Frequently Asked Questions

General
Billing
Claims
Manage Communications
Prescription Drug List
Eligibility
Blue KC Mobile
Primary Care Physician Change
PPO Questions
Provider Selection
Other Insurance
Health Savings Account
Personal Care Account
Prior Authorization
Medications
Medications—ACA (Affordable Care Act) Plans ONLY
Predetermination
Medical Policy

General

Learn about Blue KC business hours and services and how to get your Blue KC questions answered.

What does Blue KC offer?
Blue KC is a leader in the development of innovative managed care programs. Nearly one million members are enrolled in a wide range of group and individual insurance products, including health maintenance organizations (HMO), preferred provider organizations (PPO), dental, and Medicare supplemental insurance plan. Visit the What We Offer section of our website to learn more, or give us a call at 800-860-2227, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

What is Blue KC's address?
The address of our main headquarters is One Pershing Square, 2301 Main, Kansas City, Missouri 64108. For the claims address specific to your health insurance plan, refer to the back of your member ID card.

What are Blue KC's business hours?
Blue KC is open from 8 a.m. to 8 p.m. Central time.

What geographic areas does Blue KC cover?
Blue KC is proud to be the largest provider of health insurance plans in a 32-county area serving greater Kansas City and northwest Missouri. The Missouri counties covered are: Andrew, Atchison, Bates, Benton, Buchanan, Caldwell, Carroll, Cass, Clay, Clinton, Daviess, DeKalb, Gentry, Grundy, Harrison, Henry, Holt, Jackson, Johnson, Lafayette, Livingston, Mercer, Nodaway, Pettis, Platte, Ray, Saline, St. Clair, Vernon, and Worth. We also serve Johnson and Wyandotte counties in Kansas.

What is Blue KC's mission statement?
We will use our role as the leading health insurer to provide affordable access to healthcare and to improve the health of our members.

Who do I contact for questions about the plans Blue KC offers?
If you work for an employer that offers Blue KC health insurance plans, check with your Human Resources department or your group benefits administrator for more information about our plans. If your company does NOT offer Blue KC health insurance plans, have your group benefits administrator contact us for more information on what we offer. You may also contact a licensed agent at 800-860-2227 for questions.

To see what plans we offer and apply online for health insurance, visit the What We Offer section of our website. If you have questions as you look at our plan options, contact a Blue KC marketing representative at 800-860-2227. You may also call the Customer Service department at 816-395-2583 or 800-645-8346.

I am having trouble using the Blue KC website. Who can I contact for help?
Contact us for help using this website.

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Billing

Find answers to billing questions for HMO, PPO and Medicare Supplemental Insurance plans

Please note, these questions only apply to members who do not have health insurance through an employer.

If I do not agree with the information reflected on my billing summary page, what should I do?
To dispute information on your billing summary, call the Customer Service number listed on your member ID card. You may also contact us through our site. Log in and visit the Contact section. If you are a representative from an employer group, please call our Member Services department at 816-395-2950.

If my billing address is not correct on the website, how can I have it corrected?
To correct a billing address, call the Customer Service number listed on your member ID card or log in and visit the Contact section to send us an email. If you are a representative from an employer group, please call your Blue KC marketing representative.

How can I tell if my account has been billed for the current month?
Your billing information is available online. Log in and visit the Pay My Bill section. Your bill summary includes your billing date, amount due, due date and the coverage period for the bill. Please note that billing statements are mailed to you for the upcoming month. For example, a statement is generated in July for your August premium.

How can I tell if my payment has been processed?
Your online billing summary shows your last statement activity and any activity since the date of your last statement. If we have received a payment, it will be reflected on this page. The total payment due is the amount you owe Blue KC as of the current calendar date.

How can I get a copy of my last billing statement?
Copies of your billing statement can be found in your File Cabinet. To access your File Cabinet log in to MyBlueKC.com and select “File Cabinet” in the lower left side of the page. Then select My Blue KC Bill to expand the view of your past billing statements.

How can I pay my bill?
To pay a bill, you may pay by mail, online, over the phone using a credit card or electronic funds transfer (EFT).

  • To pay by mail, send in your payment to:

Individual Policies:
Blue Cross and Blue Shield of Kansas City
P.O. Box 801285
Kansas City, MO 64180-1285

Group Policies:
Small Group:
Blue Cross and Blue Shield of Kansas City
P.O. Box 801714
Kansas City, MO 64180-1714

Large Group:
Blue Cross and Blue Shield of Kansas City
P.O. Box 843928
Kansas City, MO 64184-3928

To ensure we post the payment to your account in a timely manner, please include the payment stub from the bottom of your statement with your payment.

  • To pay online, log in and select Pay My Bill. If you have a balance due, a "Pay Bill" button will display at the bottom of the page. You will be directed to a secure payment site to enter your credit card or bank account information (for EFT payments).
  • To pay over the phone, call Blue KC Customer Service at the number listed on your member ID card. You must pay by credit card or EFT when making a payment over the phone.

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Claims

Learn how we process your claims and pay your providers.

Do I pay my provider at the time of service?
Yes, you must pay your copayment when you see your in-network provider. Your copayment amount depends on the health insurance plan you have and the services you are receiving from your provider.

How can I find out the amount I'm responsible for paying on a claim?
To find out the amount you are responsible for paying on a claim, log in and visit the Claims section at the top of the page. Recent claims are listed on the Claims page. If you do not see the claim you are looking for, you may search for a specific claim by the date of service. Once you have found the claim you are looking for, select the plus sign "+" to view details about that specific claim. You can see the amount you are responsible for paying under the Your Part section of the claim detail.

Why is my HMO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says "Insurance Pending." We will send you an Explanation of Benefits (EOB) once we have processed your claim. The EOB will tell you how much you owe to your provider. If you are still unsure if you owe the provider, call their billing office. Please note, if your provider was not in the Blue KC HMO network, you will be responsible for paying all services and fees for seeing that provider. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims section.

Why is my PPO provider billing me?
Sometimes providers send statements to their patients before Blue KC has finished processing and paying the claim. You might see a note on the bill that says "Insurance Pending." If the provider you saw is in-network or contracted for payment from Blue KC, we will send you an Explanation of Benefits (EOB.) The EOB will tell you what you will be responsible for paying. If the provider you saw is out-of-network you will be responsible for paying the provider directly. Blue KC will process your claim. We will send you a payment for the amount that is covered by your plan. The EOB will explain how we calculated that amount. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims section.

I received a check from Blue KC. What is it for?
When you see an out-of-network provider, we send a check to you for the covered amount of those services. You are responsible for paying your provider directly. We will send you an EOB that explains how that amount was calculated. You can view your EOBs and details about your claims, including how much you owe, by logging in and visiting the Claims section.

What claim information is on the website?
A summary of your claims, the status of those claims and details regarding each claim can be found online. Log in and visit the Claims section to view claims processed during the past 24 months.

How can I get a claim form?
To get a claim form, you can log in and visit the Claims section. From here, select Claim Forms on the left side of the page.

For your convenience, you may also obtain a claim form by selecting one of the following:

Medical/Dental Claim Form
Pharmacy Claim Form
BlueCard Worldwide International Claim Form

What do I do if I disagree with how my claim was processed?
If you have questions about how a claim was processed or you think it was processed incorrectly, please let us know. Call the number listed on your member ID card or log in and select Contact.

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Manage Communications

  1. What is the Manage Communications page?
    Manage Communications is a place for you to tell us how you want to receive your Blue KC communications. You can select email, text or US mail as your preferred delivery option. You can also elect to receive some communications by text, some by email, and opt-out of others, based on the category of communications.

    It's your information; you choose how to receive it!
  2. What types of communications are included?
    The Manage Communications page includes:
    • My Blue KC Bill: Information related to your Blue KC premium bill (only applies to direct pay members).
    • My Claims: Your Explanation of Benefits (EOB).
    • My Plan Information: Your member certificate, communication about activity status, and requests for information.
    • Health & Wellness: Newsletters, preventive guidelines, and information specific to your health condition.
    • Products & Services: Information about new products or value added services we offer.
    • Blue Loop: Special member panel to provide input about Blue KC products, services & staff.
    You can customize your delivery preferences, based on the category of communication. For example, you can choose to only receive an EOB when you owe money.

    Please note that not all Blue KC communications are available in a digital format at this time.
  3. Do I have to register a preference for each category?
    You can select a different preference for each communication category, or you can pick one preference to apply to all categories.

    Please note that some items are not available by US mail (for example, the notification of auto-bill payments and preventive care guidelines), and not all Blue KC communications are available in a digital format at this time.
  4. Can I select more than one communication preference (email, text and/or US Mail)?
    Yes, you can choose more than one preference for a communication category. For example, you can elect to receive both an email and text notification that you have a new EOB ready to view.
  5. Why can I not select US Mail as a preference for My Blue KC Bill payment notifications?
    These notifications are tied to the automatic payments from your bank account for your Blue KC premium bill. Due to the "just in time" nature of these communications, providing a notification by US Mail would be outdated. We encourage you to sign up for email or text notifications for your automatic premium payment.

