Medical Supplies Under the Consumer-Directed Health Plan, Enhanced 80/20 Plan and the Traditional 70/30 Plan
- Why won't my local pharmacy file my claims for medical supplies, such as needles and syringes?
- Because certain medical supplies, such as needles and syringes, are considered durable medical equipment and they are covered under your medical benefit. It reduces the processing time when these claims are submitted directly to Blue Cross and Blue Shield of North Carolina (BCBSNC) rather than to Express Scripts, the pharmacy benefits manager, first.
- How do I file a claim for medical supplies if I am enrolled in the Consumer-Directed Health Plan, Enhanced 80/20 Plan or the Traditional 70/30 Plan?
- Complete the Member Claim form and then submit the claim form with your receipt to BCBSNC for reimbursement. The charges will be applied to your applicable deductible and coinsurance just as if the pharmacy had submitted the claim for you.
- Are my diabetic syringes covered under my pharmacy benefit for the applicable copay if I am enrolled in the Consumer-Directed Health Plan, Enhanced 80/20 Plan or the Traditional 70/30 Plan?
- On the Enhanced 80/20 Plan and the Traditional 70/30 Plan, diabetic syringes are covered under your pharmacy benefit for the applicable copay. On the CDHP, diabetic syringes are covered by the deductible and coinsurance.
Claims for needles and syringes not related to diabetes will need to be filed by the member under the medical benefit. Examples include syringes for allergies, IV administration, sub-Q administration, etc.
- Are my diabetic test strips covered under my pharmacy benefit or my medical benefit?
- State Health Plan members enrolled in the Enhanced 80/20 Plan and the Traditional 70/30 Plan may obtain diabetic blood glucose testing strips under the pharmacy benefit for a single copay. Insulin dependent members may receive up to 204 test strips and non-insulin dependent members receive 102 test strips per 30-day supply. The copay amount for these quantities depends on the brand of testing strips you use.
On the CDHP, diabetic test strips, whether obtained through the pharmacy benefit or the medical benefit, are applied to the deductible and coinsurance.
- What if I require more diabetic test strips than those allowed under my pharmacy benefit?
- You will still be able to acquire additional test strips above those allowed under your pharmacy benefit by submitting the medical claim form to BCBSNC, and it will be applied to your deductible and coinsurance.
- How can I find out more about my coverage for medical supplies and filing medical claim forms?
- You may contact Customer Service at BCBSNC at 888-234-2416 and a representative will be happy to assist you.
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