Urgent Care and Follow-Up Care Outside Keystone’s Service Area

Emergency, Urgent and Follow-Up Care

What are Emergency Services? | What is Urgent Care? | What is Follow-Up Care?
Urgent Care and Follow-Up Care Outside Keystone’s Service Area —
The BlueCard® Program’s Urgent and Follow-Up Care Benefits

Urgent Care and Follow-Up Care Outside Keystone’s Service Area —
The BlueCard Program’s Urgent and Follow-Up Care Benefits

CHIP members have access to health care services when traveling outside of Keystone’s service area. These services are available through the Blue Cross and Blue Shield Association’s BlueCard Program. The length of time that your child will be outside the service area may affect:

	(a)		the benefits he or she receives; or
	(b)		the procedures you must follow to obtain care for your child covered under CHIP.

A claim form is not required to be submitted in order for a CHIP member to receive benefits, provided the member meets the requirements identified below.

When Traveling Outside Keystone’s Service Area

Urgent Care Benefits

Urgent care benefits cover medically necessary treatment for any unforeseen illness or injury that requires treatment prior to when your child returns to Keystone’s service area.

Covered services for urgent care are provided by a contracting Blue Cross and Blue Shield Association traditional participating provider (“BlueCard Traditional Provider”).
Coverage is for medically necessary services required to prevent serious deterioration of the CHIP member’s health while traveling outside Keystone’s service area during a temporary absence (less than 90 consecutive days).

Urgent Care required during a temporary absence will be covered when:

You call 1-800-810-BLUE for your child. This number is available 24 hours a day, 7 days a week. You will be given the names, addresses and phone numbers of three BlueCard traditional providers. The BlueCard Program has some international locations. When you call, you will be asked whether you are inside or outside of the United States.
You decide which provider you will take your child to.
You call 1-800-227-3116 to get prior authorization (approval) for the service from Keystone.
After receiving Keystone’s approval, you call the provider to schedule an appointment for your child. The BlueCard traditional provider confirms member eligibility.
You show your child’s ID Card when seeking services from the BlueCard traditional provider.

Follow-Up Care Benefits When Traveling Outside Keystone’s Service Area

Follow-up care benefits under the BlueCard program cover medically necessary follow-up care required while your child is traveling outside of Keystone’s service area. The care must be needed for urgent ongoing treatment of an injury, illness, or condition that occurred while your child was in Keystone’s service area.

Follow-up care must be pre-arranged and preapproved by your child’s primary care physician in Keystone’s service area prior to leaving the service area.
Under the BlueCard Program, coverage is provided only for those specified, preapproved services authorized by your child’s primary care physician in Keystone’s service area and Keystone’s patient care management department.
Follow-up care benefits under the BlueCard Program are available during your child’s temporary absence (less that 90 consecutive days) from Keystone’s service area.

Follow-up care required during a temporary absence (less than 90 consecutive days) from Keystone’s service area will be covered when these steps are followed:

Your child is currently receiving urgent ongoing treatment for a condition.
You plan to go out of Keystone’s service area with your child temporarily, and your child’s primary care physician recommends that he or she continue treatment.
Your child’s primary care physician must call 1-800-227-3116 to get prior authorization for the service from Keystone. If a BlueCard traditional provider has not been pre-selected for the follow-up care, your child’s primary care physician or you will be told to call 1-800-810-BLUE.
You or your child’s primary care physician will be given the names, addresses and phone numbers of three BlueCard traditional providers.

You or your child’s primary care physician must inform Keystone by calling 1-800-227-3116.
You should call the BlueCard traditional provider to schedule an appointment for your child.
The BlueCard traditional provider confirms your child’s eligibility.
You show your child’s ID Card when seeking services from the BlueCard traditional provider.

When You Don’t Use the BlueCard Program
If you have out-of-area urgent care or emergency services, not provided as described above and provided by a non-participating provider, ask the provider to submit the bill to Keystone. Show the provider your child’s ID Card for necessary information about his or her plan. For direct billing, the provider should mail the bill to the address listed below. If direct billing cannot be arranged, send us a letter explaining the reason care was needed and an original itemized bill to:

Keystone Health Plan East
P.O. Box 898815
Camp Hill, PA 17089-8815