    Please note: "My Blue KC Bill" only applies to direct pay members.
  6. Do I have to use the email I registered with on MyBlueKC.com to receive my communications? Or, can I designate a different email address for my communication preference?
    You can designate any email address you want for delivery of your Blue KC communication notifications; it does not have to be the same email address you use to register on MyBlueKC.com.

    Once you register your preferred email on the Manage Communications page, we'll send an email to validate your preferred email address.

    If at any time you change email addresses, be sure to update your personal information on the Manage Communications page to ensure you continue receiving information from Blue KC.
  7. Can I select communication preferences for my dependents?
    The communication preferences you select for yourself will automatically be applied to dependents on your policy that are under the age of 18. Due to HIPAA privacy rules, you can't establish communication preferences for dependents over the age of 18. They will need to register on the website, using the information from their member ID card, and designate their own preferences on the Manage Communications page.
  8. How can I update my personal information for my communication preferences?
    Simply log in to MyBlueKC.com and visit the Manage Communications page. Here you can update your preferences, as well as your personal information including your preferred communication email and mobile phone number.
  9. What is Blue Loop?
    Blue Loop is a special member panel we've created to gather input from our customers. As a participant of Blue Loop, you'll be asked to complete a brief online survey to tell us what Blue KC is already doing that works for you, what doesn't work for you, and how our products, services and people can serve you better. Participants will be sent a new survey periodically. You can sign up for Blue Loop on the Manage Communications page.

File Cabinet

  1. What is the File Cabinet?
    The File Cabinet is your central location for viewing information sent by Blue KC. Here you can find information specific to your Blue KC policy such as your member certificate, claims information, health and wellness news, and more.

    All Blue KC communications, which are available in a digital format, will be posted in your file cabinet. Even if you select US Mail as your preferred delivery channel on the Manage Communications page, your documents will still be posted in your file cabinet and available to view online.
  2. What documents can I view in the file cabinet?
    A variety of communication categories are available in the file cabinet:
    • My Bill: If you're a direct pay member, you can view your current and past premium bills in this section.
    • My Claims: Includes your Explanation of Benefits (EOB) from the past 24 months.
    • My Plan Information: Your member certificate, communication about activity status, and requests for information.
    • Health & Wellness: Newsletters, preventive guidelines, and information specific to your health condition.
    • Products & Services: Information about new products or value added services we offer.
  3. How will I know if there are new documents in my file cabinet?
    It depends on how you setup your preferences on Manage Communications. If you elected email or text, you'll receive a notification that a document is ready to view in your file cabinet. If you opted out of a specific communication category, you won't receive a notification, but the documents will still be posted and available for you to reference/view in your file cabinet.
  4. I've registered my preferences, and there are new documents in my file cabinet, but I haven't received any notifications by text and/or email. What happened?
    Log in to MyBlueKC.com, visit the Manage Communications page and confirm your email and/or mobile phone number are correct.
  5. I registered my preference as email and/or text, but I continue to receive Blue KC information via US Mail. What happened?
    Not all Blue KC documents are available in a digital format at this time, which means we will continue to send some items to you via US mail. Be assured we are working hard to meet your needs.
  6. What if I want to change my preferences?
    You can change your preferences at any time. Simply log in to MyBlueKC.com and go to Manage Communications. Please note: At the time you change your preference, you may have communication from Blue KC that is in progress and may not be delivered according to your new preference.

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Prescription Drug List

Learn about the differences between brand name and prescription drugs.

What is the difference between brand-name drugs and generic drugs?
When a drug company develops a new medication they apply for a patent. This patent protects the drug from being copied by other drug companies for a certain period of time. These drugs are brand name drugs. Once the patent period expires, other manufacturers can produce the same drug as long as they follow strict guidelines established by the Food and Drug Administration's (FDA) guidelines. These same drugs are generic drugs. Generic drugs are less expensive versions of those brand name drugs whose patents have expired. They are made with the same active ingredients of the brand name drug, but they may have a different color, shape or filler material. The cost of a generic drug is typically less than a brand name drug. All generic medications are approved by the FDA before they are released on the market. Some examples of generic drugs and their brand name equivalent include furosemide and Lasix®, ranitidine and Zantac®, and cephalexin and Keflex®.

What is the difference between a generic equivalent and a generic alternative?
A generic equivalent is a medication that contains the same active ingredient and works the same way as the original brand name drug. A generic alternative is a generic medication that may not have the same active ingredient, but works in the same way as another drug. An example of a generic alternative is ranitidine. It is the generic equivalent of Zantac®, but it works in the same way to relieve stomach acid as Axid® and Pepcid®.

Zantac, Axid, and Pepcid are the same "class" of medicine but contain different active ingredients. So, the generic form of Zantac, "ranitidine," is a lower cost alternative in the same class of medicine as Axid and Pepcid.

How is the tier level status determined for medications?
The Prescription Drug List (PDL) is a list of prescription medications that have been reviewed and recommended by the Blue KC Medical and Pharmacy Management Committee. The list has a combination of brand name and generic medications. Each of these medications has been reviewed for its safety, effectiveness, clinical outcomes, and cost. Physicians and pharmacists on the committee look at drug utilization issues, the number of adverse events, and any proven advantages over other drugs on the PDL. The most efficient and cost effective drugs are on Tier 1 of the PDL. All other drugs are designated Tier 2 or Tier 3 status.

ACA
Kansas
Missouri

Non-ACA
Commercial
High Performance Formulary

To make sure you are viewing the correct PDL Login at MyBlueKC.com.

What is a maintenance drug?
A maintenance drug is a medication used to treat a chronic condition like diabetes or high blood pressure. The FDA must approve maintenance drugs as safe for long-term use. Blue KC uses a national drug information database called First DataBank to determine which medications are included on the maintenance drug list. If your prescription is a maintenance drug, you can have it filled for several months instead of just one prescription at a time.

Do I need to show my member ID card at the pharmacy?
Yes, show your member ID card to your pharmacist whenever you have a prescription filled. Your prescription claim is electronically transmitted to Blue KC when you fill your prescription. Please make sure the pharmacy has your most current health insurance information and correct birth date so there won't be any delays or claim denials when we process your claim.

What do I do if I need to refill my prescription early (i.e., leaving on vacation, the doctor increased my dosage)?
To have a prescription refilled early, have your pharmacist call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

What if I am out of town and need to have a prescription filled?
Blue KC contracts with most major pharmacy chains and has a network of over 44,000 pharmacies nationwide. If the pharmacy you are using has difficulty in processing your prescription claim, have them contact the Pharmacy Customer Service unit for assistance at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

Why does Blue KC require prior authorization for some drugs before they are covered?
Blue KC may require prior authorization for some drugs or a class. Medications on the prior authorization list may have safety concerns or have FDA approval, only for a certain use. Some of the prior authorization medications may also have a lower-cost alternative that should be considered first or the drug may not be as effective as something else in the same drug class. Some medications are also on the prior authorization list because they have the potential to be misused. Your provider and Blue KC will work together to get prior authorization and approval for your prescription when needed.

What if I have questions about my prescription drug coverage?
For more information on your prescription drug coverage, call the Pharmacy Customer Service unit at 816-395-2176 or 800-228-1436, Monday through Friday from 8 a.m. to 5 p.m. Central Time.

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Eligibility

Learn about the health insurance eligibility requirements for you and your dependents and information on enrollment.

When can I change from individual to family enrollment or from family to an individual?
There are two times you can make a change to your enrollment options. The first time is during the open enrollment period. Your employer schedules an open enrollment period once a calendar year when all employees may make changes to their health insurance plan. You may also make a change during a special enrollment period if you acquire a new dependent or if your coverage is terminated under another health insurance plan. If you have health insurance through an employer, your group benefits administrator, typically someone in your Human Resources department, can help you make changes to your health insurance plan. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.

Am I eligible for health insurance through my employer if I have a pre-existing condition?
Yes, you are eligible for health insurance through an employer if you have a pre-existing condition. However, you may not have coverage for your pre-existing condition for a certain period of time.

How do I add a dependent to my health insurance plan?
If you have health insurance through your employer, check with your group benefits administrator to have a dependent added to your plan. He or she has the information and/or forms you need to add your dependent to your health insurance plan. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.

Are my children covered when they are away from home and at school?
Your children's coverage while they are away from home depends on the type of health insurance plan you have. If you have health insurance through your employer, check with your group benefits administrator for more information. If you do not have health insurance through an employer and instead pay your monthly premiums directly to Blue KC, call the Customer Service number listed on your member ID card.

I noticed my membership information was wrong during enrollment. How do I have it corrected?
Log in and click on "Contact Us." Please make sure your e-mail includes your member ID number, the current date and the correct information.

