2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Index
Page 139
Index
Page 139
Member facilities - 39-41, 65-76, 78-79, 81-84
Mental health/substance use disorder - 17-19, 72-73, 81-84, 105
MRIs - 38, 69-72
Multiple procedures - 56-57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 38, 69-72
Never Events - 6-8, 133
Newborn care - 27, 43-44, 67-69
No Surprises Act (NSA) - 30-31
NON-CORE benefits - 133
Non-member facilities - 65-76, 81-84
Non-participating providers - 30, 133-134
Non-preferred providers - 14-15, 17, 30
Nurse - 52-53, 73-75, 103
Nutritional counseling - 17, 37-41, 105, 136
Observation care - 133
Obstetrical care - 43-44, 67-69
Occupational therapy - 48, 65-76
Office visits - 37-38, 81-82
Oral surgery - 59
Organ/tissue transplants - 55-64
Orthopedic devices - 50-51, 69-72
Osteoporosis screening - 39-41, 135
Ostomy and catheter supplies - 52
Out-of-pocket expenses - 31, 134
Outpatient facility services - 69-72, 102
Outpatient professional services - 37-38, 81-82
Overpayments - 32
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 31, 107-109
Oxygen - 50-51, 65-76
Pap tests - 39-43
Participating providers - 30-31, 133-134
Patient Safety and Quality Monitoring (PSQM) program - 88
Personal Health Record - 103
PET scans - 38, 69-72
Pharmacotherapy - 37-38, 47-48
Physical examinations - 106
Physical therapy - 48, 65-76
Physician - 14-15, 37-38, 126-127
Plan allowance - 30, 133-134
PPO - 14-15, 17-19, 135
Pre-admission testing - 66-67
Precertification - 20, 25, 135
Preferred providers - 14-15, 17, 19, 30
Pregnancy (see: Maternity care)
Prescription drugs
Prior approval - 20-23, 88, 91-94, 135
Professional providers - 17
Prostate cancer - 39-41
Prosthetic devices - 50-51, 56-57, 66-67, 69-72
Psychotherapy - 81-84
Pulmonary rehabilitation - 47-48, 69-72
Radiation therapy - 47-48, 69-72
Reconsiderations - 27, 116-118
Replacement coverage - 12-13
Reproductive servicesResidential treatment center (RTC) - 17-20, 72-73, 83, 130
Rights and responsibilities - 14-15
Room and board - 66-69, 72-73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 39-41, 135
Second surgical opinion - 37-38
Self-injectable drugs - 85, 87-88
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 53-54, 96-99
Social worker - 104-105
Specialty Drug Pharmacy Program - 85-86, 89-90, 108-109, 114
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Speech therapy - 48, 69-73
Speech-generating devices - 51-52
Stem cell transplants - 60-62
Sterilization procedures - 45, 56-57
Subrogation - 120-121, 136
Substance use disorder - 17, 72-73, 81-84
Surgery
Telehealth
Tobacco cessation - 53-54, 96-99
Transplants - 59-62
Travel benefit - 63, 103
Treatment therapies - 47-48
TRICARE - 119-120
Ultrasounds - 38, 69-72
Urgent care center - 77-80, 141
Urgent care claims - 26, 136
VA facility - 127
Vaccines - 39-43, 96-99
Verbal statements - 4, 27
Vision services - 49-50, 121
Waivers - 30
Weight control - 103, 110-112
Wheelchairs - 51-52
Wigs - 50-51
WRAP benefits - 137
X-rays - 38, 69-72
Mental health/substance use disorder - 17-19, 72-73, 81-84, 105
MRIs - 38, 69-72
Multiple procedures - 56-57
MyBlue Customer eService - 104
National Doctor & Hospital Finder - 104
Neurological testing - 38, 69-72
Never Events - 6-8, 133
Newborn care - 27, 43-44, 67-69
No Surprises Act (NSA) - 30-31
NON-CORE benefits - 133
Non-member facilities - 65-76, 81-84
Non-participating providers - 30, 133-134
Non-preferred providers - 14-15, 17, 30
Nurse - 52-53, 73-75, 103
Nutritional counseling - 17, 37-41, 105, 136
Observation care - 133
Obstetrical care - 43-44, 67-69
Occupational therapy - 48, 65-76
Office visits - 37-38, 81-82
Oral surgery - 59
Organ/tissue transplants - 55-64
Orthopedic devices - 50-51, 69-72
Osteoporosis screening - 39-41, 135
Ostomy and catheter supplies - 52
Out-of-pocket expenses - 31, 134
