CareFirst BlueChoice Opt-Out Plus Open Access (POS)
The CareFirst BlueChoice Opt-Out Plus Open Access plan is a point-of-service (POS) plan that provides the affordability of an HMO with the freedom of a PPO. The open access feature allows you to receive care without referral from your primary care physician. However, you may be responsible for obtaining prior authorization from the plan for some services.
If you recently elected CareFirst BlueChoice as your medical plan and have not yet received an ID card, you can access temporary ID cards online through their My Account feature on www.carefirst.com or call 1-866-520-6099.
- Summary of Benefits (2010) - coming soon
Accessing Care
The CareFirst BlueChoice plan provides you with three different ways to access care:
1. BlueChoice Network: A more strictly defined network of local providers. With no deductible or coinsurance, members typically pay only a copay at time of service.
2. BCBS Participating Network (BCBS provider): Members also have freedom of choice and out-of-pocket savings received through tradional medical coverage by using BCBS-participating providers. Deductible and coinsurance apply. Over 80% of all providers nationwide participate in the BlueCross BlueShield (BCBS) network. You’ll pay more, but generally less than going completely non-network.
3. Non-Network (non-BCBS provider): Providers who do not participate in either the BlueChoice network or “par” network. Members may see a provider who is not a member of the BlueCross BlueShield network but may pay a higher out-of-pocket cost due to balance billing. Members typically must file their own claims.
For more details on how to access care through the CareFirst BlueChoice plan, click here.
Finding a Doctor
The BlueChoice network is a local network of providers. To locate a medical provider, go to CareFirst's online directory. You may also use this online directory to search for BlueCross BlueShield participating providers. You may request a paper copy of the directory by sending an e-mail to benefitshelp@georgetown.edu. We suggest that you use the on-line directory instead of the paper directory as the on-line version is more up-to-date than the paper version.
In-Network (BlueChoice) versus BCBS "Participating " or "Traditional" Providers
In order to access ‘in-network’ care, and receive the greatest benefit with the lowest out-of-pocket expense, visit a BlueChoice network provider. In the CareFirst BlueChoice Opt-Out Plus Open Access plan, you may also choose to access your care from a non-network provider. There are two types of non-network providers: ‘par’ and ‘non-par.’
Visit our Provider Directory page to search for providers.
Prescription Drug Plan
Participants in the CareFirst BlueChoice plan automatically participate in the prescription drug plan which is integrated into and administered through the health plan. You can choose between retail and mail order options. If you are a member of the CareFirst BlueChoice plan, and take maintenance prescription medication, we encourage you to investigate the mail order option. Click here to learn more about the prescription drug benefit available through CareFirst BlueChoice.
Filing a Claim
When you use a BlueChoice network or BCBS participating provider, that provider will submit your claim to CareFirst BluceChoice on your behalf. CareFirst will pay the provider as determined by plan rules and send you an Explanation of Benefits (EOB) which details for you the total amount billed by the provider, the amount that CareFirst paid, and the amount for which you are responsible. Your provider will send you an invoice for the amount owed (if any).
When you use a non-network provider, your provider may require you to pay the full bill at the time the service is rendered. You should then submit a copy of your invoice to CareFirst BlueChoice, along with a claim form. CareFirst will reimburse your for any amount determined to be payable by the Plan.