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Blue KC Mobile FAQs

What is Blue KC Mobile?
Blue KC Mobile is a mobile version of our website (www.BlueKC.com) that you can access directly from your Smartphone, making it easier and more convenient for you to find Blue KC information when you need it.

What is the difference in using Blue KC Mobile versus a home computer?
When you visit www.BlueKC.com from a computer, you will see all the information and tools available from the full website. Blue KC Mobile offers the most frequently used tools from the website, making it easier to access this information when you're on the go.

What can I do on Blue KC Mobile?
Our mobile site is designed with you in mind and features the most frequently used member tools:

  • Find a Doctor—Use our online provider directory to locate a Blue KC doctor near your location. View their office location on a map and call them directly from your search results.
  • Contact Us—Access Blue KC contact information—our phone number and street address.

Behind the Member Login button you can access your personalized Blue KC information:

  • My Claims—View your claims from the past 24 months
  • My Plan Info—Access basic plan information such as your copayment and deductible amounts
  • My ID Card—Order a replacement ID card
  • My Bill—Individual members can pay your insurance bill and set-up automatic payments from your bank account or credit card.

How can I access Blue KC Mobile?
Simply type "www.BlueKC.com" into the browser of your Smartphone and you'll be directed to the mobile site.

What mobile devices are supported with this feature?
The Blue KC Mobile site can best be accessed using most Apple iPhone, BlackBerry and Android Smartphones.

Is it free to use Blue KC Mobile?
Yes! There is no charge to use the Blue KC Mobile site. However, it is always a good idea to contact your service provider to see if they charge any connectivity or internet usage fees.

Do I have to be registered with BlueKC.com to use Blue KC Mobile?
No. Anyone with a mobile device can use the Find a Doctor, Contact us, or Plans and Pricing tools on the mobile site. You must be a Blue KC member to log in to the secure member site. If you are a Blue KC member, but have not registered online yet, you'll need to do so from our main website before you can access the member section of the mobile site.

Do I need a separate username and password for the mobile site?
No. You use your existing MyBlueKC.com username and password.

How do I get a username and password for the member section of the mobile site?
You need to register on our main website from a computer. Once you've set up your username and password, you'll be able to log in using your Smartphone.

Do I need Internet access on my cell phone?
Yes, you must have Internet access on your phone in order to use Blue KC Mobile. If you do not have Internet access, please contact your service provider for details on specific fees and charges.

Is there a Blue KC Mobile application I can download to my phone?
There is no application for Blue KC Mobile. You can access it through your browser on most Smartphones. That way you don't have to worry about prompts or downloads to access the site when you need it.

Can I still visit the full BlueKC.com site from my Smartphone?
Yes, select the link "view full site" at the bottom of the Blue KC Mobile site. Although the full website is not optimized for a Smartphone, it does provide you access to all the information and tools available online. However, you may need to "zoom in and out" to read everything.

Can my Blue KC Mobile session time out?
Yes, if you are using the secure member section. Your session will time out after 20 minutes, just like it does when using a computer. This helps to protect your privacy. There is no time limit when using the "Find a Doctor" tool.

SECURITY FAQS

Is my information secure with Blue KC Mobile?
Yes. You have to enter a username and password to access any personal information on Blue KC Mobile.

Can I use the secure member site without a User Name and Password?
No. For the safety and security of your health information, you must log in using your BlueKC.com username and password each time you visit the member section of the site.

How can I be sure my secure information is safe if my mobile device is lost or stolen?
You must always enter a username and password to access the member section of the site, which contains your personal health information. Without your username and password, no one can access your personal data.

If your phone is lost or stolen, call your wireless provider right away and ask them to deactivate the device. It may also be wise to change the password to your secure member site, just to be safe!

Should I store personal health information locally on my device?
No. Personal information stored on your mobile device that is not password protected is not secure. Make sure you know how to lock your mobile phone with a password.

What if I forgot my username and password?
You'll need to visit our main website to retrieve your username and/or password. Please note you'll need information from your Member ID card in order to retrieve your log in information.

TROUBLESHOOTING FAQS

If I experience technical problems, what should I do?

  • Try to refresh your browser
  • Confirm that you have good cellular service or reception. Often browsers "time-out" when service levels are low and it takes too long to access a specific site.

What if I'm no longer able to access Blue KC Mobile?
Although it's rare, some users may experience issues with viewing text and graphics, or entry fields. If this happens, trying turning off your Smartphone and turning it back on again. If you continue to experience problems, try clearing your internet cache. An explanation about how to do this can be found in your device's manual, or check with your carrier for more information.

Why does my Blue KC mobile screen look different than my friend's screen, even though we are both Blue KC members?
Each Smartphone model and service provider offers a variety of web browser applications and Blue KC Mobile is capable of adjusting to most types of phones that offer web access. However, different mobile devices may display a variety of font sizes, colors and buttons.

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Primary Care Physician Change

Learn how to select and change your Primary Care Physician.

What is a Primary Care Physician?
A Primary Care Physician (PCP) is the physician you choose to be your primary source for medical care. Your PCP coordinates all your medical care and knows your specific health history. You can designate a physician who specializes in family practice, general practice, internal medicine or pediatrics and is in your network as your PCP. Each dependent on your health insurance plan will also need a designed PCP. Everyone on your health insurance plan may have a different PCP.

Do I need to select a PCP?
Blue KC members who enroll in the BlueCare® HMO health insurance plans need to select a PCP. If you enroll in a PPO plan, you do not need to designate a PCP.

How do I select or change my PCP?
You will first select your PCP during open enrollment. To change a PCP, log in and visit My Profile on the left side of your member homepage. Then select Primary Care Physician on the left of the page. From here you can search for and designate a new PCP. Once we have processed your PCP change request, we will send you a new member ID card that contains the information of your newly selected PCP. You may also call the Customer Service number listed on your member ID card to change your PCP. Please note that if you have health insurance through your employer, you may be required to contact your group benefits administrator to change your PCP.

What if my PCP no longer participates in the network?
If your PCP no longer participates in the network, you will be assigned a new PCP. If you are not satisfied with the PCP assigned to you, you may change your PCP.

Why didn't I receive the PCP I signed up for during open enrollment?
The PCP you may have selecting during open enrollment may not be accepting new patients. Or, you may have chosen a physician who is classified as a specialist. Specialists cannot be designated as a PCP. Physicians who specialize in family practice, general practice, internal medicine or pediatrics can be designated as your PCP. If you are not satisfied with the PCP assigned to you, you may change your PCP.

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PPO Questions

Learn More About PPO deductibles, copayments and coinsurance.

What are billed charges?
Billed charges are the amount charged or billed by your healthcare provider for the services/supplies you received. Not all provider charges will be paid by your health insurance plan.

What are allowable charges?
Allowable charges are the maximum amount payable to you under your health insurance plan for a particular service. Contracted providers have agreed to accept this amount as payment in full. For example, if the provider charges $100 for a service and Blue KC pays $80 as the allowable charge, the provider cannot ask the member to pay the remaining $20. Keep in mind, however, that some health insurance plans have coinsurance. In those cases, members are required to pay a percentage of the allowable charge. For specific details about your plan, review your Blue KC certificate, which outlines your payment responsibility.

What is a provider write-off?
Providers who have entered into a contract with Blue KC have agreed to accept a specific payment amount for each of their services. This is often a discounted amount versus what these providers might normally charge. The provider write-off is the difference between what they normally charge and the discounted amount specified in our agreement with that provider. We refer to this as the "provider write-off." Ultimately three things determine what Blue KC pays a provider:

  • The agreed-upon fee
  • The amount of your copayment and/or coinsurance
  • The amount of your deductible that has been satisfied

What is a copayment?
A copayment, or copay, is the dollar amount that you pay to a provider at the time you receive a service. For example, you might pay a $30 copay each time you visit your allergy doctor. The copay amount is defined in your Blue KC certificate, which outlines your responsibilities for health insurance plan payments.

What is a deductible?
A deductible is the amount that you are responsible for paying annually for healthcare services. You pay coinsurance after you've met your deductible. Exceptions are outlined in your Blue KC certificate, which lists the exclusions related to your health insurance plan.

How is my deductible calculated?
Each payment you make for covered healthcare services you've received from your providers such as a physical exam (not counting copays that you make at the time of your visits) counts toward your deductible. Once Blue KC processes the claims we receive from your providers showing the payments that you have made for covered healthcare services, we apply those payments toward your deductible.

What services and charges do not count toward the deductible?
When you pay for certain services, those payments may not count toward you meeting your deductible. For details about exclusions, review your Blue KC certificate.

What is coinsurance?
If your plan has coinsurance, you will have to pay a portion of the allowable charge for a covered service. You pay coinsurance after you've met your deductible. For details about your payment responsibilities, please review your Blue KC certificate.

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Provider Selection

Get to Know How Blue KC Chooses Your Network of Healthcare Providers.

