How to Use Health Coverage

How to Use Health Coverage

If you have new health coverage, you probably have questions about how to use it. We hear you. Below we answer a few of the questions we most often get about using new coverage : how to choose a doctor and how to get prescriptions. Be sure to check back next week when we talk more about using your coverage and preventive services.

How to Find a Doctor – the Right One 

Now that you have new health coverage, it is time to choose a doctor to help you get the most of your benefits. Choosing the one who is right for you is just that— a choice. Here are some tips on how to find a doctor or other health care provider to meet your needs:

  • Doctor imageFind the names of medical professionals near you who are in your health plan's network so you will have lower out-of-pocket costs. Use the Provider Finder  tool on our website, or call us to find out which doctors are near you and will accept your coverage.
  • Talk to family members, friends, or co-workers and ask if they have any recommendations. Ask them what they like or don’t like about each doctor. There are some websites dedicated to doctor reviews and ratings.
  • Narrow down your choices. When you have found a few doctors you might want to try, call their offices. Ask the office staff these questions to help you decide:
    • Are they accepting new patients?
    • Is the office close to your home or your work? Will it be easy for you to get there?
    • When is the office open? Are evening or weekend appointments offered?
    • Does the doctor or someone in the office speak your language?
    • Which hospital(s) does the doctor use to see patients?
    • How long does it take to get an appointment?

 

Give the doctor a try. The next step is to schedule a visit with your top choice. During your first visit, think about how easy it is to talk with the doctor and if the doctor is a good fit for you.  Remember, if you are not comfortable with your doctor, it is okay to look for another one.

How to Get Prescriptions

Prescription drugs are a big part of your new health coverage. Your health plan will help pay the cost of certain drugs. To find out if your prescriptions are covered by your plan:

To find out if your prescriptions are covered by your plan, log in to your account in Blue Access for MembersSM from our website. This list is also called a formulary or drug list. To look for your medicines, you will need to know:

  • The medicine's exact name
  • The dose you are prescribed
  • The quantity of medication your doctor often prescribes

If prescription medicine you take isn’t covered under your formulary, you can take these steps:

  • Talk to your doctor about options. A generic version  or another covered drug could be a better choice for you.
  • Your doctor can ask that your insurer cover a drug not on its formulary if there is a health need.
    • If the request is denied, you have the right to appeal your health plan's decision and provide information to support your need for the drug.

     

Where to Get Medications

Your new health coverage allows you to get your medications from many drug stores (called "network" pharmacies). Use the Provider Finder  tool and select “pharmacies” to find out if your regular pharmacy is in your health plan's network and, if not, to find a network pharmacy near you. You can also learn if you are able to get your prescription delivered to you in the mail. Mail order prescriptions  may cost you less.

Still looking for more information? Here’s how to make the most of your prescription drug benefits and new health coverage .

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