PLEASE READ: Members of some group
health plans may have terms of coverage or benefits that differ from the
information presented here. The following information describes the
general policies of Blue Cross and Blue Shield of Florida, Inc. and is
provided for reference only. This information is not to be relied upon
as pre-authorization or pre-certification for health care services and
is not a guarantee of payment. To verify coverage or benefits or
determine pre-certification or pre-authorization requirements for a
particular member, call (800) 676-BLUE or send an electronic inquiry
through your established connection with your local Blue Plan.
| Services That Generally Require Precertification | |
|---|---|
| HMO | All services rendered out of the state of Florida require authorizations. |
| PPO | Routine, Elective, Psychiatric and Substance abuse, and all Inpatient services require prior authorization. Selected specialty drugs require authorizations. Selected DME/Orthotics/Prosthetics require an authorization on some products. Advance Imaging services may require an authorization contact National Imaging Associates at 1-866-326-6302 Questions should be referred to BCBSF at 1-800-955-5692, option 3. |
| Traditional | Routine, Elective, Psychiatric and Substance abuse, and all Inpatient services require prior authorization. Selected specialty drugs require authorizations. Questions should be referred to BCBSF at 1-800-955-5692, option 3. |
| Medicare Supplement | Medical Management is not applicable for Medicare Supplement plans. Please follow Medicare for covered services |