How does Blue KC select physicians for each of their networks?
Blue KC selects all physicians for our networks through a credentialing and contracting process. Once Blue KC approves providers who meet the criteria established in our process, they are included in our provider networks. Setting standards for participating providers is part of our commitment to bring you quality healthcare coverage.

Is my physician in the Blue KC provider network
You can easily check the Doctor and Hospital Provider Finder on our website to see whether your physician is a participating provider in your Blue KC network.

To view the most accurate information related to your Blue KC network, be sure to first log in MyBlueKC.com. By doing so, the search results will be tailored to your specific network. Because healthcare providers in your Blue KC network may change, we recommend that you verify your provider's participation before you receive care.

Besides physicians, what can I find in the provider finder?
Through the provider finder, you can also search for healthcare hospitals, facilities (e.g., home health facilities), and labs.

How do I find out if a provider is accepting new patients?
When you look up a provider and the description says, "Accepting New Patients," it means that a physician is taking new patients at that time.

How can I obtain a hard copy of the provider directory?
You can print a copy of the directory directly from the Doctor and Hospital Provider Finder. You can also request a hard copy by contacting us. Please let us know your member ID number, mailing address, a home phone number and your date of birth. If you know the name of your health insurance plan or network directory that you are requesting, please include that information as well.

How does the Cost Estimate tool work?
Cost estimates use 12 months of claims data and provide you with a cost range for a specific procedure. For example, the total cost for a knee replacement at a specific hospital may be $19,000 to $22,000.

The tool provides with you with a greater transparency by shedding light on the cost on 1,623 of the most common, elective procedures for inpatient, outpatient and diagnostic services at area hospitals, ambulatory surgery centers and free-standing radiology centers.

How can I rate my doctor?
Rate Your Doctor allows you to score doctors you've recently seen. The process is simple. All you have to do is sign in to or register at MyBlueKC.com, which enables you to share your patient experience. All feedback is confidential. Your doctors will not know if or how you rated them. Here's how to get started:

  1. Sign on to MyBlueKC.com
  2. Select "Find Blue KC Doctors, Hospitals and Pharmacies" button
  3. Locate your doctor using the search tool
  4. Select "Rate the Doctor" from your doctors
  5. Answer a few questions about you experience and submit.

What is BlueCard®?
BlueCard is a national provider program offered by Blue KC and other Blue Cross and/or Blue Shield Plans across the country. This program provides in-network benefits to PPO members who need healthcare services when they are away from home.

How can I access a PPO BlueCard provider away from the Kansas City area?
If you are traveling out of the Blue KC service area and need to access a provider, you can visit the Blue KC Doctor and Hospital Finder to find providers in this program. Be sure to first log in as a member on the website before using this tool so your network information is populated in the search results. You can also call 1-800-810-BLUE. We will provide you with the name and address of a participating provider. If you need a provider directory from another health insurance plan, please call the Customer Service number on your member ID card.

How can I access a HMO provider away from Kansas City?
If you're an HMO member, you will need to receive services from an in-network HMO provider. However, you will be able to receive emergency or urgent care services no matter where you are. For details about your coverage, please review your Blue KC certificate, which outlines the benefits and exclusions related to your health insurance plan. You can view your certificate by logging in and accessing the Plan Information section of your online file cabinet.

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Other Insurance

Learn How to Coordinate Blue KC Benefits with Other Health Insurance.

What is Coordination of Benefits?
Coordination of Benefits (COB) establishes the order of payment when two or more medical plans (primary and secondary) cover an individual and makes sure that no insured person receives more than 100 percent of the allowable expenses for an insured service. The primary plan pays benefits as it would without the presence of a secondary plan. A secondary plan reduces its benefits so that the total benefits provided by both it and the primary plan are not more than the total allowable expenses.

Why does Blue KC need to know about other health/dental coverage that I have?
Many people are insured under more than one health and/or dental insurance plan at the same time. Because of dual insurance, Medicare Secondary Plans (MSP) and Coordination of Benefit (COB) requirements, Blue KC needs to determine primary insurance based on the facts of each situation. Most health insurance and dental plans include a COB provision that defines these requirements. This provision prevents payments from all Plans from exceeding the total allowable expense.

Will my claim be delayed because of COB?
Blue KC is committed to processing your claims in a timely manner. However, if a claim is received and updated COB information is needed, the claims for that member will be delayed until Blue KC receives the requested information. After Blue KC receives the requested information and the COB information is updated with the appropriate information, Blue KC will process your claims. If you receive a COB letter requesting information about Medicare or other insurance, please respond as soon as possible.

Please note, Blue KC will send letters to you requesting the required information that may be missing in our COB file. Please follow the instructions given in the letter to respond by mail, phone or through our website. We update our files annually, so you will receive a request for updated COB information every 12 months.

How can I avoid the delay in the processing of COB claims?
To avoid a delay in the processing of COB claims, please follow these steps:

  • When your providers submit claims to Blue KC, make sure that they have the most current information on your family and other insurance. This will assist your provider in filing the claim first with the primary plan and then with the secondary plan.
  • Make sure that Blue KC has current information on your family regarding other health insurance.
  • Follow the instructions given in the letters that Blue KC mails to you requesting updated health information and whether to provide that information to us by mail, phone or through our website.

How does Blue KC determine whether they should pay my claim before or after my other plan pays?
For a detailed explanation of COB and order of benefit determination rules, please review your Blue KC certificate. If you need a current copy, please call the Customer Service number listed on your Blue KC member ID card.

Who is included in COB?
Yourself, if you are insured under two or more group health insurance plans or Medicare; your spouse, if your spouse has health and/or dental insurance coverage through his or her employer or Medicare and also has coverage under your health insurance plan; and your dependent children, if they are insured under two or more health insurance plans or Medicare.

Why does Blue KC need a copy of my divorce decree?
We want to make sure that we have the order of benefits determination identified correctly so that we can process claims accurately. Please refer to your Blue KC certificate for detailed information.

Why does Blue KC need a copy of my Medicare card?
Sometimes it's unclear as to whether or not a member has both parts A & B of Medicare. Or, the effective date of Medicare benefits is unclear. When Blue KC receives a copy of your Medicare card, it helps us input the Medicare information accurately and process claims in a timely manner. Other information that helps with COB determinations include the age of the insured and reason for Medicare insurance (e.g., Disability, End Stage Renal Disease, etc.).

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Health Savings Account

Learn About the Benefits of a Health Savings Account.

These FAQs are presented as general information by Blue KC. Precise Health Savings Account (HSA) tax effects depend on federal law. Blue KC recommends you see your tax adviser for specific tax advice.

HSA General Information
What is a Health Savings Account (HSA)?
Am I eligible for an HSA?
How much does an HSA cost? Are there fees charged for the account and/or services?

HSA and Health Coverage
What is a qualified high-deductible health plan?
How do I enroll in a high-deductible health plan and open an HSA?
What other types of health coverage can I maintain without losing eligibility for an HSA?
What happens to my HSA funds if I no longer have a high-deductible health plan?

HSAs and Qualified Medical Expenses
What are qualified medical expenses?
Who is responsible for determining whether HSA funds are used for qualified medical expenses?
Can I use the funds in my HSA to pay for medical expenses incurred before I enrolled in my high-deductible health plan?
Can I use the funds in my HSA for my dependents' expenses if they are not covered by the high-deductible health plan?
How long do I have to use the funds in my HSA for qualified medical expenses?

HSA Debit Cards
How can I access my HSA funds to pay for a qualified medical expense?
How do I activate my HSA debit card?
What if my HSA debit card doesn't work or my transaction is declined?
How do I order additional debit cards or add people who may use my HSA debit card?
What should I do if my HSA debit card gets lost or is stolen?
Do I need to save my itemized receipts from making qualified medical expense purchases?

HSA Contributions
How can I make an HSA deposit?
What are the contribution limits to my HSA?
Can I make contributions through my employer on a pre-tax basis?
When can "catch-up" contributions be made to my HSA?
When is the deadline for contributions to an HSA for any particular year?
What happens when HSA contributions exceed the amount that may be deducted or excluded from gross income?
How are contributions treated for owners and shareholders of S corps?
How are contributions treated for partners in a partnership or limited liability company (LLC)?
May a self-employed person contribute to an HSA on a pre-tax basis?

HSA Taxes
How are distributions from an HSA taxed?
What is the tax treatment of an eligible individual's HSA contributions?
What is the tax treatment of employer contributions to an HSA?
What is the tax treatment of earnings on amounts in an HSA?
Will any tax advice be provided to me in connection with my HSA?
What happens to the funds in my HSA after I turn age 65?
What happens to the funds in my HSA upon my death?
What are the tax consequences of HSA distributions following my death?

Establishing an HSA and Beneficiaries
How do I designate or change the beneficiary of my HSA?
How do I establish an HSA?
Who can serve as an HSA custodian or trustee?

HSAs, Other Accounts and Investments
What are the rules regarding rollovers and transfers to my HSA?
What are the rules regarding the rollover of IRA funds into an HSA?
What are my HSA investment options?
Can I borrow against my HSA?

