Member Frequently Asked Questions

To get help in languages other than English, call our Member Service department at the phone number on the back of your member ID card. TTY users call 711.

Español – ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. También hay disponibles ayudas y servicios auxiliares adecuados para proporcionar información en formatos accesibles sin cargo. Llame al 1-844-363-8457 (TTY: 1-800-366-6888 o 711) o hable con su proveedor.

Deutsch – ACHTUNG: Wenn Sie Deutsch sprechen, steht Ihnen kostenfreie fremdsprachliche Unterstützung zur Verfügung. Außerdem sind kostenlos entsprechende Hilfsmittel und Dienstleistungen zur Bereitstellung von Informationen in barrierefreien Formaten erhältlich. Rufen Sie 1-844-363-8457 (TTY: 1-800-366-6888 oder 711) an oder sprechen Sie mit Ihrem Anbieter.

中文 – 注意：如果您說中文，我們可以為您提供免費的語言協助服務。亦免費提供適當的輔 助工具和服務，以無障礙格式提供資訊。請撥打 1-844-363-8457（聽障服務專線 TTY：1-800-366-6888 或 711）或與您的醫療服務提供者討論。

Oromoo – XIYYEEFFANNOO: Afaan Oromoo dubbattu yoo ta’e, tajaajilli gargaarsa afaan hiikuu kaffaltii malee ni argama. Gargaarsi dabalataa gargaaraadhaaf tajaajilli sirrii ta’ee fi odeeffannoo bifa dhaqqabamaa ta’een kennuunis bilisaan ni argama. Bilbili 1-844-363-8457 (TTY: 1-800-366-6888 or 711) ykn dhiyeessaa kee waliin haasa’i.

Tiếng Việt – CHÚ Ý: Nếu quý vị nói Tiếng Việt, có sẵn các dịch vụ hỗ trợ ngôn ngữ miễn phí cho quý vị. Chúng tôi cũng cung cấp miễn phí các dịch vụ và hỗ trợ bổ sung thích hợp để cung cấp thông tin ở các định dạng dễ tiếp cận. Xin gọi 1-844-363-8457 (TTY: 1-800-366-6888 hoặc 711) hoặc nói chuyện với nhà cung cấp của quý vị.

Ikirundi (Bantu – Kirundi) – Wiyubare: Nimba uvuga Ikirundi, wemerewe ubufasha bwo kuronka ururimi ku buntu. Wemerewe kandi ubufasha bukwiye bw’inyongera na serivisi vyo gutanga amakuru mu buryo bworoshe ku buntu. Hamagara kuri 1-844-363-8457 (TTY: 1-800-366-6888 canke 711) canke uvugane n’ujejwe kugufasha.

Kiswahili – ZINGATIA: Ikiwa unazungumza Kiswahili, huduma za msaada wa lugha bila malipo zinapatikana kwa ajili yako. Vifaa na huduma saidizi zinazofaa ili kutoa taarifa katika miundo inayoweza kufikiwa pia hupatikana bila malipo. Piga simu 1-844-363-8457 (TTY: 1-800-366-6888 au 711) au zungumza na mtoa huduma wako.

Русский – ВНИМАНИЕ! Если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Также предоставляется дополнительная бесплатная помощь и услуги отображения информации в доступных форматах. Позвоните по телефону 1-844-363-8457 (TTY: 1-800-366-6888 или 711) или обратитесь к своему поставщику услуг.

日本語 – お知らせ：日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いた だけます。情報を利用可能な形式で提供するための適切な補助具やサービスも無料でご利用いただけま す。1-844-363-8457（TTY：1-800-366-6888 または 711）にお電話いただくか、医療提供者にご相談くださ い。

Français – ATTENTION : Si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Vous pouvez aussi bénéficier gratuitement de l’accès à des outils et services auxiliaires appropriés dans des formats accessibles. Appelez le 1-844-363-8457 (ATS : 1-800-366-6888 ou 711) ou adressez-vous à votre fournisseur.

한국어 – 주의: 한국어를 사용하시는 경우, 무료 언어 지원 서비스가 제공됩니다. 접근 가능한 형식으로 정보를 제공하는 적절한 보조 수단 및 서비스도 무료로 이용하실 수 있습니다. 1-844-363-8457(TTY: 1-800-366-6888 또는 711)번으로 전화하거나 담당 의료 서비스 제공자와 상의하십시오.

Tagalog – PAUNAWA: Kung nagsasalita kayo ng Tagalog, mayroong kayong magagamit na libreng tulong na mga serbisyo sa wika. Mayroon ding mga angkop na auxiliary na tulong at serbisyo para magbigay ng impormasyon sa mga naa-access na format na makukuha ng walang singil. Tumawag sa 1-844-363-8457 (TTY: 1-800-366-6888 o 711) o makipag-usap sa iyong provider.

Norsk – OBS: Hvis du snakker norsk, er gratis språkhjelp tilgjengelig for deg. Passende ytterligere hjelpemidler og tjenester for å oppgi informasjon i tilgjengelige formater er også tilgjengelig kostnadsfritt. Ring 1-844-363-8457 (TTY: 1-800-366-6888 eller 711) eller snakk med leverandøren din.

Diné – YÁʼÁTʼÉÉH NITSÁHÁKEES: Díí Diné bizaad bee yániłtiʼgo, tʼáá íiyisí tʼáá bee yáhootʼééł dóó baa áháyáʼ átʼé. Tʼáá jííkʼehígíí bee naʼáchʼąąʼ holneʼ dóó tʼáá shikaadééʼ danilË́ Ë́ ʼígíí tʼáá jííkʼehgo bee hólǫ́ , dóó tʼáá íiyisí doo béésh bee hadooleeł da. 1-844-363-8457 bee hojiiįʼ (TTY: 1-800-366-6888 dóó 711), dóó naaltsoos nínízingo bee iiná bee nił haneʼígíí nihił chʼá hodoolʼįʼ.

