Answers to Your Common Questions
What counties are included in the Capital BlueCross service area?
The Capital BlueCross service area includes the Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York counties.
Does everyone in my family need to have the same Primary Care Provider (PCP)?
What if I get sick out of Capital BlueCross’s coverage area?
Your member ID card opens doors to hospitals and doctors across the United States participating in the . They’ll accept our payment as payment in full for covered services subject to member cost share, reducing your out-of-pocket expense. You may be responsible for more of the cost with non-participating providers or specialty care.
What if I travel outside of the country?
Your benefits travel with you! There are BlueCross BlueShield Association-participating hospitals and doctors in over 200 countries.
- Find a doctor through or download the .
- If you’re able to visit a participating provider while abroad, just show your ID card.
- If you must see a non-participating provider, ask for an itemized copy of your bill. You may have to pay this bill out-of-pocket. When you get home, submit a claim to us for possible reimbursement.
- If you want a more robust, concierge-level health plan while abroad, explore plans from *.
Can I designate a third party to help me remember to pay my premium?
Yes. Enroll in Entrust®. When you are signed up and your bill is past due, we will send your final billing notice to your designated family member, friend, or agency. They can remind you to pay your premium and avoid cancellation.
How are EOBs bundled?
What do EOBs look like online?
When you log in to your secure member account, you see individual claims listed by provider. However, the “View EOB” icon next to each claim brings up the same bundled EOB you receive in the mail.
If a claim is finalized before the bundled EOB is generated, you see the individual claim information as soon as that claim is finalized.
What are the differences between in-network and out-of-network (OON) EOBs?
Since there is not a member rate for OON services, you see “Allowed Amount” instead of “Your Member Rate” on OON EOBs. In addition, OON EOBs are not bundled and go out on a per claim basis, unless you receive multiple services by the same provider on the same day.
In you receive an in-network and OON EOB on the same day, they are mailed together in the same envelope.
Remember, you can save money by choosing in-network providers.
Where on my EOB can I see my deductible, copay, and coinsurance amounts?
You can see how much of your member and/or family deductible you have met on the bar chart(s) in the “Explanation of Benefits” section. You can find your copay/coinsurance amounts in the “Care Detail” section, along with the amount applied to your deductible and the amount you owe.
What is the “Amount You Owe” section?
This is the total amount you owe your provider(s) for the services you received. This may include your copay, coinsurance, any deductible you still need to meet, and any services that your benefits don’t cover. If you already paid your provider(s) all or part of this amount during your visit, make sure that amount is credited on your future bill.
What does it mean if the “Amount We Paid” section on an EOB shows $0?
You may see $0 if the services you received aren’t covered under your plan, if the cost went toward paying your copay, coinsurance, or deductible, or if they were paid by another insurer.
What are eligible services?
Eligible services are those that are covered under your health plan. Log in to your secure member account to review your benefits.