline: Members can speak with registered nurses about health concerns, common health information and tips and advice on where to go to receive necessary care.

You can also contact your local network management representative with any questions you may have.

BCBSTX Provider Relations Office LocationsTelephone NumberFax Number
Austin512-349-4847512-349-4853
Corpus Christi361-878-1623361-852-0624
Dallas, East Texas972-766-8900 / 800-749-0966972-766-2231
El Paso915-496-6600, press 2915-496-6611 915-469-6614
Houston, Beaumont713-663-1149713-663-1227
Lubbock, Amarillo806-783-4610806-783-4666
Midland, Abilene, San Angelo432-620-1406432-620-1428
San Antonio361-878-1623361-852-0624
Updates to the Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO) Preauthorization Lists (2024)

FAQs

What type of Medicare plan does Blue Cross Blue Shield offer? ›

For Blue Shield Medicare Advantage Plans: Blue Shield of California is an HMO, HMO D-SNP, PPO and a PDP plan with a Medicare contract and a contract with the California State Medicaid Program.

What is the phone number for Blue Shield of California Medicare supplement provider? ›

If you want help understanding your documents, call Blue Shield of California Customer Service: Medicare Advantage Prescription Drug Plans Customer Service at (800) 776-4466 (TTY:711), 8 a.m. to 8 p.m. They are available seven days a week.

Why are people leaving Medicare Advantage plans? ›

Most individuals that dislike a Medicare Advantage plan usually have had a bad experience with in-network providers, plan authorizations for medical care, or having to wait a long time to have an appointment scheduled. Some of these concerns can be attributed to the healthcare provider.

What is the most highly rated Medicare Advantage plan? ›

Our Top Medicare Advantage Plans
  • Best Consumer Reputation: Blue Cross Blue Shield.
  • Best Nationwide Coverage: Humana.
  • Best Local Support Services: Aetna.
  • Largest Provider Network: UnitedHealthcare.
  • Best Additional Benefits: Cigna.
  • Best Overall CMS Rating: Anthem.
7 days ago

Is the Blue Shield of California the same as the Blue Cross Blue Shield? ›

Blue Shield of California is a Registered® mark of the BlueCross BlueShield Association, an association of independent Blue Cross and Blue Shield plans.

Is Blue California good insurance? ›

The vast majority of Blue California's customers say they would recommend it to friends and family and just about all those polled said they'd renew their policies. It's No. 12 on Insure.com's 2024 Best Health Insurance Companies list – earning 3.7 stars out of 5.

Is Medicare supplement same as PPO? ›

With Medicare Advantage PPO plans, you'll pay less when you see an in-network provider. With Medicare Supplement Plans there are no networks. You'll be able to see any doctor who accepts Medicare, anywhere in the United States.

What does Plan G not cover? ›

High deductible plan G does not cover the Medicare Part B deductible. However, high deductible F and G count your payment of the Medicare Part B deductible toward meeting the plan deductible. 2Plans K and L pay 100% of covered services for the rest of the calendar year once you meet the out-of-pocket yearly limit.

What is the best supplemental insurance for Medicare? ›

Best for Medigap plan options: AARP/UnitedHealthcare Medicare Supplement Insurance. Best for member satisfaction: State Farm Medicare Supplement Insurance. Best for premium discounts: Mutual of Omaha Medicare Supplement Insurance. Best for extra benefits: Anthem Medicare Supplement Insurance.

Do I need Medicare Part B if I have Federal Blue Cross? ›

If you are working and have FEHB or you are covered under your spouse's group health insurance plan, then you do not have to enroll in Part B when you turn 65. You will have a special enrollment period when you retire or your spouse retires to enroll in Part B without paying a penalty.

What are four types of Medicare Advantage plans? ›

There are different types of Medicare Advantage Plans:

Health Maintenance Organization (HMO) Plan: Go to page 12. Preferred Provider Organization (PPO) Plan: Go to page 13. Private Fee-for-Service (PFFS) Plan: Go to page 14. Special Needs Plan (SNPs): Go to page 15.

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