Ever wonder what all the information means on your health insurance card? What phone number do you call? Why is there a BlueCross BlueShield (BCBS) logo? Who is OptumRx? We’ve got a complete explanation of what it all means.
PLEASE NOTE: The Member ID cards referred to in this article are samples only. For specific information about your copayments or other information, please refer to your own Member ID card.
The phone numbers listed under the UPREHS logo (for Member Services, Complete Sleep and Provider Locator) are all resources for you. Should you ever have questions about your benefits, a claim or anything else related to your health insurance, you should always call the UPREHS Member Services line.
To find a provider in your area, you can visit our website (www.uphealth.com) or you can call the Provider Locator number on your ID card.
If you participate in our Complete Sleep Program—or are interested in learning more about it—you should call the number on your Member ID.
UPREHS is your health insurance provider and we use the BlueCross BlueShield network of providers so you have access to an expansive list of providers, clinics and hospitals no matter where you live or travel to within the U.S. (Medicare Plan cards have a different provider network).
The phone numbers listed under the BCBS logo are for your provider. For instance, if your provider has a question about your benefits or whether something may or may not be covered, they can call the number for Provider Eligibility / Benefits.
If you are scheduled for a procedure or test that requires pre-certification, the phone numbers (Pre Certification and AIM) are listed on your card so the provider knows who to call for prior authorization (see our blog about prior authorizations).
The information in this area is related to you and your health plan. The ‘ID No’ is your personal identification number; you should keep this private. The group number and plan codes refer to the benefits that are associated with your health plan. The Health Plan ID (HPID) is a unique 10-14 digit code that is required by the Department of Health and Human Services (HHS) as part of the Affordable Care Act. All of these ID numbers are important in making sure you have access to health care when you need it.
Health plans have copayments for different services—office visits, emergency room visits, hospital stays, tests, etc. To list all of the required copayments on a member ID card, it would have to be 5x7. Therefore, only the most frequently used copayments are typically listed on an ID card. That said, just because a copayment isn’t listed on your ID card, don’t assume you don’t have one. You should always verify the amount you are responsible for in advance (unless in the case of an emergency).
Back of your card
The back of your UPREHS Member ID card deals with your pharmacy benefits. As you probably know, non-Medicare UPREHS members are required to use Depot Drug for any maintenance prescriptions (drugs you take on an on-going basis). The only exception to this is if you live in a state where Depot Drug isn’t able to ship. You can order new prescriptions and refills from Depot Drug online (www.depotdrug.com) or via phone using the number on the back of your card under the Depot Drug logo. The Depot Drug E-Prescribe number is for your provider to use when sending your prescriptions electronically.
OptumRx is the Pharmacy Benefits Manager (PBM) for UPREHS. Health plans use a PBM to help negotiate drug prices and keep costs down. For Members who live in a state where Depot Drug doesn’t ship, OptumRx would be your mail order pharmacy. They manage any prescriptions that require a prior authorization and process prescriptions at retail pharmacies.
Briova is the designated specialty pharmacy for UPREHS. Speciality pharmacies are used for a variety of reasons: prescriptions used to treat complex conditions or diseases, high cost prescriptions or drugs that require special handling or storage.
The RxBIN, RxPCN and RxGRP numbers help facilitate pharmacy claims and identify plan information for prescriptions.
Medicare Plan Member ID card
If you are a member of our Medicare Plan, the front of your ID card looks a little different. Instead of BCBS, UPREHS uses the FirstHealth Network for provider access. You should also have a Medicare Card and a Part D Prescription Plan card from OptumRx.
Stay tuned for an article explaining the information on Medicare and Part D cards.