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CareFirst BlueChoice Advantage offers you the flexibility and freedom to choose from both in- and out-of-network providers. CareFirst BlueChoice Advantage does not require you to designate a primary care provider PCP or to obtain a referral to see a specialist. However, if you select a patient centered medical home PCMH PCP , they can help you to better manage your health care needs and overall well-being by providing comprehensive care coordination. Your portion of the cost of the medical coverage is deducted from your pay on a pre-tax basis.
Express Scripts drug coverage is included with your cost for the CareFirst medical coverage. The Plan Allowance for covered services is determined by the contracted rate or fee schedule that participating providers have agreed to accept for that service or the rate or fee that is established by law. The in-network annual deductible applies to non-preventive care services. Preventive care such as annual physicals and mammograms are not subject to the deductible, however, copayments still apply.
The BlueChoice plan does not cover any portion of your medical bills until you first meet your annual deductible; copayments still apply and do not count toward the deductible. After the deductible is met for the year, you pay the copayment for certain covered services. The out-of-network plan does not cover any portion of your medical bills until you first meet your annual deductible. If your provider participates with BCBS through another plan, they are required to submit your claims on your behalf and BCBS will reimburse them directly.
You are responsible for arranging your own hospital certifications. There is a financial penalty if pre-certification is not arranged. Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the CareFirst site.
To find an in-network provider, visit www. If your provider is not listed in the online directory, they are considered out-of-network. You will still have coverage, but your out-of-pocket costs will be greater. Please call the provider's office directly to confirm that they still participate in the CareFirst network, even if they are listed as a provider on the BCBS site.
In addition, you can schedule visits for other needs such as behavioral health support from a therapist or psychiatrist, guidance from a certified nutritionist or breastfeeding support from a lactation consultant. Visit www. Patient centered medical home PCMH doctors provide coordination of care for patients with serious and chronic health conditions. If your physician participates, they will get streamlined access to specialist reports, test results, and hospitalization information.
A nurse in your physician's office is designated to be available to answer questions, support the treatment process, and be proactive in providing care. The program is confidential, voluntary, and provided at no additional cost to you. If you are contacted by your doctor, we strongly encourage you to enroll in the program so that you can get personalized care and support for you and your family. To find out if your physician participates in the program, go to www.
CareEssentials is a personalized, confidential, and voluntary health coaching program to help people with chronic conditions, like diabetes or asthma, to manage their overall health.
Highly trained nurses provide one-on-one telephone support and health information, help you prepare questions for doctor visits, answer questions about new diagnoses and medications; and assist with other health issues. The CareEssentials team is available to support your relationship with your physician, not replace it. They will provide coordination of care with your physician. Use the mobile app to get your member information on the go, or log in to the My Account section of CareFirst.
You can register with My Account using your social security number, or call Member Services at to get it. The BlueChoice network is a local network of providers.
You may also use this online directory to search for BlueCard PPO providers outside of the local area. Follow the instructions above, then click on the link for providers outside the Metro area. The CareFirst BlueChoice Advantage plan allows members the flexibility to choose a health care provider when and where treatment is needed.
When care is received inside the CareFirst service area members will experience the lowest out of pocket costs when they visit a BlueChoice provider. Members still have the option to access a BlueCard PPO doctor, but will be subject to higher out of pocket expenses. Members receiving care outside the CareFirst Service area will experience the lowest out of pocket costs by accessing a national BlueCard PPO provider.
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