HSA Information
I am in the process of opening an HSA. How can I check the status of my account?
How do I update the personal information (i.e., mailing address) associated with my HSA?

HSA General Information

What is a Health Savings Account?
A Health Savings Account (HSA) allows members enrolled in a qualified high-deductible health plan to contribute funds on a tax-free basis into the member's account. A member's employer may also contribute funds to the account. These funds are used for payment of qualified medical expenses as defined by the IRS. Unused funds in an HSA roll over in the member's account at the end of each calendar year.

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Am I eligible for an HSA?
You are eligible for an HSA if you are covered under a qualified high-deductible health plan, are not covered by any other health plan (with exception for certain types of permitted coverage), are not enrolled in Medicare benefits and cannot be claimed as a tax dependent on another person's tax return.

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How much does an HSA cost? Are there fees charged for the account and/or services?
An HSA generally has a low monthly service fee used to maintain the account. Other fees may apply depending upon the services selected. A fee schedule will be provided for you with your enrollment kit from your HSA bank. For more information on HSA fees, contact your HSA bank.

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HSA and Health Coverage

What is a qualified high-deductible health plan?
A qualified health-deductible health plan is a health plan with an annual deductible for an individual (a member) or a family (a member and covered tax dependents) that meet the minimum deductible amount published annually by the U.S. Treasury Department. The annual out-of-pocket expenses required by the high-deductible health plan also does not exceed the out-of-pocket maximums published by the U.S. Treasury Department. Out-of-pocket expenses include deductibles, copayments and other amounts the member must pay for, but do not include premiums or amounts incurred for non-covered benefits.

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How do I enroll in a high-deductible health plan and open an HSA?
To enroll in a high-deductible health plan, complete the Blue KC application process. The Blue-Saver® PPO health insurance plan is a high-deductible health plan that allows you to establish an HSA as part of your health benefits. When you enroll in the Blue Saver plan, you may be offered the opportunity to establish a HSA with one of our preferred banks. You will be presented with appropriate banking authorizations and disclosures necessary for Blue KC to work with the bank that will establish your HSA. Please note all financial institutions offering HSA products must comply with the USA Patriot Act, requiring your HSA bank to collect and verify information about you when processing your HSA application. Once your HSA has been established, you will be mailed a welcome kit and HSA debit card from the bank.

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What other types of health coverage can I maintain without losing eligibility for an HSA?
You are still eligible for an HSA if you have a high-deductible health plan and one or more of the following:

  • Insurance that relates to liabilities from workers' compensation laws, torts or ownership or use or property (such as automobile insurance).
  • Insurance for a specified disease or illness.
  • Insurance paying a fixed amount per day (or other period) of hospitalization.
  • Coverage (through insurance or otherwise) for accidents, disability, dental care, vision care or long-term care.

You may also have coverage under an Employee Assistance Program, and you may have a discount card that enables you to obtain discounts for healthcare services or products.

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What happens to my HSA funds if I no longer have high-deductible health plan?
Once funds are deposited into your HSA, those funds can be used to pay for qualified medical expenses tax-free, even if you no longer have high-deductible health plan coverage. The funds in your account automatically roll over each year and remain in the account indefinitely until used. There is no time limit on using the funds. Once you discontinue coverage under a high-deductible health plan and/or get coverage under another health plan that disqualifies you from an HSA, you can no longer make contributions to your HSA. However, since you own the HSA, you can continue to use it for future qualified medical expenses.

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HSAs and Qualified Medical Expenses

What are qualified medical expenses?
Qualified medical expenses include doctor visits, hospital charges, chiropractic care, prescriptions, dental care, vision care, COBRA premiums and qualified long-term care insurance premiums.

Please note it is your responsibility to withdraw funds for qualified medical expenses and maintain receipts for those expenses according to the IRS guidelines. Failure to do so could result in income taxes and a 20 percent penalty. Read the list and description of all qualified medical expenses.

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Who is responsible for determining whether HSA funds are used for qualified medical expenses?
It is your sole responsibility to ensure HSA funds are used for qualified medical expenses. It is also your responsibility to determine the tax consequences of any distributions, for maintaining adequate records for tax purposes, and for paying any taxes and penalties arising as a result of any such distribution. Please contact a legal or tax adviser with questions.

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Can I use funds in my HSA to pay for qualified medical expenses incurred before I enrolled in my high-deductible health plan?
No. You cannot use HSA funds to pay for qualified medical expenses incurred before you enrolled in a high-deductible health plan. In order to establish an HSA, you must enroll in a high-deductible health plan. Therefore, contributions to an HSA are not permitted before you enrolled in a high-deductible health plan and you cannot use HSA funds to pay for qualified medical expenses incurred prior to the date your HSA was established. Your eligibility to contribute to an HSA is determined by the effective date of your high-deductible health plan coverage.

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Can I use funds in my HSA for my tax dependents' expenses if they are not covered by the high-deductible health plan?
Yes, funds may be withdrawn and used to pay for qualified medical expenses for you and/or your tax dependent(s) without a tax penalty. For purposes of medical deductible of a child of divorced or separated parents, they can be treated as a dependent of both parents. Each parent can include the medical expenses he or she pays for the child, even if the other parent claims the child's dependency exemption. Please consult a legal or tax adviser concerning questions you may have.

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How long do I have to use the funds in my HSA for qualified medical expenses?
You can use your HSA funds to pay for eligible expenses incurred any time after you open your HSA. There is no time limit between when you incur the qualified expenses and when you withdraw the corresponding amount from your HSA. You may also elect to pay for current qualified medical expenses out-of-pocket, so that you may invest your HSA funds and grow the account for future use. It is recommended that you always save your itemized receipts and other paperwork to verify eligible expense for when you do withdraw funds, whether it is now or in the future.

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HSA Debit Cards

How can I access my HSA funds to pay for a qualified medical expense?
Use your HSA debit card or other means provided by your HSA bank to pay for qualified medical expenses. You should only use the debit card at healthcare-related locations. This may include an Internet transaction as long as the items being purchased are qualified medical expenses. You may also use your HSA debit card for online capabilities such as online bill pay.

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How do I activate my HSA debit card?
When you receive your HSA debit card in the mail from the HSA bank, you will receive instructions on activating the card. Please contact the HSA bank where you established your HSA regarding questions you may have about your HSA debit card.

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What if my HSA debit card doesn't work or my transaction is declined?
If your debit card does not work or is declined, you may need to use another form of payment. A declined transaction may be due to any of the following reasons:

  • Your purchase was not considered a qualified medical expense under your HSA plan
  • Your HSA balance was too low and there were insufficient funds to cover the cost of your transaction

Please contact the HSA bank to discuss problems with your debit card.

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How do I order additional debit cards or add people who may use my HSA debit card?
Please contact the HSA bank to order additional debit cards or add people who may use your HSA debit card.

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What should I do if my HSA debit card gets lost or is stolen?
Please contact the HSA bank immediately if your debit card is lost or stolen.

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Do I need to save my itemized receipts from making qualified medical expense purchases?
Yes, always retain your itemized receipts as proof of your qualified medical purchases. You will need the receipts if the IRS requests documentation to verify the funds in your HSA were used only for qualified medical expenses.

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HSA Contributions

How can I make an HSA deposit?
Deposits to your HSA may be made directly with the HSA bank. If your employer allows payroll deductions, you may also make automatic deposits into your account. You may mail in a deposit by check or take advantage of wire transfer or electronic funds transfer. Please contact the HSA bank for more information on depositing funds into your account.

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What are the contribution limits to my HSA?
The maximum amount that may be contributed to your HSA for any year is a certain amount established annually by the IRS. This amount depends on whether you have individual or family coverage under your qualified high-deductible health plan. The same annual contribution limit applies regardless of whether the contributions are made by an employee, an employer or both. You are allowed to make the full deductible HSA contribution for the year regardless of when you enroll in a high-deductible health plan as long as you maintain coverage under the high-deductible health plan for 12 months.

For 2013 and 2014, the maximum HSA contribution for individual high-deductible health plan coverage is $3,300. The maximum HSA contribution for family coverage is $6,550.

If you are not covered by a high-deductible health plan for 12 months at the end of the calendar year in which you enrolled in the plan, you will be subject to income tax and a 10 percent excise tax on HSA contributions for the months not covered by the plan. Under the last-month rule, if you are an eligible individual on the first day of the last month of your tax year (December 1 for most taxpayers), you are considered an eligible individual for the entire year. You are treated as having the same high-deductible health plan coverage for the entire year as you had on the first day of that last month. The total contribution for the year can be made in one or more payments at any time up to your tax-filing deadline (without extensions). However, if you wish to have a contribution made between January 1 and April 15 treated as a contribution for the preceding tax year, please contact the HSA bank.

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Can I make contributions through my employer on a pre-tax basis?
If your employer offers a "salary reduction" plan (also known as a Section 125 plan or cafeteria plan), you can make contributions to your HSA on a pre-tax basis (meaning before income taxes and FICA taxes). If you make a contribution on a pre-tax basis, you cannot take the "above-the-line" deduction on your personal taxes.

