How we make medical policy and member benefit decisions

Increasing the quality of care while containing costs When health insurance picks up most of the cost of medical care, there is a perception that “someone else” is paying. But really, it’s your money. When you, your family, and your co-workers use more and more medical services, the cost is passed on in the form of higher premiums, copayments, coinsurance, and deductibles. That’s why medical … Continue reading How we make medical policy and member benefit decisions

What’s the difference between medical necessity and a covered benefit?

Why a doctor-prescribed service or device isn’t always covered by health insurance Medical necessity and covered benefits are two entirely different things. A medical necessity is something that your doctor has decided is necessary. A covered benefit is something that your health plan or policy has agreed to cover. The fact that a doctor may prescribe, order, recommend, or approve a service does not always … Continue reading What’s the difference between medical necessity and a covered benefit?

What are my rights as a member?

When it comes to your health plan, knowledge is power As a Blue Cross and Blue Shield of Kansas member, you are entitled to certain rights and responsibilities. Some are guaranteed by federal law, such as the right to get a copy of your medical records, and the right to keep them private. The health care law also offers rights and protections that make coverage fairer … Continue reading What are my rights as a member?