Reading a BCBS insurance card is easy for a healthcare expert, while a little misinterpretation can result in denied claims. It carries important details such as the member name, ID and group number etc.
Accurate reading of BCBS (Blue Cross Blue Shield) card is crucial to faster reimbursements. Therefore, providers should remain careful when reading BCBS cards to avoid claim denials and revenue loss.
Sometimes, experts struggle to accurately read the card and bear consequences in terms of claim denials. You might wonder how to read a BCBS card the right way? We will find out in this blog:
What Is BCBS Insurance Card
A BCBS insurance card carries important data through which providers confirm insurance coverage of a patient. Moreover, it has 3 major elements including
- Member ID Number
- Group Number
- Member Name
Furthermore, It indicates the type of insurance coverage a patient has such as HMO (health maintenance organization), PPO (preferred provider organization) and POS (Point of services).
BCBS Insurance Card Reading Guidelines
Every company has a set format for the insurance card. Therefore, it’s possible that your expected information is printed on the back side instead of front.
Regardless of the card format, it has valuable information on both sides. Here is how you can accurately read the BCBS insurance card
Member ID Number
Every BlueCross insurance card has a dedicated number, also known as identification number. Patients should carry their card when visiting a hospital. Besides, they need a member id number when getting healthcare services from a provider.
Patients can use this number when registering with member resource centers and get access to various cash discounts with top-quality healthcare services. Usually, a patient needs 13-digits of the id number and 2-digits of the member line.
Plan Type
Patients who are un-sure about their insurance coverage plan, can find it out on the upper right corner of the BCBS insurance card. The type of insurance plan also educates the patients about the in-network providers
Costs
BlueCross BlueShield insurance card also has the details of patient co-pays to help them know what amount they must pay upon visiting the healthcare facility.
- Co-pay is a specific amount that a patient pays against healthcare services.
- Deductible is a sum of the amount a patient has to pay for covered health insurance before the plan starts. Let suppose the deductible is $500, the patient is liable to pay for the services of this amount before the insurance plan starts.
- Coinsurance is a part of the amount you should pay after submitting the deductibles. Suppose, service costs $400 and co-insurance is 20%. The patient will only pay $80.
- Out of pocket maximum refers to the payment you are liable to pay against a yearly healthcare insurance plan.
Pharmacy Coverage
If your card has a VERMONT BLUE Rx printed on the back then you are eligible for the pharmacy benefits as well.
- The pharmacy rep will use the Rx group to process your medicine prescription benefits.
- BIN number or bank identification number indicates that BlueCross and BlueShield covers your pharmacy expenses.
- The card also has a processor control number that a pharmacy representative checks to locate your pharmacy member profile.
Back Section
Back side of your insurance card has data related to insurance claims, and customer supports
- Claim Address: It is where you need to dispatch the paper claims. Make sure the address is correct to avoid the unnecessary delays. Here is the accurate information format for a better understanding P.O. Box 01234, Hartford, CT 06150
- Customer Services Numbers: These numbers help patients do general queries and know about the billing-related problems. In some insurance cards, the provider numbers differ from the members.
- Payer ID: It is an alphanumeric code that providers use when submitting claims against the services rendered. Payer ID plays a key role in quick claim acceptance and getting timely payments.
Important Factors to Consider When Reading BCBS Insurance Card
Make sure to check the below mentioned factors when reading your insurance card. These are very crucial in determining the expiry of your BCBS insurance coverage.
- Coverage Expiry: Carefully check the expiry date of your card. Sometimes, the card looks valid but the insurance expires due to any reason such as losing the job or non-payment of the insurance.
- Duplicate ID Numbers: It often happens (especially in families) that two patients have the same ID number on their BCBS insurance card. Therefore, you must double check the ID number to avoid unwanted circumstances.
- Manual Changes: Don’t fall for the manual (hand written) changes on the insurance cards. Such edits have no official status and ignoring them can lead to rejected claims and lost revenue.
Digital/Mobile Insurance Cards
BlueCross and BlueShield plans now accommodate the digital insurance cards, enabling patients to access their card using smart phones or online portals. This facility allows patients not to carry their cards with them during the healthcare facility visit.
In addition, the digital cards remain on auto update and allow pharmacies to check patient insurance coverage within minutes.
Final Thoughts
Reading a BlueCross Blue Shield insurance card may seem simple, but it requires careful attention to detail. Since card layouts and formats vary by company, providers should always review both the front and back sections thoroughly.
Following the BCBS card reading guidelines helps healthcare providers avoid claim denials, ensure accurate billing, and receive timely reimbursements. At Paymedics, we help healthcare organizations in streamlining the medical billing process by verifying everything from documents to insurance coverage, ensuring maximized profits.
Frequently Asked Questions
How to read my BCBS insurance card?
- Your Identifying Information. Your health insurance card usually has your name on it.
- Policy Number
- Group Plan Number
- Insurance Company Contact
- Coverage Amounts, In and Out of Network, and Co-pays
- Prescription Coverage
What does a blue card indicate in medical insurance?
A blue card allows patients to get insurance coverage upon getting healthcare services in another service area of BlueCross or BlueShield.
Does a blue insurance card expire?
Yes it experts and you need to reapply to avail the medical coverage and pharmacy benefits.
What are the key points to check on a medical insurance card?
Some key elements on an insurance card include
- Group Number
- Member Name
- Member Number
Where to find the policy number on my medical insurance card?
Insurance policy number is written on the front side of the medical insurance card. You can find it in the top right corner.