BCBSND providers will file claims on your behalf. If you receive care outside of the BCBSND doctor network and need to file your own claim, use the Member Submitted Claim form.

You can get information about providers in your network, including contact information, professional qualifications, specialty, education, board certification status, gender and languages spoken, using our Find a Doctor page.

Log in to your member portal for a personalized doctor search in your network: Member Portal Login ›

Having health insurance is a great first step in your health care journey. The next best step is choosing a primary care provider (PCP). A PCP is your trusted guide. They offer personal support and help you navigate every season of your health. Why you should choose a Primary Care Provider (PCP) ›

Finding a PCP for your needs
Choosing your PCP is a personal decision. We recommend using our Find a Doctor Tool to get started. From there, you can look for someone you feel comfortable talking to and works well with your insurance plan. For a more personalized search, sign into your account.

You can find PCPs, in-network specialists, behavioral health care providers, and hospital services using our Find a Doctor page.

Log in for personalized doctor search in your network: Member Portal Login ›

For more information about benefits, restrictions or your provider network, sign into your account or call the Customer Service number on the back of your member ID card.

Visit our Get Care page for more information about getting care after normal business hours.

If you have an emergency, call 911 or go to the nearest emergency room.

A walk-in clinic is the place to go for non-life-threatening but urgently needed care. Visit our Get Care page for more information about getting care after normal business hours.

You can also look up virtual care options, urgent care, and walk-in and retail clinics by using the provider search tool at bcbsnd.com or on the Regence app.

If you think you are having a life-threatening emergency or illness, call 911 or go to the emergency room immediately. Visit our Get Care page for more information about when and where to get care.

Read our Insurance 101 page to learn about finding care when traveling or outside your service area.

If you get services from an out-of-network health care provider, benefit payment will be at the out-of-network level. Refer to your plan's Certificate of Insurance. Log into your member portal Member Login to access your Certificate of Insurance and other plan documents.

To request a benefit plan booklet specific to your plan, please contact us.

For Blue Cross Blue Shield of North Dakota (BCBSND) Marketplace (Affordable Care Act) members who need non-urgent, nonemergency care from a provider outside of North Dakota who is non-participating with BCBSND, you may need to fill out the Out of State Non-Participating Health Care Provider Waiver prior to your appointment before services are covered.

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.

In certain situations, a Member and/or the Member's Authorized Representative may file a grievance with BCBSND. A "grievance" is a written or oral complaint. More information and the process can be found in your Certificate of Insurance. Visit our Insurance 101 page for more information.

Prior authorization is when your doctor checks with your health insurance company before you get certain types of care. You may hear it called pre-approval.

Examples of UM procedures are: pre-service review (prior-authorization), concurrent review (including urgent concurrent review) and post-service review.

Visit our Pre Authorization Page for more information. Prior Authorization (Member)

Please refer to your Certificate of Insurance for information on how to request an external review or call the customer service phone number on the back of your member ID card.

We are here to help. Call the customer service phone number on the back of your member ID card to have someone answer your questions.

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: Submit the online appeal form ›

You have the right to appeal or request an independent review of any action we take or decision we make about your coverage, benefits or services. Log into your member portal Member Login to access your Certificate of Insurance and other plan documents.

BCBSND care management services are designed to provide personalized support for members who need it most. Whether you've been referred by your provider or want to reach out on your own, we are ready to guide you through your care journey.

Get support from your care management team at no additional cost.

Call us today and we can answer your questions. 800-336-2488 Mon-Fri, 8:00 a.m. – 5:00 p.m.

Review Pharmacy Tools to find information on the following:

• Covered drugs and use of generic substitutions
• Co-payments and other charges for which members may be responsible
• Pharmaceuticals that require prior authorization
• Limits on refills, doses or prescriptions
• How formulary updates are communicated and updated quarterly on our website
• How to submit information for an exception request

Your Pharmacy Program information is listed in your plan's Certificate of Insurance, which can be found on the Plan Documents page. To request a benefit plan booklet specific to your plan, please contact us.

The formulary is a list of drugs proven to be safe, therapeutically effective, high quality and cost effective, as determined by a committee of physicians and pharmacists. Formulary drugs are covered at the highest benefit level.

A non-formulary drug is a drug that is not included on the formulary listing.

Review your benefit plan materials to determine your Formulary. Then access your Formulary here.

If you are unsure, please contact customer service using the number on the back of your Insurance ID card with any questions.

A brand name drug is the registered trademark name given to a prescription medication by its manufacturer. Generics are lower-cost alternatives developed after the original drug’s patent has ended. Brand name and generics are the same in dosage, safety, effectiveness, strength, stability, quality and delivery system.

Co-payments and cost-sharing amounts for covered prescriptions drugs are listed in your plan's Certificate of Insurance, which can be found on the Plan Documents page. To request a benefit plan booklet specific to your plan, please contact us.

Review your benefit plan materials to determine your Formulary. Then access your Formulary here and search under Restricted-Use Drugs.

You can also use the Prior Authorization Search tool to check which drugs require prior authorization.

If you are unsure, please contact customer service using the number on the back of your Insurance ID card with any questions.

Review your benefit plan materials to determine your Formulary. Then access your Formulary here and search under Restricted-Use Drugs.

If you are unsure, please contact customer service using the number on the back of your Insurance ID card with any questions.

We strive to maintain the highest standards of integrity and objectivity when making decisions about your care and service, rather than on our own personal interests. For the complete policy on our corporate values, please see our Code of Conduct.

We have a legal duty to protect your information. For the complete policies regarding your privacy, routine consent and disclosure, see our Privacy Policy.