Outpatient facility services - 69-72, 102
Outpatient professional services - 37-38, 81-82
Overpayments - 32
Overseas Assistance Center - 107
Overseas services, drugs, supplies and claims - 31, 107-109
Oxygen - 50-51, 65-76
Pap tests - 39-43
Participating providers - 30-31, 133-134
Patient Safety and Quality Monitoring (PSQM) program - 88
Personal Health Record - 103
PET scans - 38, 69-72
Pharmacotherapy - 37-38, 47-48
Physical examinations - 106
Physical therapy - 48, 65-76
Physician - 14-15, 37-38, 126-127
Plan allowance - 30, 133-134
PPO - 14-15, 17-19, 135
Pre-admission testing - 66-67
Precertification - 20, 25, 135
Preferred providers - 14-15, 17, 19, 30
Pregnancy (see: Maternity care)
Prescription drugs
Brand-name drugs - 89-90, 94-95
Drugs from other sources - 99-100
Generic drugs - 89-90, 94-95
Preferred retail pharmacies - 85-86, 89-90, 114
Retail Pharmacy Program - 85-86, 96-99, 141
Self-injectable drugs - 85, 87-88
Specialty Drug Pharmacy Program - 85-86, 89-90, 114, 141
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Preventive carePrimary care provider (PCP) - 36-54Drugs from other sources - 99-100
Generic drugs - 89-90, 94-95
Preferred retail pharmacies - 85-86, 89-90, 114
Retail Pharmacy Program - 85-86, 96-99, 141
Self-injectable drugs - 85, 87-88
Specialty Drug Pharmacy Program - 85-86, 89-90, 114, 141
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Prior approval - 20-23, 88, 91-94, 135
Professional providers - 17
Prostate cancer - 39-41
Prosthetic devices - 50-51, 56-57, 66-67, 69-72
Psychotherapy - 81-84
Pulmonary rehabilitation - 47-48, 69-72
Radiation therapy - 47-48, 69-72
Reconsiderations - 27, 116-118
Replacement coverage - 12-13
Reproductive servicesResidential treatment center (RTC) - 17-20, 72-73, 83, 130
Rights and responsibilities - 14-15
Room and board - 66-69, 72-73, 83
Routine Annual Physical Incentive Program - 106
Screening services - 39-41, 135
Second surgical opinion - 37-38
Self-injectable drugs - 85, 87-88
Skilled nursing facility (SNF) care - 73, 130
Smoking cessation - 53-54, 96-99
Social worker - 104-105
Specialty Drug Pharmacy Program - 85-86, 89-90, 108-109, 114
Specialty drugs - 85-86, 89-90, 94-95, 114, 136
Speech therapy - 48, 69-73
Speech-generating devices - 51-52
Stem cell transplants - 60-62
Sterilization procedures - 45, 56-57
Subrogation - 120-121, 136
Substance use disorder - 17, 72-73, 81-84
Surgery
Assistant surgeon - 19, 56-59, 62-64
Eye: cataract, amblyopia, strabismus - 49-50, 56-57
Gender affirming - 17, 57-58
Multiple procedures - 55-57
Oral and maxillofacial - 59
Outpatient - 17-19, 69-72
Reconstructive - 57-58
Sterilization, reversal of voluntary - 45, 56-57
Surgical implants - 50-51, 69-72
Surgical treatment of severe obesity - 20-23
Transplants - 59-64
Syringes - 89-90, 94-95Eye: cataract, amblyopia, strabismus - 49-50, 56-57
Gender affirming - 17, 57-58
Multiple procedures - 55-57
Oral and maxillofacial - 59
Outpatient - 17-19, 69-72
Reconstructive - 57-58
Sterilization, reversal of voluntary - 45, 56-57
Surgical implants - 50-51, 69-72
Surgical treatment of severe obesity - 20-23
Transplants - 59-64
Telehealth
Dermatology - 17, 37-38, 136
Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 133
Nutritional counseling - 17, 39-41, 105, 136
Temporary Continuation of Coverage (TCC) - 12Mental health/substance use disorder - 105
Minor acute conditions - 17, 37-38, 133
Nutritional counseling - 17, 39-41, 105, 136
Tobacco cessation - 53-54, 96-99
Transplants - 59-62
Travel benefit - 63, 103
Treatment therapies - 47-48
TRICARE - 119-120
Ultrasounds - 38, 69-72
Urgent care center - 77-80, 141
Urgent care claims - 26, 136
VA facility - 127
Vaccines - 39-43, 96-99
Verbal statements - 4, 27
Vision services - 49-50, 121
Waivers - 30
Weight control - 103, 110-112
Wheelchairs - 51-52
Wigs - 50-51
WRAP benefits - 137
X-rays - 38, 69-72