Benefits and Claims
Q: How can I know what is covered on my plan?
- You or your provider may contact Highmark to verify benefits for your specific situation
- Sometimes procedure or diagnosis codes will be used to determine whether a service is covered
- You may read the Benefits Summary Guide for general information
- You may read the detailed plan documents form each vendor to learn more
Q: How can I find the detailed plan documents for Highmark?
For a detailed description of your medical and prescription plan, please log in at www.highmarkbcbs.com and follow links to "View Your Benefits Booklet."
Q: How can I learn about my plan's Deductible and Out-of-Pocket limit?
- You may see your specific plan's deductible and out-of-pocket limit figures in your Benefits Summary Guide. To learn more detail about how this works, you can log into www.highmarkbcbs.com and read your Benefit Booklet. See the section on Medical Cost-Sharing Provisions
- You may call Highmark at the number on your ID card
- If you still nee more help understanding your plan, you are welcom to call Alliance Benefits
Q: Do I pay the deductible to Highmark?
No, you will pay the deductible to your provider(s), such as doctor, hospital, or lab. Keep in mind not every claim is subject to deductible, but for claims that are, Highmark will process claims as they arrive. Whichever ones are processed first will count toward the deductible until it is met. When you and your providers receive the Explanation of Benefits (EOB) statements, you will see which claim(s) show the deductible due, and to which provider(s). If you have any questions about what amount to pay to each provider, you should call Highmark.