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Health Insurance and Claims Chapter 13

QuestionAnswer
What BCBS program enables its members to obtain healthcare services while traveling or living in another BCBS Plan's service area to receive the benefits of their home Plan contract and to access local provider networks? BlueCard program
What BCBS plan is an employer-sponsored health plan program for federal employees? Federal Employee Health Benefits Program (FEHBP)
What is another name for the Federal Employee Health Benefits Program? Federal Employee Program (FEP)
What BCBS plan offers choice and flexibility to subscribers who want to receive a full range of benefits, along with the freedom to use any licensed health care provider? indemnity coverage
This is a special clause stipulating additional coverage over and above the standard contract. rider
If a BCBS patient is considering elective, nonemergency surgical they must get what? second surgical opinion (SSO)
Some BCBS plans use this basis to determine alloed fees for a given procedure. It is the amount commonly charged for a particular medical service by providers within a particular geographic region. usual, customary, and reasonable (UCR)
This type of provider has not signed a contract, and will expect to be paid the full fee charged for services rendered to a BCBS patient. BCBS nonparticipating provider
Created by: Kcompleta
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