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When can "catch-up" contributions be made to my HSA?
If you are age 55 or older, you can make additional "catch-up" contributions to your HSA. The amount of this additional catch-up contribution is published annually by the U.S. Treasury Department. For 2013 and 2014, the catch-up contribution amount is $1,000.

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When is the deadline for contributions to an HSA for any particular year?
You may make HSA contributions for a particular year no later than the deadline, without extensions, for filing your federal income tax return for that year. For calendar year taxpayers, this is generally April 15 following the year for which the contributions were made.

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What happens when HSA contributions exceed the amount that may be deducted or excluded from gross income?
A contribution made by you or your employer to an HSA that exceeds the amount allowed by law, or which is made during any year when you are not eligible to contribute, is called an "excess contribution." Excess contributions are not deductible by you or your employer and are included in your gross income for each year they remain in your HSA. In addition, excess contributions are subject to a six-percent excise tax. However, you may avoid the excise tax if you remove the excess contribution from your HSA, together with any net income attributable to the excess contribution, before the due date for filing your federal income tax return, including extensions, for the year in which the excess contribution was made. In that case, the net income attributable to the excess contribution would be taxable as income for the year in which the distribution is made, but the removed excess contribution would not be taxable as income to you. Rollover contributions do not count in determining whether an excess contribution has been made.

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How are contributions treated for owners and shareholders of S corps?
Owners and officers with greater than 2% share of a Subchapter S corporation cannot make pretax contributions to their HSAs through the company by salary reduction. In addition, any contributions made to their HSAs by the corporation are taxable as income. However, they can make their own personal contributions to their HSAs and take the "above-the-line" deduction on their personal income taxes.

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How are contributions treated for partners in a partnership or limited liability company (LLC)?
Partners in a partnership or LLC cannot make pre-tax contributions to their HSAs through the partnership by salary reduction. However, they can make their own personal contributions to their HSAs and take the "above-the-line" deduction on their personal income taxes.

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May a self-employed person contribute to an HSA on a pre-tax basis?
Self-employed persons may not contribute to an HSA on a pre-tax basis and may not take the amount of their HSA contribution as a deduction for SECA purposes. However, they may contribute to an HSA with after-tax dollars and take the above-the-line deduction.

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HSA Taxes

How are distributions from an HSA taxed?
Distributions from an HSA for the qualified medical expense of you or your spouse or tax dependents who are covered by the high-deductible health plan are generally excludable from income for federal tax income purposes if such expenses are not covered by insurance. Distributions used for any other purpose are includable in income and may also be subject to an additional 20 percent tax. This 20-percent penalty tax does not apply to distributions made after your death, disability or attainment of age 65.

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What is the tax treatment of an eligible individual's HSA contributions?
When you make an eligible contribution to an HSA, the amount of your contribution (up to the maximum contribution limit) is deductible in computing your adjusted gross income. This means that your contributions are deductible whether or not you itemize your deductions.

Any person who may be claimed as a tax dependent on another taxpayer's return may not claim a deduction for a contribution to an HSA.

A special rule applies to certain married couples. If either spouse has family coverage under a high-deductible health plan, both spouses will be treated as having only the family coverage (and if such spouses each have family coverage under different plans, both spouses will be treated as having the family coverage with the lowest annual deductible). The amount allowed as a deduction after application of this rule will be divided equally between the spouses unless they agree on a different division.

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What is the tax treatment of employer contributions to an HSA?
If your employer makes a contribution to your HSA, you are not allowed to deduct that contribution on your income tax return. Your employer, however, will be able to deduct the contribution up to your maximum contribution limit for that year. Although you cannot deduct your employer's HSA contribution, the contribution is not taxable to you or subject to income tax withholding or other employment taxes if it does not exceed your maximum contribution limit for the year.

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What is the tax treatment of earnings on amount in an HSA?
Earnings on amounts in an HSA are not taxable prior to distribution from the HSA.

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Will any tax advice be provided to me in connection with my HSA?
No, neither Blue KC nor the HSA bank will provide tax advice concerning your HSA. The tax consequences of your HSA, including all contributions to and distributions from your HSA, are your sole responsibility. Please contact a tax adviser concerning questions you may have.

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What happens to the funds in my HSA after I turn age 65?
You can continue to use the funds in your account tax-free for out-of-pocket health expenses. If you enroll in Medicare, you can use your account to pay Medicare premiums, deductibles, copayments and coinsurance under any part of Medicare. If you have retiree health benefits through your former employer, you can also use your account to pay for your share of retiree medical insurance premiums. The one expense you cannot use your account for is to purchase a Medicare supplemental insurance or "Medigap" policy.

Once you turn age 65, you can also use your account to pay for things other than qualified medical expenses. If you do choose to use your account for other expenses, the amount withdrawn will be taxable as income but will not be subject to any other penalties. Individuals under age 65 who use their accounts for non-medical expenses must pay income tax and a 20 percent penalty on the amount withdrawn.

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What happens to the funds in my HSA upon my death?
You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. Please contact the HSA bank for beneficiary designation forms or for more information.

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What are the tax consequences of HSA distributions following my death?
If your spouse is the named beneficiary of your HSA, your HSA becomes the HSA of your spouse upon your death, subject to the completion of documents as required by your bank. Your surviving spouse is not required to include any amount in gross income for tax purposes as a result of your death and he or she is subject to income tax only on those distributions that are not made for qualified medical expenses.

If someone other than your spouse is named the beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death. Rather the beneficiary is required to include the fair market value of the HSA assets as of the date of death in his or her gross income for the taxable year that includes the date of death. The included amount is reduced by the amount in the HSA used, within one year of your death, to pay your qualified medical expenses that incurred prior to your death.

If there is no named beneficiary of your HSA, the HSA will no longer be considered an HSA as of the date of your death, and the fair market value of the HSA assets as of the date of death is included in your gross income for the year of your death.

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Establishing an HSA and Beneficiaries

How do I designate or change the beneficiary of my HSA?
You have the right at any time to designate one or more beneficiaries to whom distribution of your HSA will be made upon your death. You also have the right to revoke a prior beneficiary designation and, if desired, designate different individuals as beneficiaries. If no beneficiary is designated, the HSA bank will distribute the assets of your HSA upon your death to your estate. Please contact your bank for beneficiary designation forms or for more information.

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How do I establish an HSA?
If eligible, you can establish an HSA with a qualified HSA custodian or trustee. No permission or authorization from the IRS is required. The custodian or trustee will furnish you a written HSA trust or custodial agreement.

You can pick any bank you like or you can use our preferred vendor, UMB Bank, n.a. an independent company, to set up an HSA. It’s easy to set up a UMB HSA—simply visit the UMB HSA enrollment website after you enroll in a Blue Saver PPO health plan.

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Who can serve as an HSA custodian or trustee?
Any insurance company or bank can be an HSA custodian or trustee. Any other persons already approved by the IRS to be custodians or trustees of IRAs are automatically approved to be HSA custodian or trustees.

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HSAs, Other Accounts and Investments

What are the rules regarding rollovers and transfers of my HSA?
You may withdraw a portion or all of the funds from one HSA and roll them into an HSA with another custodian or trustee. However, you are required to roll the funds into a new HSA within 60 calendar days of your receipt of the funds. You are allowed to make only one HSA rollover in a 12-month period. The 12-month period begins on the date you receive the distribution, not on the date you roll it into another HSA. You may also transfer your HSA funds directly from one HSA custodian or trustee to another without ever having direct custody or control of the funds. Rollover and transfer contributions are not deductible and do not count against annual contribution limits.

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What are the rules regarding the rollover of IRA funds into an HSA?
You are allowed a one-time, tax-free, trustee-to-trustee transfer of IRA funds into your HSA if the following certain conditions are met:

  • The transfer of funds from the IRA to the HSA is made in direct trustee-to-trustee transfer
  • You are covered by a high-deductible health plan and remain eligible for 12 months after your IRA rollover. If you are not eligible for 12 months after the rollover, the funds transferred will be treated as taxable income and subject to a 10 percent excise tax
  • The IRA being rolled over into the HSA is a traditional or Roth IRA
  • The amount of the IRA rollover to the HSA does not exceed the maximum annual contribution limits. The amount transferred from your IRA, plus your employer contributions, plus your contributions will all apply against the maximum annual contribution and you must ensure the total of all these do not exceed the maximum annual contribution limits

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What are my HSA investment options? After establishing an HSA and reaching financial benchmarks set by the HSA bank, you may choose to maximize your potential wealth by electing investment options. For more information on HSA investment options, contact the HSA bank.

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Can I borrow against my HSA?
No, you cannot borrow against or pledge funds in your HSA.

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HSA Information

I am in the process of opening an HSA. How can I check the status of my account?
Please contact the HSA bank to check the status of your account as your HSA application is processed.

