https://connect.bcbsok.com/my-coverage-explained/en-USTelligent Community 12https://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/pharmacy-benefit-vs-medical-benefitThu, 30 Jul 2026 15:00:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:8a0522f1-d0aa-4687-b50e-fd413d96eabcBCBSOK Connect TeamIt’s no secret that prescription drugs can be pricey. One of the best ways to save on the drugs you are prescribed is to make sure you understand how your health plan benefits work. A good place to start is to answer this question: Is my prescription drug a pharmacy or medical benefit? In most cases, a prescription drug is covered under your pharmacy benefit . There are times, though, when a prescription drug is considered a medical benefit . Here is a breakdown to help you understand which is which. Drugs That Fall Under Your Pharmacy Benefit Think about the common medicines you pick up at your local drugstore or have delivered to your home. Drugs that help keep your blood pressure or cholesterol in check. The cream your dermatologist gave you for that itchy rash. Antibiotics for a sinus infection. Or insulin to manage your diabetes. These are just a few examples of prescription medicines you may take that may be part of your pharmacy benefit. Drugs That Are a Medical Benefit Sometimes, medicines must be given by a care provider in a health care setting. Birth control implants are one example. So are chemotherapy infusions for cancer and immunotherapy for complex and chronic diseases. These types of medicines usually require patients to be monitored by a medical professional during their treatment. Your medical benefit may cover the costs of these drugs and their administration. Some Drugs Can Be Both Vaccines given as part of preventive health care can be either a pharmacy benefit or a medical benefit. A flu shot is the most common example. Did you go to your local retail pharmacy for your flu shot? Or did your primary care provider give you a flu shot during your annual wellness check? The benefit category for the vaccine depends on your health plan and where you got it. Of course, understanding the details of your Blue Cross and Blue Shield of Oklahoma plan is one of the best ways to get the most out of your pharmacy benefit. Here are some things you can do: Check Your Plan’s Drug List The list is exactly what the name suggests — a list of prescription drugs covered by your health care plan. The list is organized into different levels of coverage called member payment tiers. Some plans may have up to six tiers. Each tier has its own cost. The lower the tier, the lower your out-of-pocket costs will be for the drug. Generic drugs are usually found in the lower tier. Name brand drugs and specialty drugs are often in higher tiers. You may pay more for a brand name drug if you choose the brand name drug when a generic equivalent is available. Talk with your doctor and pharmacist about all your medicines. Always check to see if they are covered under your health care plan. For any name-brand drug, ask if there are generics or lower-cost options you can take. If your drug isn’t covered on your drug list, ask if there are other covered drugs or treatments that meet your needs. To check your drug list, log in to your member account online or through the BCBSOK App . Be In-the-Know About In-Network Pharmacies BCBSOK works with a broad network of pharmacies. When you use an in-network pharmacy, your out-of-pocket costs are often less. You may also be able to get up to a 90-day supply of covered drugs you use regularly . Understand Special Requirements and Limits Sometimes, you may need to meet certain criteria before your prescription drug coverage is approved. Members who use a specialty drug to treat a complex or rare condition may need to follow specialty pharmacy program guidelines. Some drugs may have limits on how much medicine can be dispensed per prescription or in a given time span. Your doctor may need to get prior authorization before your drug is covered. You might need to use step therapy , which means you must try a more cost-effective drug first before moving to another higher cost drug. To review your pharmacy benefits, you can: Log in to your online member account or the BCBSOK App to see in-network pharmacies, get cost and coverage information, check refills and more. Call BCBSOK customer service at the number on your member ID card. Prime Therapeutics LLC is a separate company contracted by Blue Cross and Blue Shield of Oklahoma to provide pharmacy solutions. BCBSOK, as well as several independent Blue Cross and Blue Shield Plans, has an ownership interest in Prime Therapeutics.PrescriptionsIn-NetworkDrug ListGeneric DrugsPharmacyBenefits and CoveragePharmacy Benefitshttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/what-is-an-out-of-pocket-maximumThu, 30 Jul 2026 13:32:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:223b2be7-4256-416d-b522-ef42847a2cb3BCBSOK Connect TeamWe know health care terms can be confusing. One you’re sure to run across is “out-of-pocket maximum.” What does it mean? How does it affect you and your family? How does it influence your choice of health plan? You share the cost of your care with your health insurance company. You pay money to cover your deductible, copays and coinsurance (if coinsurance applies to your plan). But here’s some good news: There is a limit to how much you are required to pay. It’s called your out-of-pocket maximum (OOPM). And it is the most you’ll have to pay during a policy period – usually a year – for health care services. If you are a current BCBSOK member, you can see your plan’s OOPM on your member ID card and in online member account . It’s different for every type of plan. Here are some things to keep in mind: Your OOPM limits how much you can be charged for your health care expenses. This limit protects you if serious and expensive medical issues come up. The government can change the OOPM each year. For 2027, the highest OOPM a plan can have is $12,000 for an individual and $24,000 for families. But some plans will have a lower OOPM. Remember, if you go out of your health plan's network for services, those expenses may not count toward your OOPM, and you could have to pay more. Take this scenario for example: Joe’s plan has an $9,200 out-of-pocket maximum. That is the most Joe will pay this year out of his own pocket for covered medical expenses. Joe only pays for the medical care he uses. If he’s healthy, he may only pay for a few doctor visits and prescriptions. But if he has an accident or major illness, that accident or illness could mean costly hospital bills. But Joe has health insurance and stays in network. So he won’t have to pay more than $9,200 for covered expenses this year, even if his care costs more. Read more about a deductible vs out of pocket maximum. Before you choose a health insurance plan, it’s important to first consider a plan’s provider network. To see which providers are in a plan’s network, you can search online . If you already have a health insurance plan, log in to your account and click Find Care to find a provider in your plan's network.Out-of-pocket costsProvider FinderHealth Care CostsMedical BillsHow Health Insurance WorksInsurance Basicshttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/make-most-of-plan-year-endThu, 30 Jul 2026 10:11:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:6ceb9d78-bb4b-48f0-92af-3b266496d94dBCBSOK