Blue Cross Blue Shield - other out of state plans
Blue Cross Blue Shield is not one single insurance company, but a collection of franchises that are all independently operated and which have vastly different policies and coverage criteria.
We work so frequently with BCBS of Massachusetts, that we have a basic familiarity with many of their plan types and requirements. In addition, BCBSMA sends us regular updates of changes and news relevant to us. This is not true for other out of state plans.
Plan types, coverage for speech therapy and authorization procedures vary greatly between out of state plans. Extra caution is required to ensure the highest likelihood that you will not end up responsible for payment.
Step 1: Look at your insurance card
The state/company that administers your plan will be listed most likely on the back of the card and a member services number will be given Contact Member Services and obtain the following information
- Do you have speech therapy benefits on your plan and what are the limitations on number of visits
- Are there specific exclusions from coverage that you need to be aware of
- Ask them to read you their definition of "medical necessity", if they tell you that "medically necessary speech therapy is covered". For some plans, the definition of medically necessary is quite restrictive.
- Ask what are the requirement to obtain speech therapy. (physician referral, pre-authorization, etc)
Step 2: Obtain your insurance referral, if you need one
- Most BCBSMA plans require an "insurance referral" from your primary care physician.
- Call your Primary Care Physician's office
- Let them know that you have an appointment for speech therapy
- Give them our National Provider Identifier - 1558424994
- Ask for 10 visits to start with
- Ask your Primary Care Physician to fax us the referral at 781-329-2207
- If you believe you do not need a referral, you should make certain of this. Call member services and ask if a referral or other preauthorization is needed for speech therapy
Do you have a deductible?
- Be aware that your deductible begins again with each new plan year. For some, this will be January 1, for others this will be based on the plan year established by your employer.
- If you have a deductible, you will pay your co-payment at the time of your visit as usual. When Harvard Pilgrim lets us know the balance due, we will bill you for your deductible amount.