An agreement with a provider not to charge the subscriber a difference between the fees charged for covered services (excluding co-insurance) and the amount agreed by contract with a Blue Cross Blue Shield company as a full payment for these services. An independent centre that performs different types of operations. Accounts that employers can create for workers to reimburse a portion of the sickness costs not set up in their pocket by their rightful family members, for example. B, deductibles, co-insurance and pharmacy fees. A contractual provision that is included in all standard supplier contracts and allows the MCO (Managed Care Organisation) or supplier to terminate the contract if the other party does not comply with its contractual obligations. Maximum dollar amounts set by MCOs (Managed Care Organizations) that limit the total amount the plan must pay for all health care provided to a subscriber per year or in his or her lifetime. The Medicare component, which provides basic hospital insurance to cover hospitalization costs, retention in care facilities or other advanced care facilities after hospitalization, post-hospital home care after hospitalization and palliative care. A coding inconsistency in which a procedure must be divided into pieces and loaded for each piece, instead of using a single code for the entire procedure. The process of identifying and classifying the risk presented by an individual or group. A lump sum that the member must pay before the insurer can make any payments. The deductible is, as a rule, a specified amount or percentage, determined by the member`s contract and set for a specified period. A toll-free number, 1-800-810-BLUE, which allows members to find suppliers at another Blue Cross Blue Shield company.
BlueCard Access© helps members who need referral to a doctor or health facility in another location. Preventive care programs to monitor and promote vaccines to protect against childhood diseases such as chickenpox, mumps and measles, as well as adult diseases such as pneumonia and influenza. An organization that provides dental services to its members through a network of providers in exchange for some form of prepayment. For all dental questions and/or application forms, please contact your local Blue Cross Blue Shield company. The wide range of activities that an MCO and its collaborators will take to support the provision of the benefits promised to members and ensure member satisfaction. a person`s first or last name and name, in combination with one or more people, include: (1) the Social Security number; (2) driver`s licence number or state identification number; or (3) account number, credit or debit card number in combination with any required security code, passcode or password that would allow access to a person`s financial account.