Connect TeamIf you’re the kind of person who needs a deadline to get things done, there may be a big one just around the corner. If your health plan year is ending soon, it’s a good time to review your health benefits. Doing so could be a boost to your overall health — and could even save you money. That’s because you might have benefits you want to use before the end of the plan year. It pays to check it out and make a few appointments. Deductibles Looking at your health benefits now may save you money. If your plan has a deductible and you’ve met it, you might want to schedule care your doctor has been recommending now, rather than waiting until your next plan year. A deductible is the amount you pay for health care services each plan year before your health plan starts to pay. For example, if you have a $1,500 deductible, you pay the first $1,500 of the services you need. Once you’ve met your deductible, you usually pay only a copay and/or coinsurance for covered services. Coinsurance is when your plan pays a large percentage of the cost of care and you pay the rest. For example, if your coinsurance is 20 percent, you’ll pay 20 percent of the costs when you need care. Your health plan pays the other 80 percent. Since your deductible resets each plan year, it’s a good idea to keep an eye on the figures. If you’ve met your deductible for the year or are close to meeting it, you may want to squeeze in some needed tests or procedures before your plan year ends to lower your out-of-pocket costs. If you have had a lot of medical expenses this year, you may have also met your out-of-pocket maximum. If that’s the case, you may not have to pay anything for in-network services covered by your plan. So you'll save even more on treatment you’ve been putting off. If you wait until your new plan year starts for the same treatment, your deductible and your out-of-pocket maximum will have reset. That means you will have to pay more out of pocket for the very same care. High Finance The end of your plan year is also a good time to review your financial paperwork. Members with employer-sponsored plans may have a Flexible Spending Account balance that needs to be used before the end of the plan year. A Flexible Spending Account, or FSA, is an employer-sponsored option that lets you set aside a part of your earnings before taxes for qualified medical expenses. Qualified expenses include doctor’s visits and products such as contact lenses and prescription glasses. Using an FSA may save you money. But pay attention to the calendar. FSA money is often a “use-it-or-lose-it” benefit. Sometimes FSA money will roll to the next plan year, but check with your benefits department to make sure. For both employer-sponsored and individual plans, a Health Savings Account is also money set aside to be used for qualified health care costs. But any money you don’t spend can be rolled to the next plan year. Find out more about flexible spending accounts and health savings accounts . Keep Smiling It’s nice to have a clean report from the dentist, no matter your age. If you think you might need to have some work done, now’s a good time to check it out. If you have a dental plan, double check your yearly maximums. If you expect to need fillings, crowns or root canals, you might want to plan them in the current plan year to use your available funds. Some people have one procedure at the end of one plan year and the next at the beginning of the new plan year to break the treatment into two different plan years. It’s an efficient, cost-effective way to use your benefits. Check Your Benefits With Ease If you have questions, there’s one place to go — your member account. You can access your account any time via the online portal or our free BCBSOK App . Your member account lets you manage your health plan online. You can get easy access to whatever information you’re looking for. Stay organized and cut the time you spend looking for paperwork. One thing to check is your deductible amounts. That’s the amount you pay on some visits and treatments each year before your health plan starts to pay. You can see an overview of your deductible information on your Dashboard. You can find more details in the Coverage section. You can also get more plan details and a new printed or digital ID card. The Claims section shows your claims for the past 18 months. It’s also where you will find your claim statements or Explanation of Benefits (EOB). The statements will show the service supplied, what your plan covers, your financial responsibility and more. You can also sort claims by date, status, provider and claim type. While you’re logged in, you can change your contact preferences under My Account. You can also search for doctors and other providers in your network by selecting Find Care. Sources: Health Checkup , U.S. National Library of Medicine, 2024; Year-End Tips to Maximize Your Health Benefits , JDRF.org, 2022DeductibleBlue Access for MembersBAMMy Coverage ExplainedPreventive CareHealth Care CostsSave Moneyhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/appeals-processThu, 30 Jul 2026 08:50:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:a76d7305-cc7f-4da4-ba9f-152f27f8662bBCBSOK Connect TeamWe want you to be happy with your health plan. If you don’t understand a benefit decision made by Blue Cross and Blue Shield of Oklahoma or BlueLincs HMO SM , first call customer service. In most cases, a customer service representative will be able to help you with your problem. But if they can’t resolve your issue, you may request an administrative review of the problem through our appeals process. You have the right to a full and fair review of: Denied claims Denied requests for preauthorization or precertification Any other determination made by us according to the benefits and procedures explained in your benefit booklet Call the customer service number on your member ID card for more information. BlueLincs HMO SM is an Independent Licensee of the Blue Cross and Blue Shield Association, a Subsidiary of Health Care Service Corporation, a Mutual Legal Reserve CompanyAppealsBlueLincs HMOEmployer CoverageBenefits and CoverageHMOhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/understand-planThu, 30 Jul 2026 08:48:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:9b19ca36-f838-4960-a511-abff75ee3f71BCBSOK Connect TeamThis article is intended for HMO members. Blue Cross and Blue Shield of Oklahoma and BlueLincs HMO SM support our members’ communication needs. We use software to help make sure the information we send is easy to understand. If you are language, vision or hearing impaired or physically challenged, you can call customer service to get help. Members can get help from bilingual customer service advocates. And we offer some programs and support in several languages. For more information, please call the customer service number on your member ID card. BlueLincs HMO is an Independent Licensee of the Blue Cross and Blue Shield Association, a Subsidiary of Health Care Service Corporation, a Mutual Legal Reserve Company.BlueLincs HMOCustomer ServiceEmployer CoverageBenefits and CoverageHMOhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/coordination-of-benefitsTue, 28 Jul 2026 06:08:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:81c131d4-c337-442c-bc8e-1acc0abc38f3BCBSOK Connect TeamWhen