Frequently Asked Questions
Q. HOW DO I ADD/DROP DEPENDENTS TO/FROM MY INSURANCE IF I HAVE A CHANGE IN STATUS?
A. Submit a SISC Membership Change Form and supporting documents to District Benefits.
Q. HOW DO I MAKE CHANGES TO MY PERSONAL INFORMATION SUCH AS ADDRESS CHANGE, BENEFICIARIES, ETC.?
A. Submit a SISC Membership Change Form and supporting documents to District Benefits. You may also want to update your beneficiary(ies) for Basic Life and/or AD&D. If so, fill out and submit a Beneficiary Designation Form to District Benefits.
Q. HOW DO I KNOW IF MY DOCTOR IS IN THE BLUE SHIELD NETWORK?
A. You can find a list of contracted doctors on the Blue Shield website at www.blueshieldca.com. Click on "Find a Provider Now". At this point you have the option to log-in with your name and password or you can elect to "skip" the log-in and search for a provider. You can search for doctors, hospitals or other facilities. In addition, it is important to also check with your doctor to confirm that they are a contracted doctor with Blue Shield.
Q. HOW WILL I BE AFFECTED IF MY PRIMARY CARE PHYSICIAN (PCP) LEAVES THE NETWORK (HMO PLAN ONLY)?
A. If your doctor leaves the network, you will be asked to select another Blue Shield participating provider. You can find a new PCP who participates in your network on your secure member website by clicking on "Find a Provider Now". At this point you have the option to log-in with your name and password or you can elect to "skip" the log-in and search for a provider. You can search for doctors, hospitals or other facilities. In addition, it is important to also check with your doctor to confirm that they are a contracted doctor with Blue Shield.
Q. HOW CAN I GET A NEW ID CARD, CHANGE MY PCP (HMO PLAN) OR VIEW DETAILED CLAIM INFORMATION?
A. You can either call the number on the back of your ID card or log onto Blue Shield's website at www.blueshieldca.com and click on the "Register Now" link located on the left hand side. You will need your member ID which is located on your Blue Shield ID card. Follow the step-by-step instructions. Once you have completed the registration process, you can log in by entering your user name and password (located on the left hand side under "I'm a member") and immediately access your account and begin taking full advantage of your personalized website. You will be able to print a temporary ID card, change your PCP, view detailed claim information and more.
Q. WHAT IS COVERED OUT OF THE HMO SERVICE AREA?
A. If you are out of the service area (out-of-state), the only coverage available is for emergency treatment for potential life and limb-threatening conditions. Out-of-state coverage on the HMO plan is always subject to approval by Blue Shield before the claims will be paid as an emergency.
Q. WHAT IS COVERED OUT OF THE SERVICE AREA ON THE PPO PLAN?
A. Many states have Blue Cross/Blue Shield networks. This network is called "BlueCard". Blue Cross and Blue Shield share this network. If you are out of California, it is important to utilize the Blue Card network so benefits will be paid at the higher in-network level. If you choose to see a non-network provider, the benefits will be paid at the lower non- network level. Claims for Blue Card benefits are filed in the state where services were received and are sent electronically to Blue Shield for payment. Blue Card information can be obtained by calling (800) 810-2583.
Q. I WOULD LIKE TO UTILIZE THE MAIL ORDER OPTION FOR MY PRESCRIPTIONS. HOW DO I SUBMIT A PRESCRIPTION?
A. You will need to obtain a 90 day prescription from your physician and submit mail order paperwork to Blue Shield if you are a PPO member and Medco if you are an HMO member. Blue Shield mail order forms can be found at www.blueshieldca.com. Medco mail order forms can be found at www.medcohealth.com and they are also available from District Benefits.
Q. HOW DO I KNOW IF A PROCEDURE OR TEST WILL REQUIRE PREAUTHORIZATION AND IF SO, HOW TO I OBTAIN PREAUTHORIZATION?
A. Often your doctor will know whether or not Blue Shield requires preauthorization and will obtain that authorization for you. However, any time you are unsure, you can call Customer Service at (800) 642-6155 and inquire. If preauthorization is required, you should ask your doctor to request it. The doctor can best communicate the type of test or procedure and the medical necessity for the procedure. Please note that Blue Shield is contracted with National Imaging Associates, Inc. (NIA) to provide medical necessity reviews and prior authorization for selected outpatient radiology procedures (PET/CAT Scans, MRI's, etc).
Q. WHO DO I CONTACT WITH CLAIMS/BILLING QUESTIONS?
A. You should call the number on the back of your ID card.
Q. WHAT NETWORK DO I USE IF I AM SEARCHING FOR A MENTAL HEALTH CARE PROVIDER?
A. If you are enrolled in the Blue Shield PPO plan, you can access Mental Health Care providers under the Blue Shield PPO network. If you are on the HMO plan, you can find a provider through Blue Shield of California's Mental Health Service Administrator (MHSA) provider network. You can access a listing of providers for both the Blue Shield Network and MHSA network at www.blueshieldca.com and click on "Find a Provider Now". If you are a PPO member, the website will provide you with two network choices: Blue Shield and MHSA. It is important that you elect the Blue Shield network for your search of Network providers.
Q. CAN I USE ANY BLUE SHIELD CONTRACTED DOCTOR TO PERFORM BARIATRIC SURGERY?A. Bariatric surgery is covered when preauthorized by Blue Shield. However, for members residing in Imperial, Kern, Los Angeles, Orange, Riverside, San Bernardino, San Diego, Santa Barbara and Ventura Counties ("Designated Counties"), bariatric surgery services are covered only when performed at designated contracting bariatric surgery facilities and by designated contracting surgeons; coverage is not available for bariatric services from any other preferred provider and there is no coverage for bariatric services from non-preferred Providers. In addition, if prior authorized by Blue Shield of California, a member in a Designated County who is required to travel more than 50 miles to a designated bariatric surgery facility will be eligible for limited reimbursement for specified travel expenses for the member and one companion. Refer to the Evidence of Coverage for further benefit details.