Product Update - Open Access

It's more freedom for members

Open Access couples the cost-savings of a traditional HMO, with a new level of freedom and flexibility.

What does Open Access mean?
No referrals from a primary care physician (PCP) are needed!

With BlueChoice Opt-Out Open Access, members are free to visit specialists without a written referral from a PCP, which saves time and paperwork. And it puts important healthcare decisions where they belong -- in our members' hands.

Choice means more with so many providers.
The CareFirst BlueChoice regional network includes:

• 2,600 PCPs
• 14,000 participating specialists
• 55 area hospitals

No PCP Referrals.

• There are no referrals - no paperwork - it's hassle free.
• Members can self-refer out of the CareFirst BlueChoice (BlueChoice) network. If the member chooses to see an out-of-network provider, the member will be responsible for all of the pre-authorization requirements. In addition, the member's out-of-pocket costs will be greater.
  While a referral is not required to see a specialist, members must still choose a PCP to receive in-network benefits.

What procedures require preapproval and/or authorizations?
Certain services require Plan approval such as infertility treatments and services performed in the outpatient department of a hospital. With the new open access feature, chiropractic services require Plan authorization before the date of first service.

Are freestanding radiology and lab services affected?
While lab work and radiology services will not require a referral, a requisition will be needed for lab services and a prescription is still needed for radiology services.

Leave home, and your benefits travel with you.
Out-of-network benefits are available for covered services outside the CareFirst BlueChoice network. In addition, with our Guest Membership program, members can receive in-network benefits during trips away from home that are 90 days or more.* So, whether it's business travel, semesters at school, or families living apart, members can continue to enjoy a full range of benefits provided by an affiliated BlueCross BlueShield HMO.

To register for the Guest Membership program, members should call the BlueChoice member service number on the front of their BlueChoice ID card and ask to be transferred to the BlueChoice Guest Membership Coordinator.

*Members are automatically covered for emergency care when travelling out of the CareFirst BlueChoice service area for any length of stay.

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