you need care and are on two different health insurance plans, your insurers will coordinate your benefits (COB). This helps you get maximum coverage when you need it. If you’re covered by two different health plans, your provider may file the claim with both plans. The health insurers will decide which plan covers certain expenses on the claim. This is called Coordination of Benefits. If there are times when your primary plan doesn’t cover the whole claim, the secondary plan may cover them all or pay a certain amount. It depends on the COB rules. How It Works Coordination of benefits may be needed if: You are on your employer's health plan and on the plan your spouse has with their employer. You buy your own health plan, but you are also on your spouse's group plan. You and your spouse have individual policies and are listed as dependents on both. You have dependent children covered under both your and your spouse's health plan. A custody agreement requires one parent to cover the children, but both parents choose to include them on their coverage. If you have Medicare and another plan, coordination of benefits is always used. Medicare may be the primary or secondary payor. It depends on the Medicare coordination of benefits. Let your insurer know up front if you have Medicare. It will save you and your doctor time when filing claims. Why Coordination of Benefits? Coordination of benefits helps: Avoid duplicate payments so the two plans don’t pay more than the total amount of the claim. Make sure the proper payments are made by each plan. Reduce the cost of insurance premiums. You may get a form in the mail, an email or a call from your insurer to set up the coordination of benefits. You may also want to document any other coverage you have when your plan renews each year. Even if you don’t have other coverage, you'll need to let your insurer know. Sometimes claims are held until coordination of benefits is confirmed. A provider won’t be paid until primary and secondary coverage is confirmed. Want To Know More? If you have more than one health plan, check out the section of your benefit materials called Coordination of Benefits to learn how it works. For more information, call the customer service number on your health plan's member ID card. Source: Coordination of Benefits , ehealthinsurance.com, 2023; Coordination of Benefits , Centers for Medicare & Medicaid Services, 2026; How Medicare works with other insurance , medicare.govUnderstanding InsuranceMedical ClaimsCustomer ServiceBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/reasons-claim-deniedThu, 16 Jul 2026 10:22:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:73a3bc9b-d3f3-4733-a197-0cf729e5c596BCBSOK Connect TeamBelieve it or not, there are only a handful of reasons that may lead to a health care service not getting approved or a claim not being paid. They fall into these five buckets. The claim has errors. Minor data errors are the most common culprit for claim denials. Sometimes, a provider may code the submission wrong, leave information out, misspell your name or have your birth date wrong. Your explanation of benefits (EOB) will give you clues, so check it first. If you find an error, ask your provider to correct the information and submit your claim again. You used a provider who isn’t in your health plan’s network. Some plans only cover care if you use providers and facilities in your plan’s network. If you go out of network, your plan may not cover any of the costs. Other plans may only cover some of the out-of-network costs, and you have to pay the difference. Your care needed approval ahead of time. Some procedures, like CT scans, MRIs and certain surgeries, usually require prior authorization. If a claim isn’t covered because it wasn’t authorized in advance, talk to the provider who ordered it. Your provider may be able to submit patient records that show you needed the service. You get care that isn’t covered. Your health plan may not provide that benefit. For example, your plan may not cover weight-loss surgery. In that case, it doesn’t undergo medical review. If your plan doesn’t cover it, the procedure won’t be approved. This is called a coverage limit or contract exclusion. If you lost health plan coverage, your claim may not be covered. This may happen if you don’t pay your monthly premiums or run out of COBRA. The claim could also be denied for a medical reason. These types of denials may include: The services are not considered medically necessary. The right level of care wasn't provided given your condition. The treatment hasn’t been proven effective or is considered experimental for your condition. The claim went to the wrong insurance company. If you have a second health plan, like one from your employer and one from your spouse’s employer, the provider may have billed the wrong company. Or your care provider may have outdated information if you changed insurers. When you get your EOB, check to see if it is from the right health plan, then contact your provider. Sources: Reasons for Health Claim Denials and What You Should Do , VeryWellHealth, 2023; What to Do When Health Insurance Won’t Pay , Insurance.com, 2023; Appealing a Health Care Decision , HealthCare.govAppealsUnderstanding InsuranceMedical ClaimsExplanation of BenefitsHealth Care CostsHow Health Insurance Workshttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/claim-not-approvedThu, 16 Jul 2026 09:32:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:62a8036a-91e0-4736-adb0-13ed301c527cBCBSOK Connect TeamNurse care manager Lenzy Mixon got a call from a member about a large bill he received for a stay at a skilled nursing facility. He checked with his doctor, who assured him the stay had been pre-approved by his health plan. His next call was to us. Mixon said she was sure it was a mistake, so she reached out to a utilization review nurse and a customer advocate. Together, they found the error that caused the claim to be denied, adjusted the records and sent it through again for payment. “He was relieved and happy hearing that the claim was being adjusted so quickly,” Mixon said. While not every claim denial is so easily fixed, there are times a claim doesn’t get approved for reasons other than the service not being covered by a member’s health plan. Do you know what to do if a claim isn’t approved? First, Ask Why If you have a claim that isn’t approved, you can look at the explanation of benefits (EOB) for the claim to find out why. An EOB is generated for your medical claims to help you track what your insurance is covering and what amount you may need to pay, such as a copay or coinsurance. If a claim is denied, the EOB will explain the reason for the denial. Find Out Your Next Steps Do they have the wrong birth date listed for you? Is the address your doctor listed different from what we have on file? If the claim wasn’t approved because of an information error, reversing the denial may be fairly quick and easy. Call customer service at the number on your member ID card. You can give the customer advocate the right information to correct your file. If your provider’s office made the mistake, you can call the billing office to get the information corrected. If the service isn’t preauthorized or is denied for payment for another reason, you may need to ask that the claim be reviewed. This is called appealing the decision. You can appeal by phone