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How do I update the personal information (i.e., mailing address) associated with my HSA?
L Please contact the HSA bank to update your personal information.

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Personal Care Account

Learn More about PersonalBlue Personal Care Accounts
Blue KC is committed to keeping you informed when it comes to your health insurance plan. PersonalBlue is a type of health insurance plan that pairs a PPO plan with a Personal Care Account (PCA) also known as a Health Reimbursement Arrangement (HRA). Your employer puts money in the PCA that is used to pay for a portion of your PPO deductible. You only have to help pay for the deductible after your HRA balance has been spent. And if you don't use all of the money in your PCA, some or all of it will typically roll over for use in the following year.

What is PersonalBlue?
Your PersonalBlue plan will cover your healthcare needs.

  • The first part of your PersonalBlue plan is called a PCA. Your employer adds funds to this account each year. Those funds are used to pay for covered healthcare expenses.
  • After the funds in your PCA have been used, you will be responsible for a certain amount of your healthcare costs until your deductible amount has been met. You do have the benefit of the negotiated prices for healthcare from network providers, but you will pay for all of the healthcare until your individual or family deductible is met.

Note: Your PCA and individual or family deductible make up the total plan deductible amount. This is the amount that you will see referenced in your Explanation of Benefits (EOB).

  • Once your PCA funds are exhausted and the remainder of your deductible has been met, your health insurance plan will start paying. A majority of in-network expenses will be covered by your health insurance plan. You will be responsible for the coinsurance. Once your out-of-pocket maximum has been met, your health insurance plan pays 100% of your covered expenses.

What is covered under my PersonalBlue health insurance plan?
Your PersonalBlue health insurance plan includes a prescription drug coverage plan with set copayments for both generic and brand name prescription drugs. The PCA portion of your plan cannot be used to reimburse you for these copayments.

Routine Preventive care is a care benefit that is not subject to a deductible. For example, when you receive your annual well-woman exam, annual mammography, annual prostate exam, etc. from a Blue KC in-network physician, you pay only the coinsurance amount (no deductible.) The coverage of some preventive healthcare services may be subject to a calendar year maximum limit.

How are PCA claims paid?
After you see a provider for healthcare services, your provider will send a claim for those services to Blue KC. The claim is paid directly from your PCA funds. Blue KC will send you an Explanation of Benefits (EOB) showing what was paid to the provider.

What if I have questions about my PCA balance or how a claim was paid?
If you have questions about your PCA balance or how a claim was processed, please let us know. Call the number listed on your member ID card or log in and click on "Contact Us.

How can I keep track of what is left in my PCA?
To view detailed information about your PCA including the status or your funds and claims data, log in, then select Benefits at the top of the page. From here, access the Personal Care Account link on the left.

What happens if I don't spend all of the funds in my PCA?
Unused funds may be rolled over to the next year. By staying healthy and by managing your healthcare dollars wisely, you can build up a sizable account.

Is the rollover taxable?
No, any rollover amount in your PCA is not taxable as long as your account complies with certain IRS guidelines. Review information about the IRS guidelines.

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Prior Authorization

Blue KC may require prior authorization before certain medical services and/or medications are performed or dispensed. Select one of the two categories below to browse prior authorization forms.

Services, Durable Medical Equipment (DME) and Prostheses requiring Prior Authorization

Medications

Please allow at least two business days from the date of receipt of all necessary information for a determination on a prior authorization request. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.

To contact the Blue KC Prior Authorization Department, call 816-395-3989 or 800-892-6116.

Incomplete prior authorization requests and forms may result in a denial. All member information is strictly confidential. Call the Customer Service number listed on the member ID card to verify member eligibility and benefits.

Services, Durable Medical Equipment (DME) and Prostheses requiring Prior Authorization

The following Services, Durable Medical Equipment (DME) and Prostheses or the rental of such equipment require prior authorization:

All scheduled medical and surgical admissions

Augmentation Mammaplasty
19324, 19325

Bariatric Surgery
43644, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846

Blepharoplasty (Download request form)
15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909

Chiropractic services performed by an out-of-network provider

Cochlear Device
69930, L8614, L8619

Dental Implants, Bone Grafts/Reconstruction, Orthognathic Surgery
21050, 21060, 21070, 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21249, 29804, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7995, D7996

Elective Pre-Operative Observation Status

Genetic Testing for Breast Cancer
81211, 81212, 81213, 81214, 81215, 81216, 81217

Genetic Testing for Colon Cancer
81201, 81202, 81203, 81210, 81288, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81317, 81318, 81319

Intensity Modulated Radiation Therapy (IMRT)
77301, 77338, 77385, 77386, G6015, G6016

Infusion Pumps, Implantable
E0782, E0783, E0785, E0786

Insulin Pump, Implantable
E0784, A9274 Download a Prior Authorization/Predetermination Form

Lumbar Fusion Surgery ** (Download Request Form from Blue KC review partner)
0195T, 0196T, 22533, 22534, 22558, 22585, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812

** Procedure level authorization does not apply to members in the following plan types: Missouri Health Insurance Pool or Employer/Labor Union Funded Health Plans (also known as ASO or JAA). All inpatient hospital admissions require prior authorization.

Mastectomy for Gynecomastia
19300

Mobile Outpatient Cardiac Telemetry
93228, 93229

Myo-Electric Prostheses
L5856, L5857, L5858, L5859, L5961, L6026, L6715, L6880, L6925, L6935, L6945, L6955, L6965, L6975, L7007, L7008, L7009, L7040, L7045, L7170, L7180, L7185, L7186, L7190, L7191, L7259

Organ and Tissue Transplants (excluding cornea transplants)

Out of network services for HMO members

Radiology Services (Download Request Form from Blue KC review partner)
High Tech Radiology which include MRI, MRA, Nuclear Medicine, Cardiac Nuclear Medicine, CT, CTA, Echocardiogram, Stress Echocardiogram, and PET scans ** -

70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71250, 71260, 71270, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74261, 74262, 74263, 75557, 75559, 75561, 75563, 75565, 75572, 75573, 75574, 75635, 76376, 76377, 76380, 76497, 76498, 77058, 77059, 77078, 77084, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, 78499, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, 78999, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93318, 93350, 93351, C8900, C8901, C8902, C8903, C8904, C8905, C8906, C8907, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8921, C8922, C8923, C8924, C8925, C8926, C8927, C8928, C8929, C8930, G0235, G0252, S8032, S8092, S8037, S8042, S8035

** Members in groups not delegated to eviCore may require prior authorization for the following services:

  • MRI of the Breast
    77058, 77059, C8903, C8904, C8905, C8906, C8907, C8908
  • MRI ordered by a chiropractor
  • PET Scans (Download a PET Scan Request Form)
    78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, G0235, G0252

Reduction Mammaplasty (Download request form)
19318

Rhinoplasty
30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462

Speech Generating Device
E2351, E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599

Varicose Vein Treatment (Download request form)
S2202, 36470, 36471, 36475, 36476, 36478, 36479, 37500, 37760, 37761

Wheelchairs (Power, Specially Sized or Constructed, Custom) or Power Operated Vehicle
E0983, E0984, E0986, E1220, E1230, E1239, K0010, K0011, K0012, K0013, K0014, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899

To submit a prior authorization request you may fax or mail your request.

For the most timely response, fax the request to 816-502-4910. Requests may also be mailed to:

Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878

Request Form for DME: Download a request form.

General Request form for elective surgery, procedure or service: Download a request form.

Please include any supporting medical information in your fax. Please allow at least 36 hours (to include one business day) from the date of receipt of all necessary information for a prior auth determination. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.

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Medications

The following medications or classes of medications require prior authorization. Medications may appear more than once. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.

Medications requiring Prior Authorization

Medications Requiring Step Therapy

Medications that must be obtained from Specialty Pharmacy (30 Day Supply Limit)

Medications for Dose Optimization and/or Quantity Limits

ACA (Affordable Care Act) Plans ONLY

The following medications or classes of medications require prior authorization for Exchange products and some small groups. Please verify you are selecting the medication in the correct category to ensure you download the correct form. Please be aware that as new products are released and post-marketing information on existing therapies becomes available, changes in this list may occur. Physicians and pharmacy providers will be notified of any such changes via newsletters and direct mailings.

