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Lab, Durable Medical Equipment, Orthotics/Prosthetics

There are times when you may need additional services, also known as ancillary services, as part of your treatment. These services include laboratories, durable or home medical equipment and supplies, and orthotics and prosthetics.

 

To get the greatest value from your benefits, it is important that you receive services or supplies from an ancillary company that has a contract with a Blue Cross and Blue Shield Plan (Blue Plan) in the state where you are receiving care.

 

The chart below explains what you need to do so your ancillary claims process in-network starting Oct. 14, 2012.

 

Independent clinical laboratories

What It Is

A non-hospital based laboratory that analyzes blood, urine samples and more.

How It Works

Make sure the laboratory has a contract with the Blue Plan in the state where the specimen was drawn.

Durable or home medical equipment and supplies

What It Is

A supplier of hospital beds, oxygen tanks, crutches and more.

 

How It Works

Make sure the durable or home medical equipment supplier has a contract with the Blue Plan in the state where the equipment was shipped, or, if not shipped, where it was purchased from a retail store.

Orthotics and prosthetics

What It Is

A supplier of devices that straighten or align a body part (orthotics) or an artificial device extension that replaces a missing body part (prosthetics).

How It Works

Make sure the orthotic and prosthetic supplier has a contract with the Blue Plan in the state where the equipment was shipped, or, if not shipped, where it was purchased from a retail store.

 

The following Q & A provides further details about ancillary services.

General Questions

Q: What happens if I use an ancillary provider outside of my state on or after Oct. 14, 2012?

A: Starting Oct. 14, 2012, if you use a company outside of your state's Blue Cross and Blue Shield network, you may have to pay more in deductibles, copayments, coinsurance and other costs if your provider is out-of-network. 

 

Q: How do I know if I'm impacted by this policy?

A: If you use a company outside of your state's Blue Cross and Blue Shield network, you will be impacted. Medicare Supplement customers are not impacted at this time. 

 

Q: My out-of-state provider is currently listed on the Blue National Hospital and Doctor Finder. Will this change?

A: A message displays on the Blue National Hospital and Doctor Finder that reminds members to search for a provider in the area where the equipment will be shipped to or purchased (equipment or supplies) or where the referring provider is located (laboratory).

 

Q: What if I'm unable to locate an ancillary provider in my state?

A: If you are unable to locate an ancillary provider in your state, please call the customer service number on your Wellmark ID card. We will do our best to help you find a local, participating ancillary provider that meets your needs.

 

Q: Does the ancillary services policy apply to BlueCard Worldwide® claims?

A: BlueCard Worldwide claims are for medical services incurred outside the United States, Puerto Rico and U.S. Virgin Islands. These claims are not subject to the ancillary services policy. The ancillary claims policy applies only to claims incurred within the United States.

Independent Clinical Laboratory

Q: How do I know if the laboratory work my doctor ordered is going to an independent clinical laboratory?

A: Ask your provider if the laboratory work is being processed by an independent laboratory. If yes, the laboratory must be in the same state as the referring physician and within your state's Blue Plan provider network. 

 

Q: How do I know if the laboratory work my doctor ordered is going out of state?

A: Ask your provider where the laboratory work is being processed. The laboratory should be in the state where you live and within your state's Blue Cross and Blue Shield network. 

 

If you are referred to an independent laboratory to have blood drawn, check that the laboratory is participating with the Blue Plan network in the state where the lab is drawn. If your physician obtains the laboratory specimen in his or her office but sends it to a laboratory for processing, the laboratory must be participating with the Blue Plan where your physician is located.

Durable/Home Medical Equipment (DME/HME) and Supplies

Q: What if I get durable/home medical equipment and supplies shipped to my home or purchased from a retailer?

A: If you have durable/home medical equipment or supplies shipped to your home, make sure the company is participating and in-network with your state's local Blue Plan by using the Blue National Hospital and Doctor Finder or calling Customer Service.

 

If you purchase durable/home medical equipment or supplies from a pharmacy or durable/home medical equipment store, make sure the store is contracting with the Blue Plan in the state where the pharmacy or the durable/home medical equipment supplier is physically located. 

Orthotics and Prosthetics

Q: What if I get orthotics or prosthetics shipped to my home or purchased from a retailer?

A: If you have orthotics or prosthetics shipped to your home, make sure the company is participating and in-network with your state's local Blue Plan by using the Blue National Hospital and Doctor Finder or calling Customer Service. 

 

If you purchase orthotics or prosthetics from a supplier, make sure the supplier is contracting with the Blue Plan in the state where the orthotic or prosthetic supplier is physically located.

 

 


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