FAQs
Claims
How do I file a claim?
How long do I have to file
a claim?
A provider has billed me; how
do I know how much of the bill to pay?
How can I check the status
of my claim?
What is the difference between
deductibles and copayments?
How does my coinsurance maximum
work?
What is Coordination of Benefits
(COB)?
Why did I receive a Coordination
of Benefits (COB) questionnaire and do I have to return
it?
What do I do with a foreign
medical bill for care I received outside of the U.S.?
Q: How do I file a
claim?
A: In most instances you do not have to
file claims. The participating provider will file claims
for you. However, you will need to file claims for any lenses,
frames and dental products or services received.
If you need a claim form or help on how to file a claim,
call BCBSNC's Customer Service at 1-800-914-4220 or write
to:
BCBSNC Customer Service
P. O. Box 2291
Durham, NC 27702-2291
Please mail your dental claims to:
Blue Cross Blue Shield of North Carolina
Attn: Claims Unit
PO Box 30568
Salt Lake City, UT 84130-0568
If you need to file a claim for prescription drug benefits
obtained at a non-participating pharmacy, you may either
download the form online or call Customer Service and
ask for a Prescription Drug Claim Form. Prescription drug
claims should be filed to:
Paid Prescriptions L.L.C.
PO Box 307
Lee's Summit, MO 64063-2187
(In some cases, employer groups carve out the prescription
drug benefit and contract with a vendor separately. Please
refer to your Member Guide to confirm that your pharmacy
benefits are offered through BCBSNC.)
Q: How long do I have
to file a claim?
A: If you need to submit a claim, please
mail it in time to be received by BCBSNC within 18 months
after the service was provided. Claims not received within
18 months from the date the service was provided will not
be covered, except in the absence of legal capacity of the
member.
Q: A provider has
billed me; how do I know how much of the bill to pay?
A: Participating providers may only bill you for
non-covered services or collect any applicable deductible,
copayment or coinsurance amounts. Non-participating providers
may bill you for the difference in what BCBSNC allows and
their actual charge. You will receive an Explanation of
Benefits (EOB) report from BCBSNC in the mail after you
receive services. This EOB should outline the amount you
owe. If you need assistance with provider bills, please
contact Customer Service at 1-800-914-4220.
Q: How can I check
the status of my claim?
A: You can check the status of a claim
by logging on to eMember Services at bcbsnc.com. With eMember
Services, you can access the following information regarding
a submitted claim:
Processing status
Date received
Billing and payment amounts
How much money has been applied toward deductible
Coverage ratios for any member covered on the policy
Q: What is the difference
between deductibles and copayments?
A: A deductible is the dollar amount you must pay
for covered services in a benefit period before benefits
are payable by BCBSNC. You must satisfy your deductible
amount once each benefit period. The deductible does not
apply to any services where a copayment applies.
A
copayment is the fixed dollar
amount you must pay for some covered services. The provider
usually collects this amount at the time the service is
provided. Copayments are not credited toward the individual
or family benefit period deductible.
Q: How does my coinsurance
maximum work?
A: If you are enrolled in both a BCBSNC
health plan and another group health plan, we may coordinate
benefits with the other plan.
Coordination of Benefits (COB) means that if you are
covered by more than one insurance plan, benefits under
one plan are determined and paid before the second plan's
benefits are determined and paid. The plan that determines
benefits first is called the primary plan. The other plan
is called the secondary plan. COB is explained in more
detail in your Member Guide.
Q: What is Coordination of Benefits (COB)?
A: If you are enrolled in both a BCBSNC
health plan and another group health plan, we may coordinate
benefits with the other plan.
Coordination of Benefits (COB) means that if you are
covered by more than one insurance plan, benefits under
one plan are determined and paid before the second plan's
benefits are determined and paid. The plan that determines
benefits first is called the primary plan. The other plan
is called the secondary plan. COB is explained in more
detail in your Member Guide.
Q: Why did I receive a Coordination of Benefits
(COB) questionnaire and do I have to return it?
A: From time to time you may receive a
Coordination of Benefits questionnaire from BCBSNC so that
we know to coordinate benefits with the other benefit plan.
The advantage of having two benefit plans is that a greater
portion of your out-of-pocket expenses may be covered by
the secondary plan. Even if you do not have two benefit
plans, returning the questionnaire will help us keep our
records accurate.
Q: What do I do with
a foreign medical bill for care I received outside of the
U.S.?
A: Answers vary according to plan. For
more information, please visit the FAQs on your plan's Member
page.
