Using Your Medicare Plan
Blue Cross and Blue Shield of New Mexico wants you to get the most from your plan. Understanding how it works and having the right resources can help. Learn the details of what’s covered in your Blue Cross Medicare Advantage Dual Care or Dual Care Plus (HMO SNP) plan. Get the forms you need to order a directory, submit a claim, and more.
Understanding Your Claims
Your provider and pharmacist will usually file any claims for services or prescriptions you received. Once the claim is filed, you will receive an Explanation of Benefits from us.
- Explanation of Benefits (EOB)
This is a statement of services rendered. It is not a bill. It simply details what you have paid and the level of benefits you’ve used. How often you receive it depends on how often you will fill your prescriptions or see your providers. Review the details on your EOBs to be sure they are correct. If you think there are errors, call customer service. If you think you are the victim of fraud, report it immediately.
- Coinsurance and Copays
Some plans include coinsurance and/or copays when you receive care or prescriptions. These payments are your responsibility. Coinsurance and copays count toward your “Total Out-of-Pocket” expenses for the year.
- Coinsurance is the percentage of the bill. For example, your plan may include a 20% coinsurance for outpatient surgery. The provider may ask for this payment at the time of service or may send a bill afterwards.
- Copays are a set amount you pay at the time of service. For example, a visit to a specialist in your network might include a $40 copay. Or, you may have a $10 copay for a prescription drug.
Medicare Organization/Coverage Determination, Appeals and Grievances