Medications Requiring Step Therapy

  • Actonel (including generics)—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Actos (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Actoplus Met (including generics)—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Actoplus Met XR (including generics)—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Adderall XR (including generics)—Patient must first try and fail generic therapy.
  • Ambien
  • Amerge (including generics)—Patient must first try and fail a generic oral triptan.
  • Aricept (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Aricept ODT (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Aricept 23 mg (including generics)—Patients must first try and fail the requirements for Aricept above.
  • Atelvia (including generics)—Patient must first try an oral bisphosphonate tablet or generic ibandronate, THEN an oral bisphosphonate.
  • Avandia (including generics)—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Avandamet—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Avandaryl—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Avodart (including generics)—Patients must first try and fail finasteride 5 mg.
  • Axert (including generics)—Patient must first try and fail a generic oral triptan.
  • Binosto (including generics)—Patient must first try an oral bisphosphonate tablet or generic ibandronate, THEN an oral bisphosphonate.
  • Blocadren (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Boniva (including generics)—Patient must first try an oral bisphosphonate tablet or generic ibandronate, THEN an oral bisphosphonate.
  • Brintellix (including generics)—Patients must try and fail one SSRI.
  • Brisdelle (including generics)—Patients must try and fail one SSRI.
  • Bystolic (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Cardura (including generics)—Patient must fail a generic alpha-blocker.
  • Cardura XL (including generics)—Patient must fail a generic alpha-blocker.
  • Celexa (including generics)—Patients must try and fail one SSRI.
  • Cognex (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Colestid (including generics)—Patient must first try and fail a generic bile acid sequestrants.
  • Concerta (including generics)—Patient must first try and fail generic therapy.
  • ConZip (including generics)—Patient must first try and fail a generic tramadol product.
  • Corgard (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Coreg (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Coreg CR (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Corzide (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Cymbalta (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Daytrana (including generics)—Patient must first try and fail generic therapy.
  • Depakote (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Depakote Sprinkle Capsules (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Depakote ER (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Depakene (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Desvenlafaxine extended-release—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Desvenlafaxine fumarate extended-release—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Dexedrine Spansules (including generics)—Patient must first try and fail generic therapy.
  • Duetact (including generics)—Patient must first try generic metformin, a metformin-containing combination product (brand or generic), or a pioglitazone-containing combination product.
  • Dutoprol (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Effexor (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Effexor XR (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Exelon (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Exelon Patch (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Fetzima (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Flomax (including generics)—Patient must fail a generic alpha-blocker.
  • Fluoxetine 60 mg tablets—Patients must try and fail one SSRI.
  • Fluvoxamine—Patients must try and fail one SSRI.
  • Focalin XR (including generics)—Patient must first try and fail generic therapy.
  • Fosamax (including generics)—Patient must first try an oral bisphosphonate tablet or generic ibandronate, THEN an oral bisphosphonate.
  • Fosamax Plus D (including generics)—Patient must first try an oral bisphosphonate tablet or generic ibandronate, THEN an oral bisphosphonate.
  • Frova (including generics)—Patient must first try and fail a generic oral triptan.
  • Hytrin (including generics)—Patient must fail a generic alpha-blocker.
  • Imitrex (including generics)—Patient must first try and fail a generic oral triptan.
  • Inderal (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Inderal LA (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Inderal XL (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Inderide (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • InnoPran XL (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Intuniv (including generics)—Patient must first try and fail generic CNS stimulants.
  • Jalyn (including generics)—Patients must first try and fail finasteride 5 mg.
  • Kapvay (including generics)—Patient must first try and fail generic CNS stimulants.
  • Keppra (including generics)— Patient must first try a generic levetiracetam product.
  • Keppra XR (including generics)—Patient must first try a generic levetiracetam product.
  • Kerlone (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Khedezla (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Lamictal (including generics)—Patient must first try and fail generic lamotrigine product.
  • Lamictal ODT (including generics)—Patient must first try and fail generic lamotrigine product.
  • Lamictal XR (including generics)—Patient must first try and fail generic lamotrigine product.
  • Levatol (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Lexapro (including generics)—Patients must try and fail one SSRI.
  • Lopressor (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Lopressor HCT (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Lumigan (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Luvox CR (including generics)—Patients must try and fail one SSRI.
  • Maxalt (including generics)—Patient must first try and fail a generic oral triptan.
  • Maxalt MLT (including generics)—Patient must first try and fail a generic oral triptan.
  • Metadate CD (including generics)—Patient must first try and fail generic therapy.
  • Metadate ER (including generics)—Patient must first try and fail generic therapy.
  • Methyphenidate extended-release capsules—Patient must first try and fail generic therapy.
  • Oxtellar XR (including generics)— Patients must first try and fail oxcarbaxepine tablets or oral suspension.
  • Paxil (including generics)—Patients must try and fail one SSRI.
  • Paxil CR (including generics)—Patients must try and fail one SSRI.
  • Pexeva (including generics)—Patients must try and fail one SSRI.
  • Prevalite—Patient must first try and fail a generic bile acid sequestrants.
  • Pristiq (including generics)—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Proscar (including generics)—Patients must first try and fail finasteride 5 mg.
  • Prozac (including generics)—Patients must try and fail one SSRI.
  • Prozac Weekly (including generics)—Patients must try and fail one SSRI.
  • Questran (including generics)—Patient must first try and fail a generic bile acid sequestrants.
  • Questran Light (including generics)—Patient must first try and fail a generic bile acid sequestrants.
  • Quillivant XR (including generics)—Patient must first try and fail generic therapy.
  • Rapaflo—Patient must fail a generic alpha-blocker.
  • Razadyne (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Radadyne ER (including generics)—Patients must first try and fail a generic ChI product (does NOT include donepezil 23 mg), THEN they must try and fail Aricept 5 and 10 mg.
  • Relpax (including generics)—Patient must first try and fail a generic oral triptan.
  • Rescula (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Ritalin-LA (including generics)—Patient must first try and fail generic therapy.
  • Ritalin-SR (including generics)—Patient must first try and fail generic therapy.
  • Rybix (including generics)—Patient must first try and fail a generic tramadol product.
  • Ryzolt (including generics)—Patient must first try and fail a generic tramadol product.
  • Sarafem capsules (including generics)—Patients must try and fail one SSRI.
  • Sarafem tablets (including generics)—Patients must try and fail one SSRI.
  • Savella (including generics)—Patients must try and fail TWO SSRI (brand or generic) or SNRI (generic).
  • Sectral (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Strattera (including generics)—Patient must first try and fail generic CNS stimulants.
  • Stavzor (including generics)— Patients must first try and fail a generic divalproex sodium or valproic acid product.
  • Tenoretic (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Tenormin (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Toprol XL (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Tramadol Extended-Release—Patient must first try and fail a generic tramadol product.
  • Trandate (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Travatan Z (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Travoprost 0.0004% opthalmic solution (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Treximet (including generics)—Patient must first try and fail a generic oral triptan.
  • Trileptal (including generics)— Patients must first try and fail oxcarbaxepine tablets or oral suspension.
  • Ultracet (including generics)—Patient must first try and fail a generic tramadol product.
  • Ultram (including generics)—Patient must first try and fail a generic tramadol product.
  • Ultram ER (including generics)—Patient must first try and fail a generic tramadol product.
  • Uloric (including generics)—Patient must first try and fail allopurinol.
  • UroXatral (including generics)—Patient must fail a generic alpha-blocker.
  • Venlafaxine HCI—Patients must try and fail one SSRI (brand or generic) or SNRI (generic).
  • Viibryd (including generics)—Patients must try and fail one SSRI.
  • Visken (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Vyvanse (including generics)—Patient must first try and fail generic therapy.
  • Welchol—Patient must first try and fail a generic bile acid sequestrants.
  • Xalatan (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Zebeta (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Ziac (including generics)—Patients must first try and fail a generic beta-blocker or a generic beta-blocker/diuretic combination.
  • Zioptan (including generics)— Patients must first try and fail latanoprost or travoprost.
  • Zoloft (including generics)—Patients must try and fail one SSRI.
  • Zomig (including generics)—Patient must first try and fail a generic oral triptan.
  • Zomig ZMT (including generics)—Patient must first try and fail a generic oral triptan.

Medications requiring Prior Authorization

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To submit a prior authorization request for one of these medications, click on the medication name to download the appropriate request form. For the most timely response, fax the request to 816-502-4915. Requests may also be mailed to:

Blue Cross and Blue Shield of Kansas City
Attention: Pharmacy Services
P.O. Box 419169
Kansas City, MO 64141-2735

Please include any supporting medical information in your fax. Please allow at least two business days from the date of receipt of all necessary information for a determination. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.

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Predetermination

Predetermination is a voluntary pre-service review and is strongly recommended for those services indicated in medical policy as "sometimes investigational" or "not medically necessary." To access our Medical Policy, review our Medical Policy.

To submit a general predetermination request, download a request form.

Facet Joint Denervation request form

For the most timely response, fax the form to 816-502-4910. Requests may also be mailed to:

Blue Cross and Blue Shield of Kansas City
Attention: Predetermination, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878

Please include any relevant clinical information in your fax and allow at least ten business days from the date of receipt of all necessary information for a determination. To check the status of a predetermination, call the Customer Service number listed on the member ID card.

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Medical Policy

This Medical Policy is designed for informational purposes only and is not an authorization, an explanation of benefits, or a contract. Medical technology is constantly changing, and Blue KC reserves the right to review and revise medical policy. This information is proprietary and confidential and cannot be shared without the written permission of Blue KC.

Review our Medical Policy
Review our Behavioral Health Criteria

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