PPO options grant members greater benefits if they access care through a physician in the network and use network providers for health services. The member does not have to select a primary care physician and can self-refer to any specialist physician in the network. If out-of-network providers are used, benefits are still payable but at a lower percentage and after a deductible is satisfied.
- Blue Cross Blue Shield Preventive Care Guidelines
- If provided or authorized by a network physician, expenses for routine physical exams, well baby & child care, immunizations, mammograms, etc., are covered at 100%.
- The Concordia Health Plan (CHP) does not provide coverage under Preventive Care Services for the following:
- Contraceptive methods and counseling
- Counseling for Domestic Violence - For members in a CHP PPO Option, Counseling for Domestic Violence and HIV are covered under the CHP behavioral health benefit administered by Cigna Behavioral Health. For members in Option HDHP, behavioral health benefits are administered by Blue Cross Blue Shield of Minnesota.
- Counseling for HIV
- Blue Cross Blue Shield Preventive Care Recommendations - These guidelines are recommended preventive care, however, your physician should always verify coverage.
- Charges for out-of-network care and services are not covered.
- If preventive doctor visits or screenings reveal potential medical concerns, your visit could change from preventive care to medical treatment or diagnosis for billing purposes.
- Provider Preventive Care Notice - Printable to share with your doctor during preventive care visits to explain the preventive care billing process.
- One manual breast pump per pregnancy/delivery is covered as a preventive service at 100% under CHP Options A-E and HDHP, as well as Select 500, Select 1000, Choice 1500, and Choice 2000. The pump must be purchased through the medical benefit from a participating Durable Medical Equipment (DME) provider* – not a pharmacy benefit or retail store. BCBS does not require a prescription to process DME breast pump claims, but DME providers may require a prescription. The breast pump can be purchased prior to delivery and up to six-months postpartum.
*Choose "Support and Other Services", National BlueCard PPO, and your zip - after clicking enter, under “Other Service Type,” choose “DME/Medical Supplies” and search again.
Shingles Vaccine Coverage
For members enrolled in CHP Medicare supplemental coverage, Medicare B does not cover the administration of the shingles vaccine. However, for members over age 50, the cost is covered at 100% by Blue Cross Blue Shield, as long as the vaccine is administered by a network provider. It is also available at network pharmacies, but may require a prescription. Missouri network pharmacies only administer the shingles vaccine to members over the age of 60.
Seasonal Flu Vaccine Coverage
- October 1 - June 1: 100% covered. Members can present their Express Scripts prescription drug card at Express Scripts vaccine network retail pharmacies and receive the seasonal flu vaccine (shot or FluMist).
- If a member receives the vaccine at a pharmacy not participating in the Express Scripts vaccine network, the member pays for the costs associated with the vaccine and submits a manual claim for reimbursement.
- 100% covered at a participating provider’s office with no cost at time of service.
- If a member receives the vaccine at another provider (including community clinics), the member pays for upfront costs, and may submit a manual claim and receipt to BCBS for reimbursement. The receipt should show: provider name and address, date of service, type of service (flu vaccine), and service charges.