Make the Most of My Coverage

Check out these tips to help you make the most of your health care coverage:

Know the best ways to get information about your benefits

We are always happy to answer your questions about benefits or anything else. You have a lot of information at your fingertips.

  1. Send us an email through our secure My Health Toolkit®. If you are using it for the first time, you will need to create a profile — it just takes a few minutes.
  2. Read your Schedule of Benefits. We send you this when you first become a member, and whenever your benefits change. You can also view your benefits in My Health Toolkit.
  3. View your Member Guide. You can also call us at the number on the back of your ID card to request we mail you a copy of your Schedule of Benefits or Member Guide.
Be familiar with what to do after hours if you need care

If you select a primary care physician (PCP), he or she has an agreement with us to provide 24-hour call coverage. This means no matter when you call your PCP, someone will answer the phone and advise you of the proper action to take based on your condition. If an emergency arises, try to phone your PCP first. If he or she is unavailable, you can go directly to the nearest Doctor's Care or other urgent care provider. But if your condition is life- or limb-threatening, you should go directly to the nearest emergency room. As soon as possible, let your PCP know about any emergency care you have received.

Phone ahead for appointments and cancel at least 24 hours in advance

This helps you receive your medical care on a more timely basis. When you call first, your doctor's staff will arrange for the most appropriate care — either an appointment or advice for an ailment. If you must cancel any appointments, please let your doctor's office know as soon as possible. Some physicians may charge for missed appointments and BlueChoice HealthPlan does not cover those charges.

Make the most of your appointment

Be prepared to ask your doctor questions and provide as much background about your health as you possibly can. On your first visit, bring all the medicines you currently take. Your doctor will need this information to assess your medical condition and monitor possible drug interactions.

Always bring your ID card with you

Whenever you seek medical care, be sure to identify yourself as a BlueChoice HealthPlan member. When you arrive for your appointment, present your BlueChoice HealthPlan ID card to the office staff.

Help yourself stay healthy

Take advantage of our Great Expectations®for health programs. We can help you stop smoking, control your diabetes or decrease your risk for heart disease. You'll learn to breathe easier with our asthma management program. Expectant moms count on our maternity program to provide information and support, which can help them deliver healthy babies. We even have a special program for women only. For more information, call our Health Management department at 855-838-5897.

Choose a primary care physician

BlueChoice HealthPlan strongly recommends you choose a primary care physician (PCP). This is a doctor who specializes in family medicine, internal medicine or pediatrics (for children and adolescents). These doctors are trained to diagnose and treat many illnesses and manage chronic conditions, such as diabetes, high blood pressure and asthma. PCPs also provide preventive care, routine screenings and immunizations. Should you ever need a specialist or other type of doctor, your PCP can recommend one in your Blue Option network and coordinate your care with him or her. Always seek care from your PCP first, unless it's an emergency.

Where You Go Matters!

Where Should I Go For My Health Care Needs? 

Where you go matters! We care about you and want to help you take charge of your health. Avoid needless worry, out-of-pocket costs and hours sitting in the emergency room (ER) by knowing how to navigate through the health care system and being familiar with other options for your care. 

Primary Care Physician

Your primary care physician (PCP) should be your first choice for health care. See your PCP for common medical issues: 

  • Illnesses such as colds, flu, earaches and sore throats
  • Minor injuries such as sprains, strains and back pain
  • Routine physical exams, vaccinations and screenings
  • A health problem for which you need advice

Don't have a PCP? Find one here. Or, give us a call at 855-838-5897. We can help you find a doctor that fits your needs. 

 

Network Urgent Care Clinics

Urgent care centers provide another option when you need care and your regular doctor is not available. Urgent care centers provide attention for medical problems that need seeing to right away but are not life-threatening, or for problems that could get worse if you wait. An urgent care visit usually takes less time than a hospital emergency room and costs you much less. 

Blue CareOnDemandSM

You can now visit with a doctor faster and more easily than ever. With Blue CareOnDemand, you can visit with a doctor via smartphone, tablet or computer, rather than visiting an office or urgent care facility. Doctors will diagnose and write prescriptions as appropriate. 

What types of conditions can Blue CareOnDemand doctors treat?

  • Colds
  • Pink Eye
  • Flu
  • Ear Infection 
  • Fever
  • Migraines

When should you use Blue CareOnDemand?

  • The doctor's office is closed
  • You are too sick to drive
  • You are traveling

Download the app via the App Store or Google Play or visit www.BlueCareOnDemandSC.com and sign up for Blue CareOnDemand today!

 

When Should I go to the ER?

The emergency room is only for very serious or life-threatening problems. 

  • Sudden or unexplained loss of consciousness
  • Signs of a stroke
  • Poisoning
  • Signs of heart attack
  • Severe shortness of breath
  • Medication/drug overdose, alcohol poisoning

The ER is not a substitute for a PCP visit. Going to the ER for something that is not a true emergency could result in long wait times and may result in your claim not being paid. The good news is that you have options! And if you're ever in doubt, err on the side of caution and seek immediate care. 

For more information about making the most of your benefits and navigating the complex health care system, contact our team of ER Care Guardians: 

855-838-5897

Monday–Thursday, 8:30 a.m. – 8 p.m.

Friday 8:30 a.m. – 5 p.m. EST

Our ER Care Guardian team consists of licensed social workers and certified medical assistants that aim to address and modify the habits of high utilizers and reduce ER visits.