or by mail. You, your doctor or another person you’ve named to represent you can appeal. Understand the Appeals Process There is a multi-step process in place that can help you if you think a claim has been denied in error. It is outlined in an insert included with your EOB. It is also explained in your benefit information. I f our reviewer is going to deny a service as not medically necessary, your doctor will receive a notification. That notification will include the option to schedule a call with the reviewer. Your doctor can review the case over the phone with us to try to resolve the issue. If the issue is not resolved and the claim is denied, you can appeal. A standard appeal is an internal review of your claim. You’ll call or send a letter to ask that the claim be reviewed to see if something can be done to reverse the denial. If a claim is denied for a medical reason, a medical doctor will review the claim. If a standard appeal does not resolve the issue, you can request to have a second medical reviewer look at the request. This second level of appeal is done by an outside, independent review organization. Your EOB will explain what types of denials can be sent for external review. There is no cost to you for an external review. Get Started You’ll need to provide as much information as you can to support the claim. Maybe the claim reviewer didn’t have the films from your MRI that showed you needed the surgery your doctor requested. It may be that a referral was required, and the referral wasn’t documented. The need for more information is another reason that often leads to a claim not getting approved. Medical review will require more information. For example, you may need: A letter from your doctor explaining why the requested treatment should be approved Patient notes from your treating physician on other care you have had for your condition The results of other tests or procedures related to the request Current medical articles or study results that support the treatment’s effectiveness Your own letter explaining why you believe the treatment is needed Hang in There For things like wrong information, a quick correction can be made and the claim refiled for approval. But other reviews take time. A standard appeal takes about 30 days for review for getting care pre-approved. Other appeals may take up to 60 days. These timeframes start when you file the appeal, not from the time of your treatment or from when the claim wasn’t approved. You have 180 days to file an appeal from the date the claim wasn’t approved. An external review takes about 45 days. If you qualify for urgent review, the outside review organization will give you a decision within 72 hours. You have four months from the date of your internal review decision notice to file a request for external review. Check Your EOB You should always check your EOB to make sure your claim information is correct. Every EOB has instructions on what to do if a claim has been denied. You may get your EOB in the mail. If you are signed up for paperless communications, your EOB can be found in your online account. Sources: Engaging with Insurers: Appealing a Denial , Patient Advocate FoundationAppealsUnderstanding InsuranceMedical ClaimsExplanation of BenefitsHealth Care CostsHow Health Insurance Workshttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/know-your-planWed, 08 Jul 2026 23:32:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:cc36288c-ff7f-4be3-bbf0-9265175b5909BCBSOK Connect TeamThis article is intended for HMO members. As an informed consumer, you should know about the benefit exclusions and limits of your health plan. Your BlueLincs HMO SM exclusions and limits are listed in your schedule of benefits. To see the exclusions and limitations on your prescription drugs, refer to your member handbook and your Prescription Drug Schedule of Benefits. Or log in to your online member account. Sometimes, changes are made to these exclusions and limitations. When that happens, we will let you know about the changes by mail or through your employer. Please look at this information carefully. Call the customer service number on your member ID card if you have questions.BlueLincs HMOUnderstanding InsuranceUsing Health InsuranceEmployer CoverageBenefits and CoverageHMOhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/multi-language-supportWed, 08 Jul 2026 14:40:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:8c3867ca-329a-4246-8661-9438293d2f82BCBSOK Connect TeamIf you or someone you are helping has questions and English is not your primary language, you have the right to get help and information in your primary language at no cost. To speak to an interpreter, call the customer service number on your member ID card. If you are not a member or don’t have a card, call 855-710-6984 . We provide assistance for the following languages: Español / Spanish العربية / Arabic 繁體中文 / Chinese Français / French Deutsch / German ગુજરાતી / Gujarati हिंदी / Hindi Italiano / Italian 한국어 / Korean Diné / Navajo فارسی / Persian Polski / Polish Русский / Russian Tagalog / Tagalog اردو / Urdu Tiếng Việt / Vietnamese There may be options for other languages not on this list. Call 855-710-6984 to find out more.Customer ServiceBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/hipaa-what-more-do-you-need-to-knowWed, 08 Jul 2026 13:56:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:2d22af50-cf79-4b0f-8a57-64ffa48db4beBCBSOK Connect TeamWhen you go to a doctor, dentist or eye doctor, you are asked to sign that you’ve seen their privacy statement. What does that mean? Thanks to the Health Insurance Portability and Accountability Act ( HIPAA ), you are reminded at each visit that your health information will be private and used only for making sure you get the care you need. Privacy Before HIPAA Before HIPAA, a University of Illinois study found, more than one-third of Fortune 500 companies looked at health records or health information as part of their employment decisions. Imagine worrying that a potential employer could refuse to hire you or your current employer could fire you if they found out that: You’re a recovering addict You may need to take extra time to handle your cancer treatment You have HIV, Hepatitis C, or some other health issue You receive care for mental health issues Before HIPAA, this happened. It happened to FBI agents. It happened to truck drivers. It may have happened to you or someone you know. Since HIPAA was signed into law in 1996, employers have not been allowed to see your health information. Privacy with HIPAA Have you: Been told to stand well back from the pharmacy counter? Signed a privacy form when you see a new doctor or go to a hospital? Found it impossible to get health information about a family member? Though these steps may sometimes frustrate you, they are needed to protect your health information and that of others. Things to Consider with HIPAA Your adult child . Do you have a child going off to college? If your child is 18 or over, you may not be able to receive their health information as you had in the past. If you want to know about the health care services your child receives, you’ll need to fill out an authorization form — with your child’s written permission. Helping loved ones with HIPAA . You notice an elderly family member having odd spells or memory issues. You want to know about their care and if