What is a deductible?
Your deductible is the amount you owe for health care services before your insurance begins to contribute. After you have met your deductible, you and your insurance company will share the cost of covered services.
Check out this article to learn more about health insurance terminology.
What is a copay?
It’s a specified amount you pay for each covered health care service—things like prescription refills, physical therapy appointments or a visit to the emergency room. Providers may request payment of the copayment amount at the time of service.
Check out this article to learn more about health insurance terminology.
What is coinsurance?
Some of the services covered by your plan may require that you pay a percentage of the cost (coinsurance) instead of a set fee (copay). In most situations, your deductible must be met before coinsurance will apply.
Check out this article to learn more about health insurance terminology.
What is an out-of-pocket maximum?
There’s an upper limit to what you’ll contribute each year known as your out-of-pocket-maximum. After you’ve met that amount, your health insurance policy will pay 100% of the allowed amounts on your behalf.
Check out this article to learn more about health insurance terminology.
How do I get an approved referral?
A BCBSND provider requests authorization for you to receive care from a provider who is not part of your chosen network. You will need to work with your provider to initiate the referral process.
What services require precertification?
Check the listing of services that require precertification.
Where do I find BCBSND medical policies?
Find medical policies here.
Where do I find forms?
Find common forms here.
What is an appeal, and how can an appeal be submitted?
When you disagree with the claim determination you can submit an official inquiry.
There are two major types of appeals—preservice or post service. An appeal can be verbal or written.
Verbal appeals: call 844-363-8457
Written appeal: use this form and mail or fax to:
Fax: 701-277-2209
Mail: Blue Cross Blue Shield of North Dakota, P.O. Box 1570, Fargo, ND 58107-1570