| FAQ's |
Medicare
Advantage vs. Medicare Supplement
|
Freedom Blue PPO
Prurudent
Buyer ® Net work With our Freedom
Blue PPO Prudent Buyer network you can
select any physician and specialist without
a referral. The Prudent Buyer network
offers you a wide variety of physicians
conveniently located throughout the state
to help you with all of your health care
needs. The Prudent Buyer network includes
nearly 50,000 quality physicians and specialists
and more than 300 participating hospitals
across all of California. This is the
largest network in California, with over
one half of all physicians in the state
participating as a Prudent Buyer Provider. |
Blue Cross Freedom Blue PPO -
2008
Freedom
Blue PPO Summary
of Benefits
2008 -Printable 
Freedom
Blue Network Chain Pharmacies
Freedom
Blue PPO -
Order the
Application
Blue
Cross Freedom Blue Provider Finder |
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| Q. HOW CAN I COMPARE MY OPTIONS?
A.You can compare Freedom
Blue Plans and the Original Medicare Plan
using this Summary
of Benefits. The charts in
this booklet list some important health
benefits. For each benefit, you can see
what our plan covers and what the Original
Medicare Plan covers. Our members receive
all of the benefits that the Original
Medicare Plan offers. We also offer more
benefits, which may change from year to
year.
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Q. WHO IS ELIGIBLE TO JOIN FREEDOM
BLUE?
You can join Freedom Blue if you are entitled
to
Medicare Part A and enrolled in Medicare
Part B
and live in the service area. However, individuals
with End Stage Renal Disease are not eligible
to
enroll in Freedom Blue. |
Q. WHERE IS FREEDOM BLUE AVAILABLE?
A.The service area for
this plan includes: California.
You must live in this state to join the
plan. |
Q. CAN I CHOOSE MY DOCTORS?
A.Freedom Blue has formed
a network of doctors,
specialists, and hospitals. You can use
any doctor
who is part of our network. You may also
go to
doctors outside of our network. The health
providers in our network can change at any
time.
You can ask for a current Provider Directory
for an
up-to-date list or visit at providerfinder.net. |
Q. DOES MY PLAN COVER MEDICARE
PART B
OR PART D DRUGS?
A.Freedom
Blue Plans cover both Medicare
Part B prescription drugs and Medicare Part
D prescription drugs. |
Q. WHAT HAPPENS IF I GO TO A DOCTOR
WHO'S NOT IN YOUR NETWORK?
You can go to doctors, specialists, or hospitals
in or out of network. You may have to pay
more
for the services you receive outside the
network,
and you may have to follow special rules
prior to
getting services in and/or out of network.
Please see the Summary
of Benefits
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Q. WHERE CAN I GET MY PRESCRIPTIONS
IF I JOIN THIS PLAN?
A.
Freedom Blue has formed a network of pharmacies.
You must use a network pharmacy to receive
plan
benefits. We may not pay for your prescriptions
if you use an out-of-network pharmacy, except
in certain cases. The pharmacies in our
network
can change at any time. You can ask for
a
current Pharmacy Network List or visit us
at
www.bluecrossca.com. Our customer service
number is listed at the end of this introduction.
BC Life & Health Insurance Company has
a list of
preferred pharmacies. At these pharmacies,
you
may get your drugs at a lower co-pay or
co-insurance.
You may go to a non-preferred pharmacy,
but you
may have to pay more for your prescription
drugs. |
Q. HOW CAN I GET EXTRA HELP WITH
PRESCRIPTION DRUG PLAN COSTS?
A. If you qualify for extra
help with your Medicare
prescription drug plan costs, your premium
and
costs at the pharmacy will be lower. When
you join
Freedom Blue, Medicare will tell us how
much extra
help you are getting. Then we will let you
know the
amount you will pay. If you are not getting
this extra
help you can see if you qualify by calling
1-800-
Medicare (1-800-633-4227), TTY users should
call
1-877-486-2048. You can call this number
24 hours
a day, 7 days a week. |
Q. WHAT IS A PRESCRIPTION DRUG
FORMULARY?
A. Freedom Blue uses
a formulary. A formulary is a
list of drugs covered by your plan to
meet patient
needs. We may periodically add, remove,
make
changes to coverage limitations on certain
drugs
or change how much you pay for a drug.
If we make
any formulary change that limits your
ability to fill
your prescriptions, we will notify you
before the
change is made. You and you can see our
complete
formulary on our Web site at www.bluecrossca.com.
If you are currently taking a drug that
is not on our
formulary or subject to additional requirement
or
limits, you may be able to get a temporary
supply
of the drug. You can contact us to request
an
exception or switch to an alternative
drug listed on
our formulary with your physician's help.
Call us to
see if you can get a temporary supply
of the drug
or for more details about our drug transition
policy.
If you think you need an exception, you
should
contact us before you try to fill your
prescription at
a pharmacy. Your doctor must provide a
statement
to support your exception request. If
we deny coverage
for your prescription drug(s), you have
the right to
appeal and ask us to review our decision.
Finally,
you have the right to file a grievance
if you have
any type of problem with us or one of
our network
pharmacies that does not involve coverage
for a
prescription drug. |
Q. WHAT ARE MY PROTECTIONS IN
THIS PLAN?
A.
All Medicare Advantage Plan members agree
to stay
in the program for a full year at a time.
Each year,
the plans decide whether to continue for
another
year. Even if a Medicare Advantage Plan
member
leaves the program, you will not lose Medicare
coverage. If a plan decides not to continue,
it must
send you a letter at least 90 days before
your coverage
will end. The letter will explain your options
for
Medicare coverage in your area.
As a member of Freedom Blue, you have the
right to
request a coverage determination. This is
the right
to request an exception, the right to file
an appeal
if we deny coverage for a prescription drug,
and
the right to file a grievance. You have
the right to
request a coverage determination if you
want us
to cover a Part D drug that you believe
should be
covered. An exception is a type of coverage
determination.
You may ask us for an exception if you
believe you need a drug that is not on our
list of
covered drugs or believe you should get
a nonpreferred
drug at a lower out-of-pocket cost. You
can also ask for an exception to cost utilization
rules, such as a limit on the quantity of
a drug |
Q. WHAT IS A MEDICATION THERAPY
MANAGEMENT (MTM) PROGRAM?
A.
A Medication Therapy Management (MTM) Program
is a free service we may offer. You may
be invited to
participate in a program designed for your
specific
health and pharmacy needs. You may decide
not to
participate but it is recommended that you
take full
advantage of this covered service if you
are selected.
Contact Freedom Blue for more details. |
Q. I
have more questions where can I call?
A. If
you are not sure if the Freedom Blue is
right for you , please call us (818) 654-4548
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