there is anything you should be doing to help them. You’ll need an authorization or a power of attorney for health care from your family member before you can help. Completing one of these documents ahead of time can reduce the stress when an issue happens. Your spouse has a serious illness . Cancer, ALS, renal failure. These and other health problems can get critical fast. Make sure you can make decisions that will honor their wishes. Maybe they want to donate their body to science or to be an organ donor. Maybe they want a Do Not Resuscitate order on file. Be sure to complete the necessary forms so you can make or enforce those decisions if your spouse isn’t able to. Privacy laws like HIPAA have made a difference in making sure your health problems are kept private. Make sure you know how they work and what you may need to do if you want others close to you to know more.Understanding InsurancePHIStandard AuthorizationHIPAAhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/in-network-health-careWed, 08 Jul 2026 13:39:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:884d6481-7746-4701-a5f9-d95ec12013b9BCBSOK Connect TeamWhen you shop, you probably keep an eye on costs. You want to buy the things you need at a fair price. What about when you’re shopping for health care? Using providers in your health plan’s network can help you save money. A network includes hospitals, clinics, doctors, pharmacies and others who take part in your health plan. These network providers agree to work with your health plan. That helps keep your costs down. Providers who do not have a contract in place with your health plan are out-of-network . In-Network, Out-of-Network — What’s the Difference? By staying in your network, you can take advantage of discounted rates and avoid surprise charges. That’s because in-network health care providers and your health plan have agreed to a set price for each treatment or procedure in advance. A provider who is not in your plan's network can charge higher prices for the same care. You may also have to pay a higher copay or deductible for out-of-network care. In some cases, you may even have to pay the full cost. Before you go anywhere for care, make sure the provider or facility is in your health plan network. You’ll receive the same quality health care you should expect from any provider at the most affordable cost to you. Try these tips: Once you find a provider, check to see if they are in-network for your specific health plan. Simply asking if they take Blue Cross and Blue Shield insurance is not enough. Give them the information on your member ID card — including the full name of your plan — to make sure. If your primary care provider gives you a referral to another doctor, ask for one who is in your plan’s network. Then make sure that the new doctor is in your network. If you need surgery or other health services, check to make sure each facility where you will get care is in your network. It’s a good idea to see if each provider for the service or procedure is also in your network. But if you get care from an out-of-network provider while you’re at an in-network facility, you may be protected from unexpected costs, called balance billing or surprise billing. To find providers in your health plan’s network, log in to your account and select Find Care. Don’t Forget Pharmacies When you use a pharmacy that is in your network, you’ll save money. With some prescription drug plans, there can be another consideration. Along with in-network and out-of-network pharmacies, there may be a preferred pharmacy network in your plan benefits. If so, you’ll save the most money when you fill your prescriptions at preferred pharmacies. To find an in-network pharmacy, log in to your account and look under Pharmacy. On the Pharmacy page, search for retail or home delivery pharmacies. If you’ve been using a pharmacy that isn’t in-network, it’s easy to switch. You can take your prescription bottle/bag to the new in-network pharmacy. Or you can call the new pharmacy and ask them to contact your current pharmacy. You can also ask your health care provider to contact your new pharmacy. Make sure to ask your provider to send any new prescriptions to your network pharmacy. You may need to take your BCBSOK member ID card with you if it’s your first visit to the pharmacy or if you’ve changed health insurance plans. Plan in Advance Remember, whether it’s a doctor, clinic, hospital, therapist or other provider, you may pay less for care when you visit an in-network provider. That’s why it’s good to learn about your choices before you need care. It will help you be better prepared to take care of your health.In-NetworkUsing Health InsuranceHealth Insurance NetworkHealth Care CostsBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/virtual-visits-annual-examsWed, 08 Jul 2026 09:15:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:e8699c60-83f2-4209-80e9-bbd78a722872BCBSOK Connect TeamDoes your health plan offer telehealth visits with doctors in your plan’s network? Now's a good time to check. It may be just what you need to stay on top of your health. During the pandemic, more health care facilities turned to telehealth visits to help keep patients and staff safe. And telehealth visits remain a good option for things like: New health concerns Annual exams Routine check-ins on health issues When There’s a Problem Having stomach issues? A headache that won’t go away? A rash that concerns you? These are the types of issues you may see your primary care doctor about. To do so, you usually have to schedule a visit and go to the office. But a hands-on exam may not be necessary. Instead, the doctor may simply offer helpful medical advice, prescribe a medicine or send you for a test. This is the type of visit that can often be handled just as well with a telehealth visit. If your plan includes behavioral health care, a telehealth visit is also a good opportunity to talk to your doctor about depression, anxiety or other mental health issues. Annual Exams Some primary care doctors, pediatricians and women’s health providers may also choose to do annual exams using telehealth visits. These visits play a big role in catching small health problems before they become big ones. Doctors are finding that much of what they do in your yearly checkup can be done virtually: Review your health and family history Update a list of your current medicines Talk about your lifestyle Discuss tobacco and alcohol use, diet and sleep habits Other exams and tests can be scheduled separately. Blood tests, vision and hearing exams and imaging like mammograms are good examples. Your doctor can also send prescriptions directly to your pharmacy. As always, an annual exam is covered at no cost to you if you see a provider in your health plan’s network. Condition Check-ins Chronic health conditions like diabetes, asthma, heart disease and cancer need your attention every day. It’s vital that you keep your appointments, follow doctor’s instructions and let your care provider know if you have concerns. An added benefit of telehealth visits is that you don’t have to arrange travel or time off from work or school. How Telehealth Doctor Visits Work Depending on your health plan’s benefits, a telehealth visit with a doctor in your plan’s network may be covered. Signing up for a telehealth visit is easy: Make sure you have internet access and a smartphone, tablet