Travel & Emergency Care
What to do when traveling?
When you pack for your holiday or vacation travels, don’t forget your Blue Medicare Advantage ID card. As your partner in good health,
Blue KC has you covered if you should get sick or get hurt when you’re away from home. Your benefits cover services from out-of-network
providers when you have a medical emergency or are seeking urgently needed care.
If you are sick or injured when traveling, visit the nearest emergency room (or call 911, if needed) or urgent care center,
as appropriate for your symptoms.
When you check in, show the medical staff your Blue Medicare Advantage ID card so they know to bill us for your care. Since you are a
Medicare Advantage plan member, the facility must submit a claim directly to us, rather than billing you up front. You will be responsible
for your deductible, if you have one, and all applicable copayments and coinsurances.
What is a “medical emergency?”
A “medical emergency” is when you believe that your health is in serious danger. Medical emergencies include severe pain and
serious injuries or illnesses — for example, a heart attack, stroke, or bad fall.
If you go to the emergency room thinking your health is in serious danger and the doctor says you don’t have a medical emergency
after all, you are still covered for the care you received. If you get any extra care from an out-of-network provider after you
learn you don’t have a medical emergency, however, Blue KC usually will not cover this additional care.
What is urgently needed care?
Urgently needed care is a non-emergency situation where you need medical attention immediately for an unforeseen illness or injury. For example, you might seek urgent care if you come down with a sinus infection or twist your ankle.
Blue Medicare Advantage covers out-of-network urgent care if you are:
- Temporarily absent from the plan’s service area
- Unable to reasonably obtain care through the Blue Medicare Advantage network, given your health needs
Remember that you must choose a facility that is licensed as an urgent care center.
Visitor/Traveler Benefit for PPO Members Only:
Your Blue Medicare Advantage PPO includes a Visitor/Travel Benefit through Blue Cross Blue Shield Medicare Advantage PPO network sharing.
The network sharing benefit allows Blue Medicare Advantage PPO members to obtain in-network benefits when traveling or living in the service areas of the Blue Medicare Advantage PPO plans as long as the member sees a contracted Medicare Advantage PPO provider.
Blue Medicare Advantage PPO shared networks are available in 39 states and one territory:
Coverage for the MA PPO networks listed may not be available in the entire state. Please call Customer Service to confirm network availability.
Blue Medicare Advantage PPO members can see any contracted doctor or hospital and receive the highest level of benefits. Blue Medicare Advantage PPO members can also see non-contracted providers but will have a lower level of benefits which will result in higher out-of-pocket costs.
If you have any questions regarding your Visitor/Travel benefit, please see your Evidence of Coverage (EOC) or call Customer Service at the number on page 5 of this Member Handbook.
Always carry your Blue Medicare Advantage card with you in case you need emergency or urgent care. You should always present this card — not your
Medicare card — when seeking care. If you need to contact Blue Medicare Advantage while you are away from home, use the customer service number
printed on the back of your card to reach us.
Can I visit an out-of-network doctor?
Blue Medicare Advantage (HMO) members must use plan providers except in emergency or urgent care situations. If a member obtains routine care from
an out-of-network provider without prior approval from Blue KC, neither Medicare nor Blue KC will be responsible for the costs.
Blue Medicare Advantage (PPO) members are encouraged to use in-network plan providers. Out-of-network/non-contracted providers are under no obligation
to treat members, except in emergency situations. For a decision about whether Blue KC will cover an out-of-network service, we encourage you or your
provider to ask Blue KC for a pre-service organization determination before the service is received. Please call Blue Medicare Advantage Customer Service
or refer to the Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
If you have a medical emergency:
Get medical help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center.
You do not need to get approval or a referral first from your Primary Care Physician or other in-network provider.
As soon as possible, make sure that we know about your emergency, because we need to be involved in following-up on your emergency
care. You or someone else should call to tell us about your emergency care as soon as possible, usually within 48 hours. Please
call your PCP’s office at the number located on your Blue Medicare Advantage member ID Card.
We will talk with the doctors who are giving you emergency care to help manage and follow-up on your care. When the doctors who
are giving you emergency care say that your condition is stable and the medical emergency is over, you are still entitled
to follow-up post stabilization care. Your follow-up post stabilization care will be covered according to Medicare guidelines.
In general, if your emergency care is provided out-of-network we will try to arrange for in-network providers to take over your
care as soon as your medical condition and the circumstances allow.
What is covered if you have a medical emergency?
You may get covered emergency medical care whenever you need it, anywhere in the United States.
You may get covered emergency medical care wherever you need it, worldwide.
Ambulance services are covered in situations where other means of transportation in the United States would endanger your health.
(See the benefits chart in the Evidence of Coverage "EOC" for more detailed information).
How to submit a paper claim for emergency or urgently needed care.
When you receive emergency or urgently needed health care services from a provider who is not part of our network, you are still responsible
for paying any applicable copayments or coinsurance. You should tell the provider to bill our Plan for the balance of the payment due.
However, if you have received a bill from the provider, please send that claim to: Blue Medicare Advantage, P.O. Box 8494, St Louis, MO 63132,
so we can consider payment for the services. If you have any questions about provider payments
or where to send a paper claim, you may contact customer service.