Frequently Asked Questions
We’ve answered some of the most commonly asked questions about health insurance to help break down what things are, how they work and what you can expect from your care.
Not seeing the answer you’re looking for? We’re here to help.- Networks & ID Cards
- Updating Your Information
- Changing or Shopping for Plans
- Claims, Coverage & Costs
- Pharmacies & Prescriptions
Networks & ID Cards
A network is a group of doctors we work with to provide care to our members. Providers in our network agree to offer our members a discount. Providers who aren’t in our network don’t offer that discount, so their rates are higher.
To find your network, look at the front of your Member ID card. It’s most likely on the bottom left corner.
You can search for providers by network in the Find Care tool. Either search the provider’s name and check which networks they’re in, or search for providers near you and filter your results by your network. If you log in at bcbst.com, your search results will automatically list providers in your network.
That depends on your plan benefits. For most plans, if you see a provider who is not in your network, subject to your out-of-network deductible and coinsurance. In that case, we typically pay the amount that we’d pay a provider who is in your network, subject to your out-of-network deductible and coinsurance. You’ll pay whatever is left on your bill. Please keep in mind that some plans, like those you may have purchased through Healthcare.gov or signed up for through TennCare, don’t pay for providers who aren’t in your network.
This depends on what kind of plan you have.
Many employer plans include the Blue Cross Blue Shield Global Core® travel program that lets you see providers in other BlueCross networks while you’re traveling. If you see a small suitcase icon on your member ID card, then you have Global Core. If you’re planning a trip and have specific questions, the best thing to do is call Global Core directly at 1-800-810-25831-800-810-2583. They’re ready to help you out.
If you have an individual or family plan, or one through your employer, you can log in to bcbst.com and enter your location into the Find Care tool.
Medicare members should contact us, and we’ll help you decide how to get care.
Medicaid or Medicare with Medicaid members can only get coverage for providers out of the state of Tennessee if it’s a true emergency.
You can order a new Member ID card by logging in to bcbst.com or by calling or chatting with us.
You can also download a digital version or print your own copy of your card from the same page or you can see it in the BCBSTN℠ mobile app, which you can download here.
Click here to contact us, and we’ll walk you through getting your card updated.
Updating Your Information
Click here to contact us, and we’ll get your account updated.
Click here to contact us, and we’ll get your account updated.
If you want to see a different doctor than the one you were assigned, you can contact us for help, or you can do it yourself here.
Changing or Shopping for Plans
You’ll need to enroll during the Open Enrollment Period from Nov. 1 –Jan 15 this year. If you’ve had a major life change (like getting married, losing your coverage, moving out of state, etc.), you could shop now with a special enrollment window for a limited time. There’s more about that here.
Your employer likely has an enrollment window each year for you to sign up, unless you’re a new employee. Talk with your HR team about how to get enrolled.
You’ll need to shop during the Annual Enrollment Period, from Oct. 15 – Dec. 7 each year to switch plans. If you’re just turning 65 or retiring, you have a window of three months before and three months after your birthday to sign up for Medicare. Some big life events – like getting married or moving – might allow you to enroll in a plan outside this window. If you have one coming up, contact us or your broker.
If you qualify for both Medicare and Medicaid, you may sign up for a BlueCare Plus℠ plan throughout the year. Contact us or your broker to get help.
Enroll with the State of Tennessee here.
We want you to feel confident in making your Medicare decisions. Here’s a link to get you caught up on the basics or you can give our sales team a call at 1-800-292-51461-800-292-5146.
You can also visit our Medicare website for more information.
Claims, Coverage & Costs
You can check your coverage by logging in here. This will give you all the details on who and what your plan covers. Or click here to contact us, and we'll look it up and help you with the next steps if we don't cover a service you need.
Click here to contact us, and we’ll walk you through it. You can also watch this quick video that might help introduce you to the Claim Summary.
We offer free online bill pay for members with individual and employer plans. Log in to your account to view your claims. Pick the one you want to pay, then click the Pay Provider button. It will take you to InstaMed’s site, where you can make a full or partial payment.
Here’s a quick definition for the most common terms you’ll see in insurance:
Premium: The monthly payment for your insurance policy.
Copayment (Copay): A fixed dollar amount you must pay with your own money for medical services, like office visits or prescription drugs.
Deductible: The amount you pay each year before your health plan begins paying.
Coinsurance: The percentage of costs for care that you'll pay - usually after you've paid your deductible.
Your health care costs can change for a number of reasons. The cost of care rising, the amount of people sharing the costs changing or a manufacturer raising or lowering their price on a drug are a few examples. If you’d like to discuss a specific change, click here to contact us, and we’ll try to answer your questions.
This depends on your plan. For most plans, you can do a bank draft, check by phone, or mail in payment. Contact us and we’ll talk you through it or you can download the form here.
Click here to contact us, and we’ll help.
Pharmacies & Prescriptions
You can check out all our drug lists here.
You can search for pharmacies by network in the Find Care tool. Either search by the pharmacy’s name or search for ones near you and filter your results by your network. If you log in to bcbst.com first, your search results will automatically list pharmacies in your network. Need more help? Click here to contact us.
Drug tiers determine how much you pay for a drug. Usually, lower tiers have the most affordable drugs. Higher tiers have more expensive drugs. Each of our drug lists use different tiers. You can find out which drug list your plan uses and your share of the cost by looking up your formulary (drug list) on your Member ID card. Then, you can search for your medicine on the drug list to see which tier it’s on.
Preferred drugs are ones that are just as effective as more expensive drugs, but at a lower cost.
Preferred pharmacies apply to certain Medicare plans. Medicare members will get better prices at preferred pharmacies.
Specialty drugs usually require special handing and/or extra supervision while you take them. Sometimes, you can take them at home. Other times you have to take them at a doctor’s office. Most of the time, you have to get specialty drugs from a specialty pharmacy. If you can take the drug yourself, most specialty pharmacies can ship them right to your front door.