or computer with a built-in or attached camera. Call your doctor’s office to ask about telehealth visits and schedule an appointment. Be sure to ask if the provider is in your health plan’s network. You may need to handle paperwork and any payment before the call, either online or by email. When it’s time for your appointment, follow the instructions from the doctor’s office on how to connect with your doctor. Virtual Visits, powered by MDLIVE ® Telehealth visits are covered under many Blue Cross and Blue Shield of Oklahoma health care plans. Some BCBSOK health plans also include access to Virtual Visits*, powered by MDLIVE ® . This service gives you access to board-certified doctors and licensed behavioral health therapists for many non-emergency health situations. Log in to your online account to see if you have the Virtual Visits benefit. Go to My Health then Find Care. If you see Virtual Care, click there to see your telehealth options. If you have Virtual Visits, you will see instructions for how to register and schedule an appointment. *MDLIVE is a separate company that operates and administers Virtual Visits for Blue Cross and Blue Shield of Oklahoma. MDLIVE is solely responsible for its operations and for those of its contracted providers. MDLIVE and the MDLIVE logo are registered trademarks of MDLIVE, Inc., and may not be used without permission. Virtual Visits may be limited by plan. For providers licensed in New Mexico and the District of Columbia, Urgent Care service is limited to interactive online video; Behavioral Health service requires video for the initial visit but may use video or audio for follow-up visits, based on the provider’s clinical judgment. Behavioral Health is not available on all plans.TelehealthAnnual ExamBenefits and CoverageVirtual Visitshttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/fitness-program-waived-enrollmentMon, 06 Jul 2026 08:12:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:75147c78-3018-476a-8bc2-c1a602209301BCBSOK Connect TeamWell onTarget, the Fitness Program and Blue Points SM are not available to all members. Check your online account information or ask your benefits administrator to see if you have these benefits. If you’re looking to stay in shape, or get back in shape, now is a good time to join the fitness program. The $19 enrollment fee will be waived for eligible new members who sign up now through Aug. 31, 2026.* Join today and get access to a nationwide network of participating facilities so you can work out whether traveling, at home or at work. You can also choose digital options like online fitness videos and live classes. Enjoy All the Fitness Program Benefits The Fitness Program offers flexible plan options ranging from $19 to $239 a month. You can select a plan option that best suits your lifestyle. You’ll have access to all locations available in the plan you choose, as well as locations in any of the lower-priced plan options. Digital fitness options are also included in all plans at no cost. The Digital Only plan is $10 per month. Choose from thousands of digital fitness videos and live classes. More Fitness Program Features Real-time check-in and activity reporting information is provided through the Well onTarget Fitness Program mobile app and Well onTarget portal. Get Complementary and Alternative Medicine (CAM) discounts through Choices by Whole Health Living.** Save money through a nationwide network of 40,000 health and well-being providers such as acupuncturists, massage therapists and personal trainers. To take advantage of these discounts, register at wholehealthliving.com . Go online to find fitness locations and track visits. Get the Well onTarget Fitness Program Mobile App You can use the Well onTarget Fitness Program app to: Have real-time check-in and activity reporting Explore nearby locations in the Fitness Program network Get easy access to your Fitness Program membership card Download the Well onTarget Fitness Program app free of charge from the Apple and Android app stores. Search for “Well onTarget Fitness Program.” Be sure to register in the Fitness Program portal before you start using the app. After you’ve registered, you can log in to the Well onTarget Fitness Program app using your Fitness Program portal username and password. Join Now To get the waived fee, use coupon code AUG26FP when you enroll. To enroll, log in to your Blue Cross and Blue Shield of Oklahoma member account , go to the My Health drop-down menu and select Wellness . Then scroll down to Fitness Program . You can decide on the plan that best meets your needs and select the fitness location that is best for you. Remember to enter the coupon code AUG26FP during enrollment before Aug . 31 to get the waived fee. You can also enroll by calling 888-762-BLUE (2583) Monday through Friday, between 7 a.m. and 7 p.m. CT (6 a.m. and 6 p.m. MT). *After Aug 31, 2026, regular enrollment fees will apply to all new memberships. This offer can’t be combined with any other promotional offers. ** Choices by WholeHealth Living benefits are not offered in Oklahoma and Montana. The waived enrollment promotion is only available to members with the Fitness Program, which is included in the Well onTarget ® program. Individuals must be 18 years old to purchase a membership. Dependents 16 to 17 years old can join but must be accompanied to the location by a parent/guardian who is also a Fitness Program member. Check your preferred location to see their membership age policy. Underage dependents can log in and join through the primary member’s account as an “additional member.” Member agrees to comply with all applicable federal, state and local laws, including making all disclosures and paying all taxes with respect to their receipt of any reward. The Fitness Program is provided by Tivity Health TM , an independent contractor that administers the Prime Network of fitness locations. The Prime Network is made up of independently owned and operated fitness locations. No endorsements, representations or warranties are made regarding third-party vendors and the products and services offered by them.ExerciseFitness ProgramBenefits and CoverageWell onTargethttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/trouble-premium-paymentMon, 29 Jun 2026 16:54:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:685ac592-c817-4a28-b368-a25a2c057d2bBCBSOK Connect TeamWe encourage members to make payments by electronic funds transfer and to set up monthly premium payments using Auto Bill Pay electronic funds transfers. When you’re first getting started, using electronic funds transfer helps us process your enrollment quickly. And throughout the plan year, auto payments help make sure your payments are on time without you having to worry about it. Using auto bill pay lowers your risk of losing coverage due to nonpayment of monthly premiums. Our member payment portal experience is designed for quick and easy use. But what can you do if you’re having trouble getting your payments set up? Here are a few common issues and tips that may help you fix them. If your payment set-up is not going through: Recheck for errors. Typos often happen with both number and letter entries. And autocorrect may sneak in an incorrect spelling before you copy and paste. Try a different payment method. Using a different credit card or bank account may help. Banking institutions can have system