How Your Health Care Plan Works
Planning ahead can help you save money when it comes to your health. Take full advantage of your health care plan with these helpful tips:
- Stay in the network. Most health plans, like HMOs and PPOs, use certain groups of doctors, hospitals and other health care professionals called provider networks. If you visit a doctor outside of your network, you may have to pay more for your care. In some cases, you may have to pay the full cost. The same could be true about where you go for infusion drug care.
- Stay in the pharmacy network. Just as important as making sure that your doctor is in your network before making an appointment, you’ll save money if you visit an in-network pharmacy. If you have prescription drug benefits with BCBSMT, learn more about your pharmacy network.
- Know what's covered. Make sure services or treatments are covered before you schedule them. If you have a PPO, you may need pre-authorization (pre-notification) from BCBSMT before you get certain tests or services. You or your doctor must call the pre-authorization (or pre-certification) number on the back of your member ID card to confirm. BCBSMT regularly evaluates the use of new and existing medical technologies. This allows us to make decisions about what's covered. It also ensures that you have access to safe and effective care.
- Understand health insurance costs. Health insurance costs can be confusing. Knowing what premiums, deductibles, copayments and out-of-pocket maximums are and how they all work together can help you understand your plan.
- Utilization Management (UM) Program Description. The Utilization Management (UM) Program description defines the structure of the UM program for BCBSMT. Utilization management is part of our Wellbeing Management Program that supports a holistic approach to address members chronic or complex conditions and promotes member and provider satisfaction through coverage and access to affordable, quality healthcare. UM preauthorization and predetermination reviews are completed using evidenced based guidelines to deliver fair, impartial and consistent determinations that can be easily interpreted by members and providers with timely decisions to accommodate the clinical urgency of the member's situation. Learn more about the UM Program