outages that keep your payment method from going through. And sometimes other electronic bills come through sooner or later than expected, keeping your payment set up from going through. If your payment is not appearing on your bank statement: Check the auto bill pay specifics: Double check the date of your first auto draft or the next date of the auto draft. Look to see where your payment is in the process during the end of the month draft (see status indicator). Remember that it can take up to 24 hours for the bank to show the draft in your account. If you’ve checked for these common issues and are still having trouble, call the number on your member ID card. A customer service representative will be happy to help you complete the process.Individual and Family CoveragePay Premium PaymentsBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/preventive-or-medicalTue, 09 Jun 2026 00:10:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:d0942481-50f1-429b-ae51-92428a503b70BCBSOK Connect TeamMany people may not know that there are two types of care you can receive when you go to the doctor — preventive care and medical care. The type of care is different, and your costs may be different, too. Medical Care vs. Preventive Care Think about how people use health care based on their needs. A person with a chronic disease may need to see a doctor or specialist often. Others may have occasional injuries or infections. Treatment of disease and injury is considered medical care. So What Is Preventive Care? Proper diet, exercise and healthy lifestyle can all help avoid certain health problems. Preventive care does the same thing. Preventive screenings can help catch problems early, before you notice symptoms. Yearly preventive exams and screenings may include: A physical exam Screenings for things like blood pressure and cholesterol levels Vaccines you need to prevent illness Mammogram screening Colon cancer screening Cervical cancer screening Diabetes screening Sometimes Preventive Care and Medical Care Cross Paths There are both “screening” and “diagnostic” versions of many tests , such as mammograms and colonoscopies. A screening version is considered preventive care. Preventive screenings are usually ordered at certain ages and at regular intervals when there is no reason to suspect a problem. If a person has symptoms or anything looks unusual on a screening test, then they may need a diagnostic test, which is considered medical care. Diagnostic tests take a closer look to see if disease is present. The technology for screening and diagnostic (medical) tests may be similar. But where and when you take them and who reads the results are different. The out-of-pocket costs may also be different. It’s a good idea to find out what your out-of-pocket costs will be before you schedule your appointment. Check with your doctor’s office to see which kind of test you’ll be getting. And check your benefits or call the customer service number on your member ID card to get the details about your coverage and costs for the test. Why Fix What Isn’t Broken? Even if you feel healthy, once a year you should get a preventive checkup from your doctor. Preventive care may help you avoid some health problems, or find health problems early, when your chances for treatment and cure are better. A preventive checkup is worth your time and effort because: It can catch disease early and may lead to better health outcomes and lower costs. Six in 10 American adults have a chronic disease. Four in 10 have four or more chronic diseases. These diseases are a leading cause of death and disability in the U.S. These conditions are preventable or treatable in many cases. Preventive screenings can find very early signs of a condition, when simple changes in diet and daily habits may reduce the risk or even reverse it. Our qualified* health plans cover most preventive health care services with no out-of-pocket costs when you go to your primary care provider or medical group (for some HMOs) or a doctor or medical center in your plan’s network (non-HMO plans). You pay no copay or coinsurance even if you haven’t met your deductible. You can find complete details of the preventive services your plan covers in your benefit book. To make sure a provider or facility is in your plan’s network, log in to your account online or through the BCBSOK App and go to Find Care. *Preventive services at no cost applies only to members enrolled in non-grandfathered health plans. You may have to pay all or part of the cost of preventive care if your health plan is grandfathered. To find out if your plan is grandfathered or non-grandfathered, call the customer service number on your member ID card. Sources: Chronic Disease , Centers for Disease Control and Prevention; Fast Facts: Health and Economic Costs of Chronic Diseases , CDC, 2025; About Chronic Diseases , CDC, 2026Medical CarePreventive CareBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/drug-list-updateMon, 08 Jun 2026 17:40:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:a5bb9c44-0d05-4b1d-a198-37ba2d4cd169BCBSOK Connect TeamMedicines play a major role in preventing and treating many health problems. That is why a prescription drug benefit is included in most health plans. Many Blue Cross and Blue Shield of Oklahoma plans have a prescription drug list (also known as a formulary), a regularly updated list of covered drugs available to you. Care and treatment decisions are between you and your doctor. However, doctors are encouraged to prescribe medicines that are on the drug list. This helps keep your out-of-pocket costs low. We encourage you to show the drug list to your doctor and pharmacist. Keep in mind that prescription drug benefits may differ by plan. Which Drug List Applies to Me? The prescription drug lists are specific to your benefit plan. You can always view the most updated prescription drug lists in the Prescription Drug section of our website. Access Pharmacy Benefits and Search for Drugs To learn more about your pharmacy benefits and search for specific drugs, you can log in to your account online or with the BCBSOK App . Your Online Member Account Log in to your online member account for easy online access to information about your health benefits, prescription coverage and more. From your dashboard, click Pharmacy in the top navigation. You can: Find in-network pharmacies. Share your member ID with your health care provider or pharmacy. Manage your prescriptions. Find cost estimates, lower-cost options, clinical review status updates and refill reminders. Get information about your medicines, such as drug interactions, potential side effects and any special requirements or limitations If you haven’t registered for your online account yet, register today with a few easy steps. Once you're registered, you can log in to your account. BCBSOK App The BCBSOK App lets you access your benefits information from anywhere. You can use your member account login information or create a new account to log in to the app. The BCBSOK App is available in English and Spanish for iPhone and Android users. Download it today. You May be Able to Save Money with Generic Drugs Prescription drugs may be a big part of your health care costs. You may be able to lower your out-of-pocket costs by choosing generic drugs. Find out if generic drugs are right for you .PrescriptionsDrug ListBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/blue365-time-to-saveMon, 08 Jun 2026 16:49:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:fd411026-10ba-4eca-977d-53f7c2551fcfBCBSOK Connect TeamIf you’re looking for some great discounts on health-related products and services, check out the Blue365 ® program. It’s just one more advantage of being a Blue Cross and Blue Shield of Oklahoma member. You and your covered family members can save with top retailers on products and services that may not be covered by insurance. There are no claims to file and no referrals or prior authorizations needed. Find Deals You Like You can find deals in six main categories: Apparel and Footwear Fitness Hearing and Vision Home and Family Nutrition Personal Care Some examples of discounted products and services you may find include: Outdoor clothing, athletic shoes and fitness products Gyms, classes and wearable devices Glasses and contacts Dental services, vitamins and supplements, and wearables Weight loss programs and meal delivery services Mindfulness classes and products and services that support mental wellness and reducing stress Start Saving To start saving, log in to the Blue365 site . If you don’t already have an account, it’s easy to create one . Be sure to have your BCBSOK member ID card handy when setting up your account. When you log in, you’ll see all the deals available to you. When you find a discount you like, click on details . You may get a coupon code that you can apply directly to your purchase on the vendor’s site. Or you may be sent to the vendor’s site, and the discount will have already been applied for you. Deals change often, so if you see one you like, don’t wait to take advantage of it. Blue365 is a discount program only for Blue Cross and Blue Shield of Oklahoma members. This is NOT insurance. Some of the services offered through this program may be covered under your health plan. You should check your benefit booklet or call the Customer Service number on your member ID card for specific benefit facts. Use of Blue365 does not change monthly payments, nor do costs of the services or products count toward any maximums and/or plan deductibles. Discounts are only given through vendors that take part in this program. BCBSOK does not guarantee or make any claims or recommendations about the program’s services or products. You should consult your doctor before using these services and products. BCBSOK reserves the right to stop or change this program at any time without notice.DiscountsBlue365Benefits and CoverageSave Moneyhttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/protect-privacyMon, 08 Jun 2026 15:09:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:d6183b7a-4501-4b93-873a-0b040c302987BCBSOK Connect TeamBlue Cross and Blue Shield of Oklahoma is committed to protecting our members' health information. You may have received information about our Notice of Privacy Practices (NOPP) on an Explanation of Benefits or ID card mailer. You can get BCBSOK’s full NOPP three ways: Go to our website to read the notice . Call the number on your member ID card and ask for a copy. Email nopp@bcbsok.com and ask for a copy.Privacy NoticePHIHIPAAPrivacyBenefits and Coveragehttps://connect.bcbsok.com/my-coverage-explained/b/weblog/posts/travelers-checklist-protect-your-health-while-you-travelThu, 21 May 2026 15:53:00 GMT6e104328-2028-43b6-bb31-8401437dc51f:8081534c-834f-4767-8cab-56fc387e08d6BCBSOK Connect TeamVacation sounds good right about now. And whatever kind of vacation you like, there’s one thing that makes it go better – planning. Planning helps your road trip skip the bumps in the road. Planning helps you avoid turbulence, even once your plane has landed. A good first step as you plan your trip is to make sure you have health care that travels with you. Whether you’re taking a road trip or catching a plane, you don’t want sickness or injury to be part of your trip. Before you start to pack, take steps to be prepared. Double check that you have health insurance for where you're going, so you can get the help you need if something does happen. Do Your Research Don’t travel without access to your health plan information. Make sure you set up your online account account before you pack your bags. You can access coverage information, look for providers in your network and more in your account. If you're traveling domestically, you can make a list of the in-network doctors and/or hospitals near where you will be staying. This will save you time and worry if you or one of your family members gets sick. And if you or a family member has a serious, chronic health issue, be sure to talk to your doctor before your trip. There may be additional issues to consider. To find doctors and hospitals in your network, log in to your account online or through the BCBSOK App and go to Find Care . Bring Your Member ID Card Make sure you pack your member ID card . Bring along a photocopy in case you lose it. You will have to show your member ID card at the doctor's office, clinic or hospital if you need health care services. Many providers will allow you to show them a digital copy of your member ID card. You can access your digital ID card by logging into your member account or with the BCBSOK App. Pack Your Medicines and Copies of Your Prescriptions If you are taking prescription drugs, pack enough to last you the whole trip and extra in case of delays. The U.S. Department of State recommends that you leave your drugs in their original, labeled container. Pack them in your carry-on bag if you are flying. Be sure to bring copies of your prescriptions. Going Abroad? See if Your Coverage Travels with You Check your benefits to see what coverage you have when you are away from home. You may want to consider getting additional coverage if you're traveling outside of the U.S. Learn more about international coverage options. Need Shots? Talk to your doctor at least six weeks before your trip to allow time for any recommended or required vaccinations. Discuss your specific travel destinations and what shots you’ll need. Many take time to be effective. Some must be given in a series. While you’re there, make sure all your routine shots are up to date. The Centers for Disease Control and Prevention has a list of recommended shots for children and adults. Know Where You’re Traveling To stay safe, do your research and heed local warnings. Before you leave, stay informed about travel conditions abroad by checking the CDC's Travel Health notices. You’ll find up-to-date news and travel warnings about current health issues linked to specific destinations. These issues may spring from disease outbreaks, special events, natural disasters or other conditions that may affect travelers’ health and safety. Heading Home As you plan your trip, make sure you know what will be required to come back to the States. There are things you may have to do before you can get on a plane or leave the airport, from having your temperature taken to taking a test for a virus or disease. And travel from some countries back to the U.S. may be banned because of contagious disease outbreaks, including measles, malaria and yellow fever. Sources: Vaccines & Immunizations , Centers for Disease Control and Prevention; Medicine and Health: Your Health Abroad , U.S. Department of State, 2025PrescriptionsTravelingUnderstanding InsuranceHealth Insurance NetworkImmunizationsID card